Severe Group Research Articles

Hypoalbuminaemia and its association with disease and clinical outcomes incats.

To report the incidence of feline hypoalbuminaemia and characterise the distribution of presenting disease categories and pathoaetiologies of hypoalbuminaemia in cats. The secondary aim was to evaluate the relationship between hypoalbuminaemia and clinical outcomes. Medical records of cats with hypoalbuminaemia (<28.0 g/L, reference interval: 28.0 to 39.0 g/L) presenting to a veterinary teaching hospital over 5 years were retrospectively reviewed. The severity of hypoalbuminaemia was further stratified into mild (24.0 to 27.9 g/L), moderate (20.0 to 23.9 g/L) and severe (≤19.9 g/L) groups. The median albumin and severity groups were compared between the determined disease categories, pathoaetiologies and clinical outcomes. The incidence of hypoalbuminaemia was 32.7% (533/1632). Gastrointestinal disease was the most common disease category associated with hypoalbuminaemia [154/533 (28.9%)], of which, 49.4% (76/154) of cats had gastrointestinal neoplasia. Neoplastic [159/533 (29.8%)] and inflammatory conditions [158/533 (29.6%)] were common pathoaetiologies noted. Statistically significant differences in the serum albumin between individual disease and pathoaetiological categories were found. Cats with moderate to severe hypoalbuminaemia had a statistically significantly longer hospitalisation period, cost of treatment and increased odds of death (odds ratio 2.4, 95% confidence interval: 1.3 to 4.6 and odds ratio 3.2, 95% confidence interval: 1.5 to 6.6, respectively). The incidence of feline hypoalbuminaemia in our study surpasses previous canine reports. Our findings support albumin as a negative acute phase protein in cats, with hypoalbuminaemia frequently associated with inflammatory disease. Hypoalbuminaemia also features prominently in cats with gastrointestinal neoplasia, indicating careful appraisal of the presence of protein-losing enteropathy is required in these cases. Finally, albumin is found to be a prognostic indicator in this study.

Lung function at 1-year follow-up in patients with persistent dyspnea after mild COVID-19 – comparisons with moderate and critical COVID-19

Aim: To assess lung function in patients with persistent dyspnea 1 year after mild coronavirus disease 2019 (COVID-19) and compare with those hospitalized with moderate or critical COVID-19. Methods: Adults with confirmed severe acute respiratory syndrome coronavirus-2 infection with mild COVID-19 and persistent dyspnea (n = 18) or with moderate (n = 34) or critical COVID-19 (n = 19) were followed up 11–13 months after initial infection. Inclusion criteria were age &lt; 65 years, no smoking history, and no preexisting respiratory diseases. Sociodemographic and clinical data were collected, and patients underwent spirometry and measurement of diffusing capacity for carbon monoxide (DLCO). Results: The non-hospitalized patients were significantly younger and more often female compared with those in the moderate and critical groups (P = 0.002 and P &lt; 0.001, respectively). No significant differences in comorbidities or body mass index (BMI) were noted between severity groups. An obstructive spirometry pattern (ratio of forced expiratory volume during the first exhalation second to forced vital capacity under the lower limit of normal (LLN)) was found in 5.6, 5.9, and 5.3% of patients in the mild, moderate, and critical groups, respectively (P = 0.995). Abnormal DLCO (&lt; LLN) rates were seen in 5.6, 16.7, and 47.4% in the mild, moderate, and critical groups, respectively (P = 0.018). DLCO, expressed as a z-score, was significantly lower in the critical group compared with the mild group after adjustment for age, sex, and BMI. Conclusion: Only a few subjects with mild COVID-19 and persistent dyspnea had abnormal lung function 1 year after initial infection, assessed based on spirometry and DLCO measurements. An obstructive spirometry pattern at 1-year follow-up was uncommon even in patients with moderate or critical COVID-19. Impaired DLCO was more common in patients with critical COVID-19.

