Severe Grade Research Articles

Helicobacter pylori and acne vulgaris: is there a relationship?

Background: Helicobacter pylori (H. pylori) is a gastric Gram-negative, spiral-shaped microaerophilic pathogen. H. pylori may play a potential pathogenic role in extra-intestinal diseases such as hepatobiliary, respiratory, and dermatological disorders. The latter included chronic urticaria, psoriasis and rosacea. The first report in literature on the relationship between H. pylori and acne vulgaris (AV), found association between severe AV and H. pylori infection. There are very limited data in AV patients addressing the impact of H. pylori infection on various severities. In this context, the aim of the present work was to determine the association of H. Pylori infection among AV patients and correlate it with the disease severity. Methods: This case-control study included 45 Patients with AV and 45 age and sex matched healthy volunteers as a control group. H. pylori antigen in stool and serum H. pylori antibody IgG using commercially available ELISA kits was tested in all included subjects. Results: The percentage of participants with a positive H. pylori antigen in stool and positive H. pylori antibody in serum in the whole study population was 35/90 (38. 9%) and 41/90 (45. 6%). On comparing between the percentages of positive H. pylori antigen in stool and positive H. pylori antibody in serum between the patients with AV and healthy controls, a highly statistically significant difference was found between the two groups (P < 0.001, P = 0.006). On comparing between the percentages of positive H. pylori antigen in stool and positive H. pylori antibody in serum in the patients with different grades of acne severity and healthy controls, the rate of positive H. pylori antigen in stool and positive H. pylori Ab in serum was significantly associated with severity of acne comparing with healthy controls (p < 0. 001). Conclusion: The rate of H. pylori infection in patients with AV is high so it may influence the pathogenesis of this skin disease. Patients with severe AV had higher rates of H. pylori antigen in stool and H. pylori antibody in serum as compared to the patients with mild AV and healthy controls.

Correlation of Pseudocholinesterase Level with Clinical, Biochemical Parameters Including Cardiac Profile and the Outcome in Organophosphorus Poisoning.

Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available "over the counter." OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly. It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0-3 is considered mild poisoning, 4-7 as moderate poisoning, and 8-11 as severe poisoning. Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20-30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities. This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes.

Diabetic Retinopathy Lesion Types and Distribution on Ultrawide Field Imaging and the Risk of Disease Worsening Over Time.

To evaluate the effect of diabetic retinopathy (DR) lesion type [hemorrhages and/or microaneurysms (H/Ma), intraretinal microvascular abnormalities (IRMA), new vessels elsewhere (NVE), venous beading], severity and distribution on disease worsening based on the Early Treatment Diabetic Retinopathy Study (ETDRS)-Diabetic Retinopathy Severity Scale (DRSS). Post-hoc analysis of a multi-center observational study of 544 eyes with nonproliferative DR and an ETDRS-DRSS score of Level 35-53. Disease worsening was defined as ETDRS-DRSS worsening by ≥2 steps from baseline or receipt of DR treatment over 4 years. DR lesions were evaluated based on the entire visible area in the ultrawide field color (UWF-color) and UWF-fluorescein angiography (UWF-FA) images. A significantly greater risk of disease worsening was associated with the presence of more severe lesion grades outside the ETDRS fields for H/Ma (HR:1.74 [95% CI:1.28-2.36]) on UWF-color; and for H/Ma (1.90 [1.38-2.61]), IRMA (1.68 [1.13-2.49]), and NVE (1.99 [1.36-2.93]) on UWF-FA. These results suggest that features on UWF-color and UWF-FA may provide additional prognostic value in determining the risk of disease worsening. The use of UWF-FA improves identification of DR lesions and disease progression. However, the optimal method of disease risk assessment on UWF imaging still needs to be determined.

