Severe Group Research Articles

Post-COVID-19 condition in children: epidemiological evidence stratified by acute disease severity.

To determine the prevalence of pediatric Post-COVID-19 condition (PPCC), identify risk factors, and assess the quality of life in children with differing severities of acute COVID-19. During a prospective longitudinal study with a 1-year follow-up, we compared non-hospitalized (mild) and hospitalized (severe) COVID-19 cases to a negatively tested control group. 579 children were included in this study. Of these, 260 had mild acute disease (median age:8, IQR:6-10), 60 had severe acute disease (median age:1, IQR:0.1-4.0), and 259 tested negative for SARS-CoV-2 (NT) (median age:8, IQR:5-10). At three months, 14.6% of the SARS-CoV-2 positive mild group (RR:6.31 (CI 95%: 2.71-14.67)) and 29.2% of the severe group (RR:12.95 (CI 95%: 5.37-31.23)) reported sequelae, versus 2.3% of the NT group. PPCC prevalence in the mild group decreased from 16.1% at one month to 4.4% at one year. Children with PPCC exhibited lower physical health-related quality of life scores and higher fatigue scores than the NT children. Severe acute COVID-19 in children leads to a higher PPCC prevalence than in mild cases. PPCC prevalence decreases over time. Risk factors at three months include prior medical history, hospital admission, and persistent fatigue one month after a positive test. We demonstrate children with severe COVID-19 are more likely to develop Post-COVID-19 condition than those with mild or no infections, and highlights the risk factors. Here we have stratified by acute disease severity, prospectively included a negative control group, and have demonstrated the heterogeneity in prevalence when utilizing various recent definitions of post-COVID. Identifying risk factors for pediatric post-COVID and highlighting the heterogeneity in prevalence based on various current definitions for post-COVID should aid in correctly identifying potential pediatric post-COVID cases, aiding in early intervention.

The predictive significance of uric acid to high density lipoprotein- cholesterol ratio and uric acid for the severity and mortality of coronavirus disease-19

ObjectiveThe non-invasive and inexpensive predictive indicators seem to be essential for the evaluation of coronavirus disease-19 (COVID-19) prognosis. Uric acid to high-density lipoprotein-cholesterol ratio (UHR) have been known as inflammatory and metabolic biomarker in some disorders. This study aimed to evaluate the usefulness of serum uric acid (UA) and UHR values on admission as prognostic indicators for the severity and mortality of COVID-19. Regression models were accomplished to assess the association between UA and UHR with the severity and mortality of COVID-19.ResultsThis study was performed with 424 confirmed COVID-19 patients. The mean UA and UHR values of the severe group and deceased group were statistically higher than those mild group and survivor group, respectively (P < 0.05). Compared to the survivor cases, deceased subjects had lower serum concentrations of HDL-c (p < 0.05). Multivariate logistic regression analysis showed that UHR and UA values statistically are correlated with the severity (OR = 1.20 CI:1.07–1.35, OR = 1.19 CI:1.023–1.381 respectively) and mortality (OR = 10.04 CI:1.50–67.30, OR = 10.73 CI:1.47–87.11, respectively) of COVID-19. Compared with a reference range, serum UA levels ≥ 7.3 mg/dl and a UHR value greater than 0.185 increase the risk of critical care of COVID-19 almost 2.5 and 3.5 times, respectively. In summary, our results revealed that UHR index value and serum UA levels are useful biochemical indicators for predicting the severity and mortality of COVID-19.

A New Biomarker Copeptin in Determining Disease Severity in COVID-19.

Copeptin is released from the posterior pituitary gland into systemic circulation in response to various stimuli, including stress. We aimed to evaluate the role of copeptin in determining the severity of the disease in patients with COVID-19. The study was conducted prospectively in two centers between June 1, 2022, and October 1, 2022. Severe and mild-moderate COVID-19 patients were compared in terms of clinical, laboratory and imaging findings, and serum copeptin levels at hospitalization. A total of 90 patients were included in the study; 45 patients were in severe disease groups. Dyspnea, loss of appetite, and loss of smell were significantly more common in the severe disease group (p<0.001, p=0.025, and p<0.001, respectively). Among the tomography findings, the consolidation frequency was similar in both groups (p=0.259). C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase (LDH), procalcitonin, troponin and copeptin levels were higher in the severe group (p<0.05); hemoglobin, total protein and vitamin D levels were lower (p=0.05). The area under the curve (AUC) values for severe disease were 0.643 for copeptin (p=0.019), 0.656 for CRP (p=0.011), 0.684 for procalcitonin (p=0.004), 0.657 for ferritin (p=0.01), 0.72 for D-dimer (p=0), 0.688 for troponin (p=0.002), and 0.672 for age (p=0.005). In our study, copeptin was identified as a new prognostic biomarker indicating the severity of the disease in patients with COVID-19.