Investigation of the Relationship Between Prostate-Specific Antigen Levels and Prostate Cancer in Patients Attending a Urology Clinic from 2014 to 2023

Background: Prostate cancer is the second most common neoplasm and the fifth most aggressive cancer among men worldwide, with approximately 1.4 million new cases diagnosed annually. The incidence and mortality of prostate cancer increase with age, with a mean age at diagnosis of 66 years. Prostate cancer may be asymptomatic in its early stages and often has a latent period. The use of the Prostate-Specific Antigen (PSA) Index in the definitive diagnosis of prostate cancer remains a challenge for many urologists, and further research in this area can help to better understand the precise relationship between PSA levels and prostate cancer. Objectives: The present study aimed to investigate the relationship between PSA levels and prostate cancer in patients attending a urology clinic from 2014 to 2023, with the goal of improving diagnosis, developing effective treatments, and enhancing clinical outcomes. Methods: In this cross-sectional study, 242 patients with prostate cancer who attended a urology surgical clinic over a nine-year period from 2014 to 2023 were included. The patients were divided into two groups—youngest and oldest—based on the duration of their disease diagnosis. Demographic and clinical laboratory data were collected and entered into a checklist. Subsequently, the patients underwent a biopsy, and the results were recorded. Upon completion of the study, the collected data were entered into SPSS software for statistical analysis. Multiple regression analysis was used for correlation tests, while nonparametric tests, such as the Kruskal-Wallis test and the Mann-Whitney U test, were applied for nonparametric data analysis. Results: This study included 242 out of 276 samples for analysis. The ages of the participants ranged from 41 to 90 years, with a mean age of 67 ± 9.42 years. The data indicated that at PSA concentrations of 4 - 10 ng/mL, 5% of the samples were healthy, 15.2% had cancer, 46% had benign prostatic hyperplasia (BPH), and 33% had prostate intraepithelial neoplasia (PIN). At PSA concentrations of 10 - 50 ng/mL, 6% of the samples were healthy, 37% had cancer, 26% had BPH, and 29% had PIN. At PSA concentrations greater than 50 ng/mL, 3% of the samples were healthy, 76% had cancer, 14% had BPH, and 7% had PIN. A chi-square test revealed a significant association between PSA levels and pathological response (P &lt; 0.001). Additionally, an analysis of variance (ANOVA) test showed a significant difference between different age and severity groups (P &lt; 0.001). The free PSA-to-total PSA ratio in this study was 0.18, and the PSA-to-prostate volume ratio was 0.15, both of which were significantly associated with biopsy results (P &lt; 0.01). Conclusions: Overall, the data obtained from this study indicated that plasma PSA levels were directly associated with the likelihood of prostate cancer. Additionally, the results showed that plasma PSA levels were not only directly associated with age but also correlated with the severity of trophic disorders, such as cancer, as indicated by biopsy results.

Plasma Inflammation Markers Linked to Complications and Outcomes after Spontaneous Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) could trigger inflammatory responses. However, the specific role of inflammatory proteins in the pathological mechanism, complications, and prognosis of ICH remains unclear. In this study, we investigated the expression of 92 plasma inflammation-related proteins in patients with ICH (n = 55) and healthy controls (n = 20) using an Olink inflammation panel and discussed the relation to the severity of stroke, clinical complications, 30-day mortality, and 90-day outcomes. Our result showed that six proteins were upregulated in ICH patients compared with healthy controls, while seventy-four proteins were downregulated. In patients with ICH, seven proteins were increased in the severe stroke group compared with the moderate stroke group. In terms of complications, two proteins were downregulated in patients with pneumonia, while nine proteins were upregulated in patients with sepsis. Compared with the survival group, three proteins were upregulated, and one protein was downregulated in the death group. Compared with the good outcome group, eight proteins were upregulated, and four proteins were downregulated in the poor outcome group. In summary, an in-depth exploration of the differential inflammatory factors in the early stages of ICH could deepen our understanding of the pathogenesis of ICH, predict patient prognosis, and explore new treatment strategies.

Association of SNP-SNP interactions of surfactant protein genes with severity of respiratory syncytial virus infection in children.