Histopathology based study of Nile tilapia fish (Oreochromis niloticus) as a biomarker for water pollution evaluation in the southern gulf of Lake Tana, Ethiopia

In the past decade, the increasing distribution of pollutants in the aquatic environment has been observed, causing integrative effects on fish. Likewise, due to anthropogenic activities, the southern gulf of Lake Tana is an impacted region, and the production of Nile tilapia fish is reduced. For this reason, the aim of this study was to conduct a histopathological-based study of 48 Nile tilapia fishes’ health status at the southern gulf of Lake Tana and aquaculture using a cross-sectional study from February 2023 to May 2023. The study evaluated the histopathology of the gill, liver, gonads, and spleen organs using descriptive statistics accompanied by a 2 × 2 contingency table and t-test analysis. During the study, different histological alterations were detected, and the numbers of fish affected by a specific histological alteration were presented as percentage prevalence; hence, from the total fish examined, hyperplasia (54.15%), followed by pigment deposits (52%), hemorrhage (50%), and immune cell infiltration (50%), respectively, were the most frequently detected alterations. However, Nile tilapias from the southern gulf of Lake Tana were 1.4 (odds ratio) times more likely to show histopathological alterations than those from aquaculture, although statistically, was not significant (p > 0.05). In addition, the study found the mean value of the fish index (95.3) and regressive indices of the gill (13.6), liver (14.8), and gonad (12.3); moreover, the inflammatory indices of the spleen organ (11.3) and mean severity grade value of the gill (2.35) and gonad (1.7) organs, respectively, were obtained from the southern gulf of Lake Tana, and all those values were significantly higher (p < 0.05) from this site as compared to the aquaculture. In general, it has been found that tilapias from the southern gulf of Lake Tana showed higher pathological severity as compared with aquaculture. Among the four target organs evaluated, liver organs were observed to be the most damaged, while gonads were the least impacted organs. Therefore, it has been concluded that tilapia fish are living in abnormal conditions, so to ensure a sustainable fishery, water pollutant sources from Bahirdar city must receive proper attention, and future studies should consider age differences, seasonal variation, and the detection of specific pollutants.

Development and evaluation of a deep learning model for automatic segmentation of non-perfusion area in fundus fluorescein angiography

Diabetic retinopathy (DR) is the most prevalent cause of preventable vision loss worldwide, imposing a significant economic and medical burden on society today, of which early identification is the cornerstones of the management. The diagnosis and severity grading of DR rely on scales based on clinical visualized features, but lack detailed quantitative parameters. Retinal non-perfusion area (NPA) is a pathogenic characteristic of DR that symbolizes retinal hypoxia conditions, and was found to be intimately associated with disease progression, prognosis, and management. However, the practical value of NPA is constrained since it appears on fundus fluorescein angiography (FFA) as distributed, irregularly shaped, darker plaques that are challenging to measure manually. In this study, we propose a deep learning-based method, NPA-Net, for accurate and automatic segmentation of NPAs from FFA images acquired in clinical practice. NPA-Net uses the U-net structure as the basic backbone, which has an encoder-decoder model structure. To enhance the recognition performance of the model for NPA, we adaptively incorporate multi-scale features and contextual information in feature learning and design three modules: Adaptive Encoder Feature Fusion (AEFF) module, Multilayer Deep Supervised Loss, and Atrous Spatial Pyramid Pooling (ASPP) module, which enhance the recognition ability of the model for NPAs of different sizes from different perspectives. We conducted extensive experiments on a clinical dataset with 163 eyes with NPAs manually annotated by ophthalmologists, and NPA-Net achieved better segmentation performance compared to other existing methods with an area under the receiver operating characteristic curve (AUC) of 0.9752, accuracy of 0.9431, sensitivity of 0.8794, specificity of 0.9459, IOU of 0.3876 and Dice of 0.5686. This new automatic segmentation model is useful for identifying NPA in clinical practice, generating quantitative parameters that can be useful for further research as well as guiding DR detection, grading severity, treatment planning, and prognosis.

A Segmentation-Based Automated Corneal Ulcer Grading System for Ocular Staining Images Using Deep Learning and Hough Circle Transform

Corneal ulcer is a prevalent ocular condition that requires ophthalmologists to diagnose, assess, and monitor symptoms. During examination, ophthalmologists must identify the corneal ulcer area and evaluate its severity by manually comparing ocular staining images with severity indices. However, manual assessment is time-consuming and may provide inconsistent results. Variations can occur with repeated evaluations of the same images or with grading among different evaluators. To address this problem, we propose an automated corneal ulcer grading system for ocular staining images based on deep learning techniques and the Hough Circle Transform. The algorithm is structured into two components for cornea segmentation and corneal ulcer segmentation. Initially, we apply a deep learning method combined with the Hough Circle Transform to segment cornea areas. Subsequently, we develop the corneal ulcer segmentation model using deep learning methods. In this phase, the predicted cornea areas are utilized as masks for training the corneal ulcer segmentation models during the learning phase. Finally, this algorithm uses the results from these two components to determine two outputs: (1) the percentage of the ulcerated area on the cornea, and (2) the severity degree of the corneal ulcer based on the Type–Grade (TG) grading standard. These methodologies aim to enhance diagnostic efficiency across two key aspects: (1) ensuring consistency by delivering uniform and dependable results, and (2) enhancing robustness by effectively handling variations in eye size. In this research, our proposed method is evaluated using the SUSTech-SYSU public dataset, achieving an Intersection over Union of 89.23% for cornea segmentation and 82.94% for corneal ulcer segmentation, along with a Mean Absolute Error of 2.51% for determining the percentage of the ulcerated area on the cornea and an Accuracy of 86.15% for severity grading.