The severity of gambling in clinical samples of gamblers: profiles and prediction of the impulsivity and emotions.

Impulsivity and emotion impairments have been noted in individuals with gambling disorder (GD). However, little research has investigated the influence of impulsivity and emotions on the severity of gambling in clinical populations. This study aimed to examine: (i) differences in emotions and impulsivity traits according to the severity of gambling in individuals with GD, (ii) the mediating effects of emotion in the relationship between impulsivity traits and gambling severity, and (iii) the predictive effects of emotion and impulsivity traits on GD severity. The study included 214 participants seeking treatment for GD who completed assessments for emotions (Patient Health Questionnaire-9 [PHQ-9], 7-item Generalized Anxiety [GAD-7]), impulsivity traits (Barratt Impulsiveness Scale [BIS], Self-control Scale [SCS]), and GD severity (DSM-5). Participants were categorized into mild (n = 78), moderate (n = 63), and severe (n = 73) gambling severity groups. Significant differences in emotions and impulsivity traits were observed across these groups. The severe GD group exhibited higher levels of depression, anxiety, and impulsivity traits, along with lower self-control, compared to the moderate and mild groups. Mediation analyses demonstrated that negative emotions mediated the association between impulsivity traits and the severity of gambling. More specifically, the indirect effects of impulsivity traits through PHQ-9 and GAD-7 were found to be significant, indicating a mediating role of emotions. Moreover, a predictive model incorporating emotion and impulsivity traits showed moderate accuracy in predicting the severity of gambling, with an area under the receiver operating characteristic curve of 0.714. This study highlights the distinct pathways through which impulsivity traits operate and emphasizes the need for prevention and treatment strategies that consider impulsivity traits and emotions for different levels of gambling severity.

Prognostic Value of CD14 Expression in Peripheral Blood Mononuclear Cell Membrane in Patients with Severe COPD Complicated with Pulmonary Infection.

Severe chronic obstructive pulmonary disease (COPD) patients with pulmonary infections face higher morbidity and mortality. To investigate mononuclear cell membrane CD14 as a prognostic marker for their outcome. A total of 311 participants were included: 122 in the coinfection group, 127 in the severe COPD group, and 62 in the control group. The patients in the coinfection group were categorized into survival (n=106) and death (n=16) groups based on hospitalization prognosis. The CD14%, CD14MFI, and CD14IND values were compared between the groups. Death risk factors were assessed by COPD grading, FEV1% pred, FEV1/FVC, CD14%, CD14MFI, and CD14IND. Correlations between CD14 parameters and mortality, COPD grade, FEV1%pred, and FEV1/FVC were analyzed. The critical value for CD14IND to predict patient death was determined and survival rates were compared between the high and the low-risk groups. CD14% values were significantly lower in the COPD and co-infection groups than in the control groups (p<0.05). The survival group showed a steady increase in mCD14 expression, while the death group showed fluctuating low levels. Low value of CD14% was identified as a risk factor for death and correlated with mortality and COPD severity (p<0.001). CD14IND≤74.36 predicted death with 91.22% sensitivity and 95.51% specificity. The high-risk group had a significantly lower 30-day survival rate (68.42%) compared with the low-risk group (95.24%) (log-rank χ2=10.067, p=0.002). The CD14 parameters of mononuclear cell membranes prove to be promising markers for predicting prognosis and death in severe COPD patients with lung infection.

Integrating transcriptomics, eQTL, and Mendelian randomization to dissect monocyte roles in severe COVID-19 and gout flare.