The severity of respiratory syncytial virus (RSV) may be linked to host genetic susceptibility. Surfactant protein (SP) genetic variants have been associated with RSV severity, but the impact of single-nucleotide polymorphism (SNP)-SNP interactions remains unexplored. Therefore, we used a novel statistical model to investigate the association of SNP-SNP interactions of SFTP genes with RSV severity in two- and three-interaction models. We analyzed available genotype and clinical data from prospectively enrolled 405 children diagnosed with RSV, categorizing them into moderate or severe RSV groups. Using Wang's statistical model, we studied significant associations of SNP-SNP interactions with RSV severity in a case-control design. We observed, first, association of three interactions with increased risk of severe RSV in a two-SNP model. One intragenic interaction was between SNPs of SFTPA2, and the other two were intergenic, involving SNPs of hydrophilic and hydrophobic SPs alone. We also observed, second, association of 22 interactions with RSV severity in a three-SNP model. Among these, 20 were unique, with 12 and 10 interactions associated with increased or decreased risk of RSV severity, respectively, and included at least one SNP of either SFTPA1 or SFTPA2. All interactions were intergenic except one, among SNPs of SFTPA1. The remaining interactions were either among SNPs of hydrophilic SPs alone (n = 8) or among SNPs of both hydrophilic or hydrophobic SPs (n = 11). Our findings indicate that SNPs of all SFTPs may contribute to genetic susceptibility to RSV severity. However, the predominant involvement of SFTPA1 and/or SFTPA2 SNPs in these interactions underscores their significance in RSV severity.NEW & NOTEWORTHY Although surfactant protein (SP) genetic variants are associated with respiratory syncytial virus (RSV) severity, the impact of single-nucleotide polymorphism (SNP)-SNP interactions of SP genes remained unexplored. Using advanced statistical models, we uncovered 22 SNP-SNP interactions associated with RSV severity, with notable involvement of SFTPA1 and SFTPA2 SNPs. This highlights the comprehensive role of all SPs in genetic susceptibility to RSV severity, shedding light on potential avenues for targeted interventions.

Ongoing Excess Hospitalizations for Severe Pediatric Group A Streptococcal Disease in 2023-2024-A Single-Center Report.

A Europe-wide outbreak of invasive pediatric group A streptococcal infections (iGAS) began in fall 2022. Here, we report the evolution of GAS hospitalizations in children and adolescents during the second outbreak year in 2023-2024 at a tertiary center in Switzerland. Using prospective monitoring of all in-patient GAS cases below 16 years of age, including those with iGAS, we compared case frequencies and clinical characteristics in three time periods (2013-2020; 2022-2023; 2023-2024). Annual GAS hospitalizations increased from a median of 25 cases (range 11-28) in 2013-2020 to 89 and 63 cases, respectively, in 2022-2023 and 2023-2024. iGAS cases evolved similarly (2013-2020, 4 cases (3-8); 2022-2023, 32 cases; 2023-2024, 21 cases). The decline in cases from 2022-2023 to 2023-2024 included all types of GAS organ involvement, except suppurative infections in the head area, which remained largely unchanged (48 vs. 45 cases). Pleural empyema declined from 13 to 7 cases, possibly explained by a poor overlap of the GAS and influenza curves, respectively, in 2023-2024 compared to 2022-2023. These data document the prolongation of the GAS outbreak into its second winter season in 2023-2024.

Estimating effects of aging and disease progression in current and former smokers using longitudinal models

ObjectivesTo separate estimates of mean change in a health outcome into components of aging and disease progression for different severity groups of chronic obstructive pulmonary disease (COPD). Study design and methodsA longitudinal model can be used to estimate mean change in a health outcome over time. Methods to separate this change into portions due to aging and disease progression are discussed, including conditions that allow for accurate estimation. Linear mixed models were used to estimate these changes for forced expiratory volume in 1 s (FEV1) for various COPD severity and smoking groups using a large cohort (COPDGene) followed for over 10 years. ResultsBased on an analysis of 4967 subjects, age-related loss in FEV1 was found to be about 1 % per year, consistent with published work. Excess average losses (those beyond natural aging) were significant for all severity groups (except nonsmokers), including those with smoking history but normal lung function. Subjects in higher severity groups tended to have less loss in FEV1, but more relative loss, compared to baseline averages. Losses in FEV1 that included both aging and disease progression ranged from 1 to 3 % over severity groups, with current smokers generally exhibiting greater mean losses in FEV1 than former smokers. DiscussionEffects of disease progression separate from aging can be estimated in observational studies, although care should be taken in order to make sure assumptions involving this separation are reasonable for a given study. This article demonstrates methods to estimate such effects using temporal changes in lung function for subjects in the COPDGene study.