Profile of Dermatologic Side Effects of Tyrosine Kinase Inhibitor (EGFR-TKIs) in Lung Cancer Patients

Background: Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKIs) drugs are commonly used target therapies in patients with advanced-stage non-small cell carcinoma lung cancer (NSCLC).Objectives: This study aims to provide an overview of dermatologic side effects and quality of life index of NSCLC patients who received EGFR-TKIs targeted therapy at Dharmais Cancer Hospital.Methods: This study used a cross-sectional design. Inclusion criteria were patients who received EGFR-TKIs targeted therapy, namely gefitinib, erlotinib, and afatinib, in September - October 2023, who were willing to be research subjects, and patients who were not in a medical emergency. In total, 52 patients filled out the dermatology life quality index (DLQI) questionnaire through interviews and medical records. Data evaluation was performed descriptively in the form of percentages.Results: The most common occurrence of dermatologic side effects was skin hypersensitivity reactions with mild severity (grade 1) by 59.6%, moderate severity (grade 2) by 19.2%, and severe severity (grade 3) by 1.9%, and no drug dermatologic side effects by 19.2%. In comparison, the most DLQI was in the category of not affecting patient life. In general, side effects with moderate (grade 2) and severe (grade 3). The severity will decrease to mild severity (grade 1) when already getting topical corticosteroid drugs or combinations with oral antibiotics and antihistamine drugs.Conclusion: The most severe side effect was grade 1, which slightly affected the patient's quality of life. Education and monitoring of side effects and management of symptoms are necessary to reduce the severity and improve patients' quality of life.

Prevalence and severity of gag reflex in patients presenting at the department of prosthodontics.

Objective: To determine the prevalence and severity of gag reflex at initial appointment of patients visiting the department of Prosthodontics using the Gag Severity Index (GSI) tool proposed by Fiske and Dickinson. Study Design: Cross-sectional study. Setting: Department of Prosthodontics, Islamabad Dental Hospital, Islamabad. Period: 1st November, 2022 to 31st April, 2023. Methods: All the patients who presented in outpatient (OPD) of Prosthodontics with 18 to 85 years of age were included in this study. All the data of age, gender, educational levels and gag severity grades were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by using SPSS version 22. Results: A total of 150 (55.14%) patients out of 272 who gagged, were included in the study, with 61 (40.66%) males and 89 (59.3%) females, the gag reflex being more prevalent in female patients. The patients’ age range was from 18 to 85 years. In terms of gag severity grades in 150 patients, grade I was observed in 60 patients (40.0%), grade II in 49 patients (32.7%), grade III in 30 patients (20.0%), grade IV in 10 patients (6.7%) and grade V in 1 patient (0.7%). 40.0% of grade I patients were from 18-40 years age group and 51.6% were from 61-85 years age group. 37.0% of grade II patients belong to 41-60 years of age. In terms of qualification, 40.6% exhibited hyper active gag reflex in patients with university level or above. Conclusion: Female patients exhibit a higher prevalence of gag reflex than male patients, with grade I being the most common. While a definitive solution is yet to be established, effective patient education and dentist diligence can lead to productive management and future treatment exploration.

Outcomes After Extracorporeal Shockwave Therapy for Chronic Noninsertional Achilles Tendinopathy Compared With Chronic Insertional Achilles Tendinopathy: A Retrospective Review.

Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment modality that is used in the treatment of chronic Achilles tendinopathy (AT). To (1) retrospectively assess outcomes after ESWT for both noninsertional AT (NAT) and insertional AT (IAT) at >1-year follow-up and (2) identify potential predictors of outcomes. Cohort study; Level of evidence, 3. Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included patient demographic characteristics, pathological characteristics including the location of AT (NAT or IAT), presence of a Haglund deformity, and severity of tendon degeneration on magnetic resonance imaging (MRI), in addition to treatment characteristics including number of sessions and intensity of ESWT. The Victorian Institute of Sports Assessment-Achilles (VISA-A) and visual analog scale (VAS) pain scores were obtained before ESWT, 6 months after ESWT, and at final follow-up. Failures were also recorded, which were defined as no improvement in VISA-A or VAS scores or need for surgical intervention. Linear regression was performed to identify potential predictors of inferior subjective clinical outcomes and failures. Survival analysis was conducted using Kaplan-Meier curves. The study included 52 patients with IAT and 34 patients with NAT. The mean follow-up in the NAT cohort was 22.3 ± 10.2 months and the mean follow-up in the IAT cohort was 26.8 ± 15.8 months. Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6-month follow-up and at final follow-up (P < .05). Improvements in VISA-A and VAS scores were recorded in the IAT cohort at 6-month follow-up, which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6-month follow-up was 11.8%, which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6-month follow-up was 32.7%, which increased to 59.6% at final follow-up. Predictors of inferior subjective clinical outcomes and failures in the NAT cohort included pre-ESWT subjective clinical score, male sex, presence of a cardiovascular risk factor, and more severe MRI grading of tendinopathy. Predictors of inferior subjective clinical outcomes and failures in the IAT cohort included pre-ESWT subjective clinical score and more severe MRI grading of tendinopathy. Superior subjective clinical outcomes together with a lower failure rate were maintained for >1 year in the NAT cohort compared with the IAT cohort, calling into question the long-term benefit of ESWT for patients with IAT.

Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain.

Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion-to-anal-verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. Nevertheless, it is not yet known to what extent the size and LAVD of bowel DE influence the severity of gastrointestinal symptoms. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms. In this prospective study, premenopausal patients with histologically confirmed DE undergoing modified limited nerve-vessel sparing rectal segmental bowel resection or full-thickness discoid resection were evaluated. Extent of endometriosis was defined according to the #Enzian classification during surgery. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome was differences in presurgical numeric rating scale pain scores of dyschezia, dyspareunia, and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity. Of 162 consecutive patients, 151 were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS-like symptoms (p = 0.314 and p = 0.185, respectively) or pain symptoms (dyschezia, p = 0.440; dyspareunia, p = 0.136; and dysmenorrhea p = 0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 vs. C3; p = 0.611). In addition, LAVD did not affect the degree of dyschezia (p = 0.892), dyspareunia (p = 0.395), or dysmenorrhea (p = 0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p = 0.493) or dysmenorrhea (p = 0.128) but showed a trend toward affecting gastrointestinal function (p = 0.078) and was significantly associated with dyspareunia (p = 0.035). In present study, we could not find a correlation between colorectal DE lesion size and location (LAVD) and gastrointestinal function impairment or intensity of dyschezia and dysmenorrhea. Additional involvement of vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) exerts a significant impact on the degree of dyspareunia in women with colorectal DE.

Implications of Global Lung Function Initiative Spirometry Reference Equations in Northeast Asian Patients With COPD

Accurate spirometry interpretation is critical in the diagnosis and management of chronic obstructive pulmonary disease (COPD). With increasing efforts for a unified approach by the Global Lung Function Initiative (GLI), this study evaluated the application of race-specific 2012-GLI and race-neutral 2022-GLI reference equations compared to Choi's reference equations, which is derived and widely used in South Korea, for spirometry interpretation in Northeast Asian patients with COPD. What are the effects of applying race-specific 2012-GLI, race-neutral 2022-GLI, and Choi's reference equations on the diagnosis, severity grade, and clinical outcome associations of COPD STUDY DESIGN AND METHODS: Serial spirometry data from the Korea COPD Subgroup Study (KOCOSS) consisting of 3,477 patients were utilized for re-analyses using 2012-GLI, 2022-GLI, and Choi's reference equations. The COPD diagnosis and severity categorization, associations with disease manifestations and health outcomes, and longitudinal trajectories of lung function were determined. Although there was strong concordance in COPD diagnosis comparing 2012-GLI, and 2022-GLI reference equations to Choi's reference equations, a notable portion of patients were reclassified to milder disease severity (17.0% and 23.4% for 2012-GLI and 2022-GLI reference equations, respectively). Relationships between FEV1 percent-predicted values calculated using 2012-GLI, 2022-GLI, and Choi's equations with clinical outcomes including dyspnea severity, exercise capacity, health-related quality of life, and frequency of exacerbations remain consistently significant. Similar annual decline rates of FEV1 and FVC percent-predicted were observed among the reference equations used, except for slower annual decline rate of FEV1 in Choi's equation compared to 2022-GLI race-neutral equation. Application of GLI reference equations for spirometry interpretation in Northeast Asian patients with COPD has potential implications on disease severity grade for clinical management and trial participation, and maintains consistent significant relationships with key disease outcomes.