There are considerable similarities between the pathophysiology of gout flare and the dysregulated inflammatory response in severe COVID-19 infection. Monocytes are the key immune cells involved in the pathogenesis of both diseases. Therefore, it is critical to elucidate the molecular basis of the function of monocytes in gout and COVID-19 in order to develop more effective therapeutic approaches. The single-cell RNA sequencing (scRNA-seq), large-scale genome-wide association studies (GWAS), and expression quantitative trait loci (eQTL) data of gout and severe COVID-19 were comprehensively analyzed. Cellular heterogeneity and intercellular communication were identified using the scRNA-seq datasets, and the monocyte-specific differentially expressed genes (DEGs) between COVID-19, gout and normal subjects were screened. In addition, the correlation of the DEGs with severe COVID-19 and gout flare was analyzed through GWAS statistics and eQTL data. The scRNA-seq analysis exhibited that the proportion of classical monocytes was increased in both severe COVID-19 and gout patient groups compared to healthy controls. Differential expression analysis and MR analysis showed that NLRP3 was positively associated with the risk of severe COVID-19 and involved 11 SNPs, of which rs4925547 was not significantly co-localized. In contrast, IER3 was positively associated with the risk of gout and involved 9 SNPs, of which rs1264372 was significantly co-localized. Monocytes have a complex role in gout flare and severe COVID-19, which underscores the potential mechanisms and clinical significance of the interaction between the two diseases.

Burn Injury Severity in Adults: Proposed Definitions Based on the National Burn Research Dataset.

Previous iterations of burn severity (mild, moderate, and severe) were not data-driven and were outdated. Clustering analyses have gained popularity for identifying homogenous subgroups from heterogeneous medical conditions, such as asthma, sepsis, and lung disease. There is no consensus in burn literature regarding what constitutes massive burns. The current classification includes a 20% total body surface area (TBSA) burn and a 95% TBSA burn as severe. Latent class and hierarchical clustering analyses were applied to the American Burn Association National Burn Research Dataset. Cluster variables included length of stay, length of stay, intensive care unit length of, number and type of procedures, and number and type of complications. Non-clustering variables were evaluated after clustering, including burned TBSA, inhalation injury, mortality, discharge disposition, age, sex, and race. Latent class analysis suggested three clusters. Hierarchical clustering analysis was applied to the most severe latent class, creating four total burn severity groups. In total, 112,297 patients were included in the final analysis. The mean TBSA burned for each class is 4.26±4.91 for minor, 8.07±8.39 for moderate, 22.76±17.31 for severe and 36.72±21.61 for massive. The age and sex proportions were similar among all clusters. The clustering variables steadily increased for each severity cluster. Mortality was the highest in the massive cluster (18.2%). Data informed categories of burn severity were formed using clustering analyses, which will be helpful for triage, data-benchmarking, and class-specific research.

Retinal Microvasculature Changes Linked to Executive Function Impairment after COVID-19

Background/Objectives: Studies using optical coherence tomography angiography (OCTA) have revealed that individuals recovering from COVID-19 have a reduced retinal vascular density (VD) and larger foveal avascular zones (FAZs) than healthy individuals, with more severe cases showing greater reductions. We aimed to examine aspects of the retinal microvascularization in patients with post-COVID-19 condition (PCC) classified by COVID-19 severity and how these aspects relate to cognitive performance. Methods: This observational cross-sectional study included 104 PCC participants from the NAUTILUS Project, divided into severe (n = 59) and mild (n = 45) COVID-19 groups. Participants underwent cognitive assessments and OCTA to measure VD and perfusion density (PD) in the superficial capillary plexus (SVP) and FAZ. Analysis of covariance and partial Pearson and Spearman correlations were used to study intergroup differences and the relationships between cognitive and OCTA variables. Results: Severe PCC participants had significantly lower central (p = 0.03) and total (p = 0.03) VD, lower central (p = 0.02) PD measurements, and larger FAZ areas (p = 0.02) and perimeters (p = 0.02) than mild cases. Severe cases showed more cognitive impairment, particularly in speed processing (p = 0.003) and executive functions (p = 0.03). Lower central VD, lower central PD, and larger FAZ areas and perimeters were associated with worse executive function performance in the entire PCC sample and in the mild COVID-19 group. Conclusions: Retinal microvascular alterations, characterized by reduced VD and PD in the SVP and larger FAZ areas, were associated with cognitive impairments in PCC individuals. These findings suggest that severe COVID-19 leads to long-lasting microvascular damage, impacting retinal and cognitive health.