Impact of Infliximab Biosimilar (Ixifi®) Trough Levels on Disease Activity and Inflammatory Markers in Iraqi Rheumatoid Arthritis Patients

Background: Rheumatoid arthritis is an autoimmune inflammatory condition that impacts the small and larger joints. Ixifi® is a biosimilar medication derived from infliximab that exclusively targets Tumor Necrosis Factor-α. Serum Ixifi® trough concentration is necessary to manage disease activity in rheumatoid arthritis. Objective: Assess the impact of the Ixifi® trough level on disease activity and inflammatory biomarkers. Methods: A cross-sectional observational study was undertaken at Baghdad Teaching Hospital, involving forty-two patients diagnosed with rheumatoid arthritis according to ACR/EULAR 2010 criteria. After 3 months after initiating therapy with Ixifi®, the serum concentrations of Ixifi®, as well as CDAI, ESR, and CRP biomarkers, were measured. Results: After 3 months of therapy with Ixifi®, the patients in the remission group had a higher concentration of Ixifi® compared to the mild, moderate, and severe disease activity groups. Ixifi® trough level in remission was 5.45 µg/ml, while in mild, moderate, and severe groups, it was 3.575 µg/ml, 2.2 µg/ml, and 0.66 µg/ml, respectively. The CDAI scores were in the severe group (26.0), moderate group (19.0), mild group (7.0), and remission group (2.0). Furthermore, the findings indicate an inverse correlation between the Ixifi® trough level and both ESR and CRP. Conclusions: A drop in Ixifi® levels leads to an increase in disease severity and inflammation, while high concentrations of Ixifi® decrease disease activity, ESR, and CRP.

Hypoalbuminemia on admission in diabetic patients correlates with severity of illness in COVID-19: A retrospective clinical study and literature review

IntroductionTo elucidate factors associated with severe disease in patients with coronavirus disease 2019 (COVID-19) pneumonia complicated with diabetes mellitus. MethodsAmong patients with COVID-19 pneumonia hospitalized from January to September 2021, 100 patients with diabetes were included in the study. Patients in the intensive care unit admission or in-hospital death category were defined as the severe group (26 patients), and the other patients as the moderate group (74 patients). Comparisons were made between the two groups. Medical histories were extracted from the medical records, and statistical analysis was performed. ResultsPatients were 62.1 ± 13.0 years of age, 70 % male, 48 % aged 65 years and more, and HbA1c was 7.72 ± 1.51 %. The severe group had significantly higher blood glucose level, CRP, WBC, and LDH on admission. Serum albumin level was significantly lower in the severe group and was significantly negatively correlated with number of days on oxygen administration (r = 0.447) and maximal oxygen concentration (r = 0.561). Multiple logistic regression analysis with severity of illness as the objective variable showed that high CRP and low albumin levels on admission, and older age were independently associated. ConclusionsLow albumin levels on admission may be an indicator of severe disease in patients with diabetes.

Clinical characteristics and risk factors analysis of dengue fever incidence in Xishuangbanna, Yunnan Province in 2023

To analyze the clinical characteristics of dengue fever patients, summarize the course and characteristics of the disease, and analyze the risk factors that affect the condition. Retrospective collection of general information, clinical symptoms, medical history, laboratory tests, prognosis and other clinical data of dengue fever patients that admitted to Jinghong First People's Hospital and severe dengue fever patients at People's Hospital of Xishuangbanna Dai Autonomous Prefecture from June to December 2023 was conducted using a case report form (CRF). According to the diagnostic criteria of the World Health Organization (WHO), patients were divided into dengue fever group, dengue fever with warning signs group, and severe dengue fever group. The differences in clinical data between different groups of patients were analyzed and compared. Binary multiple factor Logistic regression analysis was used to explore the risk factors affecting the severity of dengue fever in patients. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of prediction models constructed for various risk factors for severe dengue fever. Subgroup analysis was performed on the prognosis of severe dengue fever patients, and the differences in clinical data between two groups of patients with different prognoses were compared. Binary multivariate Logistic regression analysis was used to explore the risk factors affecting the prognosis of severe dengue fever patients. ROC curve was drawn to analyze the predictive value of prediction models constructed for various risk factors on the prognosis of severe dengue fever patients. A total of 2 264 patients were included, including 499 cases in the dengue fever group, 1 379 cases in the dengue fever with warning signs group, and 386 in the severe dengue fever group (43 deaths and 343 survivors). The most common symptom of dengue fever patients was fever (94.70%), followed by muscle soreness (70.54%), headache (63.12%), fatigue (58.92%), and chills (46.02%). Compared with the dengue fever group and the dengue fever with warning signs group, the ratio of thalassemia and the levels of cardiac troponin (cTnI, cTnT), MB isoenzyme of creatine kinase (CK-MB), and myoglobin were significantly increased in patients with severe dengue fever group, albumin (Alb) was significantly decreased in patients with severe dengue fever group. The levels of cTnT and myoglobin in patients with dengue fever with warning signs group were significantly higher than those in the dengue fever group, and the level of Alb in patients with dengue fever with warning signs group was significantly lower than that in the dengue fever group, the differences were statistically significant (all P < 0.05). Binary multivariate Logistic regression analysis showed that thalassemia [odds ratio (OR) = 6.214, 95% confidence interval (95%CI) was 2.337-16.524, P < 0.001], Alb ≤ 36 g/L (OR = 6.297, 95%CI was 4.270-9.286, P < 0.001), and cTnT levels (OR = 1.008, 95%CI was 1.002-1.015, P = 0.016) were risk factors for severe dengue fever. ROC curve analysis showed that the area under the ROC curve (AUC) for predicting severe dengue fever based on the prediction models constructed for the above risk factors was 0.856, with the best predictive value of 0.067, sensitivity of 67.1%, and specificity of 99.4%. In the subgroup analysis of patients with severe dengue fever, compared with the survival group, the levels of hematocrit (HCT), cTnT, and CK-MB in the death group patients were significantly increased, while the level of Alb was significantly decreased, and the differences were statistically significant. Binary multivariate Logistic regression analysis showed that Alb (OR = 0.839, 95%CI was 0.755-0.932, P = 0.001), HCT (OR = 1.086, 95%CI was 1.010-1.168, P = 0.025), elevated troponin level (OR = 10.119, 95%CI was 2.596-39.440, P < 0.001), and CK-MB (OR = 1.081, 95%CI was 1.032-1.133, P < 0.001) were risk factors for mortality in patients with severe dengue fever. ROC curve analysis showed that the AUC for predicting death in severe dengue fever patients based on the prediction models constructed for the above risk factors was 0.881, with the best predictive value of 0.113, sensitivity of 75.0%, and specificity of 88.9%. Thalassemia, Alb ≤ 36 g/L, and cTnT level are risk factors for severe dengue fever, while HCT level, Alb level, CK-MB level, and elevated troponin level are risk factors for death in patients with severe dengue fever.