Addition of Elotuzumab to Backbone Treatment Regimens for Multiple Myeloma: An Updated Meta-Analysis of Randomized Clinical Trials

BackgroundThe efficacy of elotuzumab, an anti-SLAMF7 monoclonal antibody, in treating relapsed/refractory multiple myeloma (RRMM) and newly-diagnosed multiple myeloma (NDMM) has varied in randomized controlled trials (RCTs). Moreover, there is limited data on its real-world application. Patients and MethodsWe conducted a systematic review and meta-analysis of RCTs investigating the addition of elotuzumab to backbone antimyeloma regimens. The primary outcome of interest was progression-free survival (PFS). Secondary efficacy outcomes included overall survival (OS), overall response rate (ORR), and rates of very good partial response or better (VGPR). Key toxicities were also evaluated. ResultsThree RRMM trials (n = 915) and 5 NDMM trials (n = 1790) were included, with 50% of the 2705 patients receiving elotuzumab-containing triplets or quadruplets. In RRMM settings, elotuzumab use significantly improved PFS (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.60-0.82; P < .001; I² = 0%). This benefit was consistent among patients with high-risk cytogenetics (HR, 0.62; 95% CI, 0.43-0.90; P = .01; I² = 0%) and was particularly evident in those previously treated with proteasome inhibitors (PIs) or immunomodulatory drugs (IMiDs). The RRMM cohort also demonstrated better OS, ORR, and ≥VGPR rate. However, the NDMM cohort showed no significant improvements in any efficacy outcomes. Despite an increase in severe (grade ≥3) infections, elotuzumab use did not adversely affect rates of severe cytopenias, severe cardiac disorders, or second primary malignancies. ConclusionOur results suggest that elotuzumab-containing regimens represent valuable therapeutic options for PI/IMiD-exposed patients with RRMM. In contrast, elotuzumab's role in frontline settings remains limited.

Robotic and Laparoscopic Adrenalectomy for Pheochromocytoma: An International Multicenter Study

Background and objectiveRobotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients. MethodsData for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI). Key findings and limitationsOf 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07–1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07–1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63–1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023). Conclusions and clinical implicationsRA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma. Patient summaryPheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used.

Immune-related adverse events in a nationwide cohort of real-world melanoma patients treated with adjuvant anti-PD1 – Seasonal variation and association with outcome

IntroductionImmune checkpoint inhibitors (ICIs) carry the risk of immune-related adverse events (irAEs), a significant concern as therapy has transitioned to the adjuvant setting. Balancing therapeutic benefits against potential risks is crucial, necessitating real-world data from an unselected patient population in addition to clinical trial data to ensure optimal clinical decision-making. MethodsThis nationwide real-world study assessed irAEs in patients receiving adjuvant anti-PD1 therapy, primarily nivolumab, for resected stage III-IV melanoma between 2018-2022. Data were retrieved from two national databases: the IMMUNOTOX database and the Danish Metastatic Melanoma Database (DAMMED). IrAEs were sub-grouped according to organ systems graded using CTCAE ver. 5.0 ranging from mild toxicities (grade 1-2) to severe (grade 3-4) and fatal (grade 5). ResultsAmong 792 included patients, (55% male, median age 62 years (range 16-88)), 697 patients (88%) experienced an irAE. Severe irAEs occurred in 116 patients (15%) and five (0.6%) died due to toxicity. A landmark analysis showed that patients who experienced at least one irAE before the 1st evaluation at 90 days had an increased progression free survival (PFS) (p=0.032) and overall survival (OS) (p=0.0071). Additionally, a seasonal pattern was noted with higher incidence of irAEs during summer. ConclusionThe prevalence of irAEs in real-world patients is comparable to the observed risk in clinical trials. Patients experiencing irAEs demonstrate a lower risk of melanoma relapse. Further, gender, age and seasonal variation may impact the incidence of irAEs.