Early diagnostic and prognosis prediction of circ_0054633 for acute lung injury/acute respiratory distress syndrome in children with severe pneumonia

To explore the value of circ_0054633 in early diagnosis and prognosis prediction of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in children with severe pneumonia. A retrospective case-control study was conducted on children with diagnosed severe pneumonia admitted to Tianjin Children's Hospital from July 1, 2022, to February 29, 2024. The clinical data was collected by electronic medical record system and clinical follow-up, including gender, age, lung injury prediction score (LIPS), pediatric critical illness score (PCIS), serum circ_0054633, interleukin-6 (IL-6), the indicators of the arterial blood-gas analysis, oxygenation index (PaO2/FiO2) within 24 hours of admission and the survival status of 28 days. According to whether ALI/ARDS occurred, they were divided into the ALI/ARDS group and the non-ALI/ARDS group. The differences of clinical data between the two groups were compared, and multivariate Logistic regression was used to analyze the risk factors for ALI/ARDS in children with severe pneumonia. The receiver operator characteristic curve (ROC curve) will be used to explore the early diagnostic value of ALI/ARDS in children with severe pneumonia. The patients of ALI/ARDS were divided into mild group, moderate group and severe group according to the level of PaO2/FiO2. The levels of serum circ_0054633 and IL-6 in various severity ALI/ARDS were compared. The differences of serum circ_0054633, IL-6 levels, PCIS score and LIPS score were compared between the two groups of ALI/ARDS patients according to different prognoses in 28 days, as well as the correlation between various risk factors and circ_0054633. A total 74 children with severe pneumonia were included, with 34 cases in the ALI/ARDS group and 40 cases in the non-ALI/ARDS group. In ALI/ARDS group, there were 9 cases in the mild group, 15 cases in the moderate group and 10 cases in the severe group; while 12 cases died and 22 cases survived after 28 days. The serum circ_0054633, IL-6 level and LIPS score were higher in the ALI/ARDS group than the non-ALI/ARDS group, while the PCIS score was lower, and the two groups had significant difference. Multivariate Logistic regression analysis showed that circ_0054633 was independent predictors of ALI/ARDS in children with severe pneumonia [odds ratio (OR) = 3.853, 95% confidence interval (95%CI) was 1.912-7.805, P = 0.017]. ROC curve analysis showed that the cut-off values for circ_0054633 in the diagnosis of ALI/ARDS were 3.955, sensitivity was 79.4%, specificity was 92.5%, area under the ROC curve (AUC) was 0.892. The serum circ_0054633 and IL-6 levels were higher in the children who died in 28 days than the children who were survived, while the PCIS score was lower, and the two groups had significant difference. Spearman correlation analysis showed that the level of circ_0054633 in children with ALI/ARDS was positively correlated with 28-day mortality and IL-6 (r value was 0.675, 0.763, respectively, all P < 0.001), but negatively correlated with PCIS score (r = -0.626, P < 0.001), while no significant correlation with LIPS score (r = 0.389, P = 0.023). The level of serum circ_0054633 has a better value in early diagnosis and prognosis prediction of ALI/ARDS caused in children with severe pneumonia.

Survival of Children With Critical Congenital Heart Defects in the National Birth Defects Prevention Study.

Critical congenital heart defects (CCHDs) are associated with considerable morbidity and mortality. This study estimated survival of children with nonsyndromic CCHDs and evaluated relationships between exposures of interest and survival by CCHD severity (univentricular or biventricular function). This analysis included 4380 infants with CCHDs (cases) born during 1999-2011 and enrolled in the National Birth Defects Prevention Study, a multisite, population-based case-control study of major birth defects. Cases were linked to state death files. Nonparametric Kaplan-Meier survival functions were used to estimate 1- and 5-year survival probabilities overall and by severity group (univentricular/biventricular) stratified by demographic and clinical exposure variables of interest. The log-rank test was used to determine whether stratified survival curves were equivalent. Survival and 95% confidence intervals (CIs) were also estimated using Cox proportional hazards modeling adjusted for maternal age, education, race/ethnicity, study site, and birth year. One- and five-year survival rates were 85.8% (CI 84.7-86.8) and 83.7% (CI 82.5-84.9), respectively. Univentricular 5-year survival was lower than biventricular case survival [65.3% (CI 61.7-68.5) vs. 89.0% (CI 87.8-90.1; p < 0.001)]. Clinical factors (e.g. preterm birth, low birthweight, and complex/multiple defects) were associated with lower survival in each severity group. Sociodemographic factors (non-Hispanic Black race/ethnicity, <high school education, smoking, and lower household income) were only associated with survival among biventricular cases. Mortality among children with CCHDs occurred primarily in the first year of life. Survival was lower for those with univentricular defects, and social determinants of health were most important in predicting survival for those with biventricular defects.

Abstract P130: Predictive value of the MCG-based Nomogram model for the anatomical and functional evaluation of coronary artery lesions

Objective: Optical coherence tomography (OCT) is an intravascular imaging technology that can provide cross-sectional images of coronary arteries, which can more accurately assess the condition of coronary artery lesions and the degree of vascular stenosis. It is an important method for the anatomical evaluation of coronary artery lesions. Radionuclide myocardial perfusion imaging (MPI) is a commonly used non-invasive method for functional evaluation of myocardial ischemia in clinical practice. The clinical application of these two methods is greatly limited due to operational risk and high cost. This study aimed to explore the potential predictive value of the MCG-based Nomogram model for the anatomical and functional evaluation of coronary artery lesions. Methods: We reviewed the patients who were hospitalized in the cardiovascular department of our hospital from October 2021 to July 2023 for MCG test. A total of 137 patients were included in the OCT subgroup, including 48 patients in the severe coronary artery stenosis group (inclusion criteria: OCT showed coronary artery area stenosis ≥70.0%) and 89 patients in the control group (inclusion criteria: OCT showed coronary artery area stenosis &lt;50.0% or CCTA showed no coronary artery stenosis). A total of 46 patients were included in the MPI subgroup, including 10 patients in the severe myocardial ischemia group (inclusion criteria: MPI showed abnormal perfusion scores of at least one ventricular segment ≥3 points) and 36 patients in the control group (inclusion criteria: MPI showed abnormal perfusion scores of all ventricular segments ≤2 points). The Nomogram model was used to predict the results of patients in the two subgroups, and the results were compared with the OCT and MPI results. The sensitivity, specificity and Youden index were calculated. Results: The Nomogram model based on MCG had a sensitivity of 70.8%, a specificity of 85.4%, and a Youden index of 0.562 for predicting OCT results. The sensitivity, specificity and Youden index of Nomogram model for predicting MPI results were 70.0%, 72.2% and 0.422, respectively. Conclusions: The MCG-based Nomogram model has good prediction accuracy for the anatomical and functional evaluation of coronary artery lesions, which has potential application value.