Hypertensive retinopathy can predict stroke: A systematic review and meta-analysis based on observational studies

ObjectiveThe aim of this study was to determine whether hypertensive retinopathy is specifically associated with stroke. MethodsThe relevant studies published until December 18, 2023 were identified as well as selected from PubMed, Embase, Web of science, WanFang, CNKI, VIP, and CBM databases. Hazard ratios (HRs), risk ratios (RRs), and 95% confidence intervals (CIs) were combined. ResultsSix cohort studies were included in this analysis. Patients with hypertensive retinopathy exhibited a significantly higher overall risk of stroke than those without hypertensive retinopathy (RR=1.46, 95%CI: 1.29-1.65). When subgroups were analyzed by region, patients with hypertensive retinopathy in Asia had the highest risk of stroke (RR=1.53, 95%CI: 1.33-1.77). In addition, among the different severity grades of hypertensive retinopathy, the risk of stroke in patients with grade 3/4 hypertensive retinopathy (RR=1.82, 95%CI: 1.41-2.34) was observed to be higher than that in patients with grade 1/2 hypertensive retinopathy (RR=1.43, 95%CI: 1.27-1.61). ConclusionsHypertensive retinopathy was found to be associated with an increased risk of stroke. Thus, it is necessary to include retinopathy in the routine screening of patients with hypertension.

Mortality-associated risk factors for transfusion-associated circulatory overload.

Respiratory transfusion reactions associate strongly with morbidity and mortality, and transfusion-associated circulatory overload (TACO) is the leading cause of reaction-related deaths. Risk factors for TACO include transfusion speed and volume and cardiorenal comorbidities. An academic health network haemovigilance database was interrogated to assess variables associating with 371 cases of TACO and involved-visit outcomes, using univariate and multivariate regression analysis. TACO reactions over 11 years were reported in 179 males and 192 females, median age (interquartile range) 65 (53-75) years. In-hospital and 28-day mortality were 17.5% and 12.9%, respectively. In univariate regression modelling, male sex, injury severity grade, product volume administered, the use of platelets and intensive care admissions were each associated with in-hospital and 28-day mortality (p < 0.05). However, after multivariate regression analysis, only male sex in transfusion recipients independently associated with mortality (p < 0.05). In this cohort, male recipient sex and platelet administration were associated with TACO-involving admissions not ending in survival.

Increased Intestinal Inflammation and Permeability in Glaucoma.

Evidence suggests that dysbiosis of the gut microbiota plays a pivotal role in the development of glaucoma. This dysbiosis is commonly associated with chronic intestinal inflammation and increased intestinal permeability. However, the understanding of intestinal inflammation and permeability in glaucoma remains insufficient. This study aims to investigate the potential relationship between fecal inflammation and permeability markers and glaucoma. We recruited 114 glaucoma patients and 75healthy controls. Levels of fecal lactoferrin (Lf) and alpha-1 antitrypsin (AAT) were quantified using enzyme linked immunosorbent assay (ELISA) to compare both biomarkers between groups and across different severity grades of glaucoma. Logistic regression analysis was used to assess the association between these fecal biomarkers and glaucoma. The severity of glaucoma was assessed based on the mean deviation (MD) in the visual field. In this study, we observed elevated levels of fecal Lf and AAT in glaucoma patients. The proportion of glaucoma patients with abnormal fecal Lf levels (≥ 7.25µg/g) was significantly higher than that of the controls (p = 0.012). A positive correlation was noted between fecal Lf and AAT (rho = 0.20, p = 0.006). After adjusting for age and sex, multivariable logistic regression analysis indicated that both fecal Lf (OR = 1.11, 95% CI: 1.01-1.21, p = 0.026) and AAT (OR = 1.01, 95% CI: 1.01-1.02, p < 0.001) positively correlated with glaucoma. These biomarkers might reflect glaucoma severity, with significant differences in fecal Lf levels observed between moderate and severe stages, but not in the early stage. Furthermore, increasing levels of fecal AAT correlated with greater severity of glaucomatous injury and a larger vertical cup-to-disc ratio (VCDR) (p < 0.05). This study suggests an increase in intestinal inflammation and permeability in glaucoma, further indicating the importance of the 'gut-retina axis' in the pathogenesis of the disease and potentially offering new therapeutic avenues.