Prevalence and outcomes of neonates with severe COVID-19: An observational study at Children’s Hospital 1 in Ho Chi Minh City, Vietnam

Objective: To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes. Methods: We conducted an observational cross-sectional study at Children's Hospital 1 (CH1) from July 25, 2021, to May 31, 2022. All neonates who had fever or respiratory symptoms or were born from mothers with COVID-19 and had a positive RT-PCR SARS-CoV-2 result would be included. We classified neonates with COVID-19 into 2 groups: mild/moderate and severe for analysis. Differences between groups were analyzed using Fisher's exact test/Chi-square test for categorical variables and Student's t-test/Wilcoxon Rank Sum test for continuous variables. Results: This study included 88 newborns who had positive RT-PCR SARS-CoV-2 results. The severity COVID-19 rate among neonatal cases was found to be 13.6% (12/88), with a corresponding mortality rate of 1.1% (1/88). All severe cases showed lung abnormalities as evident on chest X-ray images. In addition to respiratory symptoms, a higher incidence of gastrointestinal manifestations, such as vomiting and diarrhea, was observed in the severe group, indicating a compelling association. The administration of anticoagulant and anti-inflammatory drugs in the study group resulted in a satisfactory outcome with no significant complications. Conclusions: The COVID-19 pandemic has had a substantial impact on the well-being of neonates. The management of COVID-19 in this population presents significant challenges.

Associations of Intermittent Hypoxia Burden with Gut Microbiota Dysbiosis in Adult Patients with Obstructive Sleep Apnea.

Clinical studies focusing on the association between the gut microbiota and obstructive sleep apnea (OSA) are limited. This study aimed to explore the relationship between intermittent hypoxia and the composition of gut microbiota in adults by analyzing the differences in the characteristics and functional distribution of gut microbiota between patients with different severities of OSA and healthy individuals. A cohort of 113 individuals from the First Affiliated Hospital of Sun Yat-sen University underwent overnight polysomnography from July 2019 to August 2021. The individuals included 16 healthy controls and 97 patients with OSA, categorized by the apnea-hypopnea index into mild, moderate, and severe groups. Fecal samples were analyzed using high-throughput sequencing of the 16S rRNA V3-V4 region to assess gut microbiota composition and function. Correlation analysis was used to evaluate the association between clinical indicators and microbiota markers. In patients with OSA, the gut microbiota diversity and the abundance of specific microbes that produce short-chain fatty acids decreased (P<0.05). The phyla Verrucomicrobia and Candidatus Saccharibacteria, genera Gemmiger and Faecalibacterium, and the species Gemmiger formicilis exhibited decreasing abundance with increasing OSA severity. Correlation analysis revealed a robust association between the proportion of total sleep time, characterized by nighttime blood oxygen saturation below 90%, and the alterations in the gut microbiota, demonstrating that elevated levels of desaturation are correlated with pronounced microbiota dysbiosis (P<0.05). Compared to the control group, the intermittent hypoxia exhibited by patients with OSA may be related to alterations in the composition and structure of the gut microbiota. Our results demonstrate the importance of monitoring hypoxia indicators in future clinical practice.

Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder.

Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants' psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. Our findings also suggest the significance of irritability as a separate hallmark of PTSD and the need to incorporate PTSD dimensions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pulmonary hypertension and lung transplantation waitlist outcomes for hypersensitivity pneumonitis

RationaleHypersensitivity pneumonitis is an interstitial lung disease that can progress to pulmonary hypertension which increases mortality. The European Society of Cardiology recently reduced the diagnostic criteria for pre-capillary pulmonary hypertension from mean pulmonary artery pressure ≥25mmHg to ≥20mmHg and pulmonary vascular resistance from ≥3Wu to ≥2Wu. ObjectiveWe investigated the effect of the new criteria on hypersensitivity pneumonitis lung transplantation waitlist outcomes. MethodsWe conducted a retrospective cohort study of the Scientific Registry of Transplant Recipients.1175 hypersensitivity pneumonitis patients listed for lung transplantation were divided into three groups based on the presence of pre-capillary pulmonary hypertension; those with pre-capillary pulmonary hypertension based on old criteria, new criteria, and those without pre-capillary pulmonary hypertension based on either criterion. The individual components of pre-capillary pulmonary hypertension were also assessed with three mean pulmonary artery pressure groups (≤20mmHg, >20mmHg to <25mmHg, ≥25 mmHg) and three pulmonary vascular resistance groups (≤2Wu, >2Wu to <3Wu, ≥3Wu). Survival analysis was performed. Measurements and Main ResultsKaplan-Meier analysis showed a difference in waitlist survival probability among the mean pulmonary artery pressure groups and among the pulmonary vascular resistance groups driven by the most severe groups. Multivariate Cox regression showed no difference between the various pre-capillary pulmonary hypertension groups. Pulmonary vascular resistance ≥3Wu was associated with increased waitlist mortality. ConclusionsThe new thresholds of mean pulmonary artery pressure and pulmonary vascular resistance do not appear to prognosticate waitlist outcomes when combined. PVR ≥3Wu is associated with worse waitlist outcomes and may be useful in prognostication.

Application value of P-selectin and Clara cell secretory protein 16 expression in children with severe adenovirus pneumonia.

This study investigated the roles of P-selectin and Clara cell secretory protein 16 (CC16) levels in the pathogenesis of severe adenovirus (ADV) pneumonia in children and evaluated their ability to predict disease. Fifty-one children (age, 1-5 years) with ADV pneumonia who were admitted to Xiamen Children's Hospital were included in this study and divided into the mild group (24 patients) and severe group (27 patients). A control group comprising healthy children of the same age who underwent routine physical examinations during the same period (30 patients) was also included. The univariate analysis demonstrated that the levels of the white blood cell count and C-reactive protein, procalcitonin, d-dimer, and P-selectin were increased in a severe group compared with a mild group, while CC16 levels were significantly decreased (p < 0.05). The logistic regression analysis revealed that P-selectin and CC16 levels were independent risk factors for severe ADV pneumonia in children. The areas under the ROC curves suggested that P-selectin and CC16 exhibited high predictive value for severe ADV pneumonia. P-selectin values more than 898.58 pg/mL and CC16 values less than 11.355 ng/mL predicted severe ADV pneumonia. P-selectin and CC16 levels are correlated with the severity of ADV pneumonia in children.

Tetanus Cases in Mogadishu-Somalia: A Tragic Disease Despite the Existence of a Century-Old Safe and Efficient Tetanus Vaccine.

Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities. This study includes tetanus patients who were admitted to the Recep Tayyip Erdoğan Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients' sociodemographic details. The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1-38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p<0.001), generalized/neonatal tetanus (p<0.001), high non-vaccination rate (p:0.011), antibiotic usage (p<0.001), and a positive blood culture (p<0.001). Almost all of the complications (p<0.001) and all of the deaths (p<0.001) were in the severe group. In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine's low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.

Study of histopathological and ultrastructural changes in the lungs of COVID-19 patients

BackgroundCOVID 19 infection is a multi-systemic disease with the lungs bearing the maximum brunt. Very few autopsy studies have been done on the deceased patients. The present study aimed to study the clinical spectrum and lab parameters of COVID-19 patients along with the morphological spectrum of the lung changes in these patients by histology, Immunohistochemistry and Electron microscopy. We also compared the Clinical severity and Lab parameters with the histopathological phase of the lung involvement. MethodsWe conducted a cross sectional observational study between Jun 2021 to Dec 2022 where in needle necropsy of lung tissue of COVID 19 confirmed fatal cases were studied by histopathology, immunohistochemistry (using CD3, CD4, CD8, CD19, CD20, CD68 and Pan CK markers) and Electron microscopy. Various hematological, histopathological and ultrastructural parameters were studied. The results were analyzed using SPSS 25.0 software. ResultsA total of 24 cases were studied. The mean age was 65.9 yrs, male: female ratio was 2:1. Five had moderately severe COVID while 19 had severe COVID infection. Diffuse alveolar damage (DAD) was seen in 83% of all the cases. On the basis of clinical severity and histopathological staging, broadly two histopathological groups were made (Proliferative and Organizing). Difference between TLC, N/L ratio and L/Platelet ratio in two histopathological groups was assessed using unpaired t test, however no significant difference was noted. We did not find any correlation between clinical severity and histopathological groups though severe cases of COVID-19 were found to have a shorter time between admission to the hospital and death. All the biopsies were subjected to electron microscopy and in two of the cases we could demonstrate corona virus particles. ConclusionOur study has shown that severe cases of COVID 19 are associated with a shorter time between admission to hospital and death. While the histopathology of the lung showed diffuse alveolar damage as the most common finding; the Transmission Electron Microscopy (TEM) played an important role in characterizing the ultrastructure of these cells and demonstrating corona virus particles.