K-Means Clustering Algorithm for exudates segmentation in fundus images for the diagnosis of diabetic retinopathy

Diabetic retinopathy currently remains one of the major causes of blindness or loss of vision in people. Automatic detection of diabetic retinopathy has been one of the challenging research fields in recent history. Exudates, optic disc, hemorrhages, cotton wool spots, and microaneurysms can slow the development of an illness if diagnosed early and with adequate treatment. The monitoring and identification process of the lesions associated with diabetic retinopathy remain very tedious tasks loaded with repetition and are prone to errors. It is in this regard that this research proposes a new methodology for the diagnosis of diabetic retinopathy in an automated way. First of all, EYEPACS-1 and APTOS 2019 retinal images datasets are obtained. After fundus image quality collection, some enhancements are made through adaptive histogram equalization and the Haar discrete wavelet transform with the support of filtering based on a Gaussian matched kernel. Further, the fovea and blood-retinal vessels are eliminated; through the K-means clustering segmentation algorithm, the areas of an optic disc are highlighted by the Gaussian blur approach. Color histogram features are then extracted from these segmented areas before being fed into a deep learning model, CNN, to classify healthy subjects versus those affected by DR with severity grading. According to the simulation findings, the accuracy posted by the proposed model was 97.25% against the EYEPACS-1 dataset and 96.85% against the APTOS 2019 datasets &amp; samples.

Emphysema and lung cancer risk.

With increasing significance of lung cancer screening programs, it is essential to determine the group of participants, who would benefit the most from screening. In our study, we aimed to establish the correlation between lung emphysema and lung cancer risk. The study design was cross-sectional. Low-dose computed tomography (LDCT) scans of 896 subjects from MOLTEST-BIS lung cancer screening program, including 100 subjects with detected lung cancer, were visually evaluated for the presence, type and severity of emphysema. Quantitative emphysema evaluation was performed with Siemens syngo.via Pulmo 3D application. Visually detected presence of centrilobular emphysema (CLE) correlated with male gender (P=0.02), age (P<0.001) and pack-years of smoking (P=0.004), as well as with quantitative assessment of Emphysema Index (EI) (P=0.008), and with emphysema clusters of given size (Clas 1-4) Clas 1, Clas 3 and Clas 4 (P<0.001). Visually assessed severity grade of emphysema correlated with age (P<0.001), pack-years of smoking history (P=0.002) and EI (P<0.001). There was a correlation between lung cancer occurrence and pack-years (P<0.001), age (P<0.001), and presence of CLE (P<0.001) but no correlation with gender (P=0.88) and EI (P=0.32) was found. In the logistic regression model pack-years, age, qualitative severity of CLE and Clas 1 were significant factors correlated with lung cancer occurrence (P<0.001). Qualitative and quantitative emphysema evaluation correlate with each other. Both, presence and severity of CLE correlate with higher incidence of lung cancer. Severity of visually assessed emphysema, age and pack-years of smoking are significant predictors of lung cancer occurrence.

Effect of Covishieldtm (AZD1222) Vaccination on Incidences and Severity of Covid-19 among Health-Care Workers

Introduction: Limited information is available regarding effect of vaccination on protection against Covid-19 infections and their severity as well. Objectives: In the present study, we assessed the effect of Covid-19 vaccination on incidences and severity of break through Covid-19 infections. Method: This retrospective study was conducted at a tertiary care center in Northern India during one calendar year, 1st August 2021 to 31st July 2022. The study population included Health-care workers (HCWs) who were treated for Covid 19 infection and had already received at least 1 dose of Covishield TM (AZD1222) Covid-19 vaccine. Results: Out of 1868 health care workers enrolled for the study, 513 contracted Covid-19 infections. Amongst infected HCWs, number of single and double doses of CovishieldTM (AZD1222) recipients were 112 and 401 respectively. Out of the 513 covid positive HCWs, 459 (89.4%) had mild disease, whereas 54 (10.6%) had moderate disease. None of the HCWs developed severe disease and no mortality was noted in either group. Conclusion: In this study, we found that immunization with two doses of CovishieldTM (AZD1222) vaccine was associated with decline in number of cases with moderate or severe Covid-19. Moreover, immunization with even single dose of CovishieldTM (AZD1222) vaccine prevented development of severe disease. Henceforth, it is concluded that although, immunization with CovishieldTM (AZD1222) could not protect all recipients from SARS-Cov-2 infection, it did prevent the progress of disease to severe grades.