Economic burden and health-related quality of life in patients with epidermolysis bullosa in Spain

Background. Epidermolysis bullosa (EB) is a rare genetic skin disorder characterized by fragility of skin with appearance of acute and chronic wounds. The aim of this study was to determine the economic burden and the health-related quality of life (HRQoL) of patients with epidermolysis bullosa (EB) in Spain from a societal perspective.Methods. We conducted a cross-sectional, retrospective study including 62 patients with EB (62% dystrophic, 9.6% junctional, 3.2% Kindler syndrome, and 26% with simplex EB). Data were collected from questionnaires completed by patients or their caregivers. The costs were estimated, including not only direct healthcare costs but also direct non-healthcare costs and productivity losses. We compared severe EB (Dystrophic, Junctional EB and Kindler syndrome) to non-severe EB (simplex EB) using as reference year 2022. HRQoL was measured by generic (EQ-5D) and specific (QoLEB) questionnaires.ResultsThe average annual cost for an EB patient was €31,352. Direct healthcare costs represented 17.2% of the total cost, direct non-healthcare costs (mainly informal care costs) 71.3% and productivity losses 11.5% of the total cost. Participants in the severe EB group had a slightly higher average cost than participants in the non-severe EB group (€31,706 vs. €30,337). Direct healthcare costs and non-healthcare costs were higher in the severe EB group (€6,205 vs. €3,024 and €23,148 vs. €20,113) while productivity losses were higher in the non-severe EB group (€7,200 vs. €2,353). The mean utility index score, where the maximum value possible is one, was 0.45 for patients with severe EB (0.76 for their caregivers) and 0.62 for those with non-severe EB (0.77 for their caregivers).Conclusions. The social economic burden of EB, resulting from the high direct non-healthcare cost of informal care, and from the loss of productivity, accentuates the importance of not restricting cost analysis to direct healthcare costs. This substantiates that EB, particularly severe EB represents a significant hidden cost that should be revealed to society and should be considered in the support programmes for people who suffer from this disease, and in the economic evaluation of new treatments.

Exploratory Study of Relationship Between Obstructive Sleep Apnea Syndrome and Growth Hormones and Inflammatory Factors in Children

Purpose: In children, obstructive sleep apnea (OSA) is associated with growth hormone level abnormalities and chronic systemic inflammation. This study was performed to investigate the relationship of the degree of OSA with insulin-like growth factor 1 (IGF-1) and inflammatory cytokines in pediatric OSA and the inter-relationship between inflammatory cytokines and growth hormones. Methods: Children with OSA and controls without OSA participated in the study. Information included polysomnography followed by measurement of IGF-1 and inflammatory marker levels. In total, 226 patients aged 2 to 12 years were divided into 4 groups: non-OSA, n = 57 (25.2%); mild OSA, n = 116 (51.3%); moderate OSA, n = 23 (10.2%); and severe OSA, n = 30 (13.3%). Results: Body height was not significantly different among the 4 groups. However, the minimum oxygen saturation and IGF-1 significantly differed among the different OSA groups ( P = .0001 and P = .036, respectively). IGF-1 was significantly higher in the non-OSA group ( P &lt; .05) and mild OSA group ( P &lt; .01) than in the severe OSA group. As the severity of OSA increased, the interleukin-5 level significantly increased, which caused a difference between mild OSA and moderate OSA ( P &lt; .05) and between mild OSA and severe OSA ( P &lt; .001). In the univariate quantile regression analysis of IGF-1, there was a negative relationship between IGF-1 and IL-5 ( P &lt; .001). IGF-1 was positively correlated with age, height, and minimum oxygen saturation. Furthermore, there was a negative correlation between the IGF-1 level and the severity of OSA. Quantile regression analysis on the multivariable analysis of the IGF-1 association showed that height, sex, and severity of OSA played important roles in affecting IGF-1 levels. Conclusion: High IL-5 levels may lead to the low secretion of growth hormone level (IGF-1) in children, thus affecting growth and development.

Severity of lumbar spinal stenosis does not impact responsiveness to exercise-based rehabilitation.

Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, there are no studies supporting the premise that individuals with more severe stenosis respond poorly to conservative management. The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient goals in response to an exercise-based physical therapy program across 1,806 individuals with mild, moderate, or severe lumbar spine stenosis. Participants demonstrated significant improvements in all variables of interest (p<0.001), and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across mild, moderate, or severe stenosis groups for any outcome (p>0.546). Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with severe stenosis compared to their milder counterparts. Future research is needed to evaluate long term durability and cost effectiveness of rehabilitation in this patient population.

Role of Carcinoembryonic Antigen in Severity Assessment and Mortality Prediction in COVID-19 Patients.

Background Early risk stratification of COVID-19 may yield a better prognosisby tailoring effective treatment strategies. Recent studies have identified that elevated carcinoembryonic antigen (CEA) has prognostic value in terms of disease severity and mortality in patients with pneumonia. This study aims to explore the potential of CEA as a marker for both severity assessment and mortality prediction in COVID-19 patients. Methods From August 2020 to October 2021, we conducted this observational study in which patients who tested positive for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) or had high-resolution computed tomography (HRCT) chest suggestive of COVID-19 were includedon day 0 of their admission to the COVID unit. Patients were classified into mild, moderate, severe, and critical according to the World Health Organization (WHO) guidelines. Blood samples were collected for complete blood count (CBC), C-reactive protein (CRP), ferritin, and CEA on days 0, 3, 7, and 14 of admission. The patient's profile was used to obtain lactate dehydrogenase (LDH), D-dimer, and HRCT scores [based on COVID-19 reporting and data system (CO-RADS) grade]. We used receiver operating characteristic (ROC) curves with Youden's index to find the initial (day 0) critical values of CEA for each of mild, moderate, severe, and critical COVID-19. The Kaplan-Meier survival curve was used to predict mortality with the best initial(day 0) cut-off value of CEA. Results Among 75 patients in this study, 15, 20, 19, and 21 were in the mild, moderate, severe, and critical groups, respectively;most were male (68%), and mortality was 18 (24%). Spearman's rank correlation test demonstrates a strong correlation between COVID-19 severity and changes in CEA. In the ROC curves, the area under the curve (AUC) value of CEA was higher among markers in all classifications except for mild to moderate disease. The AUC and critical values of CEA were as follows: for mild to moderate (0.948), 2.5 ng/ml; moderate to severe (1.000), 6.02 ng/ml; and severe to critical (0.769), 11.75 ng/ml. The survival curve shows the best initial cut-off values for mortality outcomes: CEA ≥7.15, CRP ≥81.52, ferritin ≥680.68, lymphocyte percentage ≤7.5, and neutrophil lymphocyte ratio ≥12.7. Conclusions The initial levels of CEA can serve as markersfor severity assessment and mortality outcome prediction of COVID-19.

Severe Mitral Regurgitation in Paradoxical Low-Flow Low-Gradient Severe Aortic Stenosis.

Patients with paradoxical low-flow, low-gradient severe aortic stenosis (LFLGAS) exhibit low transvalvular flow rate (Q), while maintaining preserved left ventricular ejection fraction (LVEF). Concomitant severe mitral regurgitation (MR) contributes to the low flow state, adding complexity to diagnosis and management. This study aimed to examine the impact of severe MR on outcomes in paradoxical LFLGAS. Data from an institutional echo database identified 1,189 patients with adjudicated severe aortic stenosis (AVA≤1.0 cm 2 ), low transaortic gradients (mean gradient<40 mmHg), preserved LVEF (≥50%), and low flow rate (Q≤210 ml/sec), to confirm paradoxical LFLGAS. Subgroups were based on MR severity (severe and non-severe). Clinical outcomes included all-cause mortality, aortic valve replacement (AVR), heart failure hospitalizations, and a composite outcome. In the severe MR group (n=80), patients had lower flow rates, increased LV dimensions and a more eccentric hypertrophy pattern compared to non-severe MR (n=1,109). Over a median 5-year follow-up, severe MR correlated with higher all-cause mortality (p=0.02) and AVR rates (p=0.012). After adjustment, severe MR was independently associated with increased all-cause mortality risk (HR=1.43, p=0.011) and composite outcome (HR=1.64, p<0.001). AVR significantly reduced mortality at every MR degree, with the most substantial impact in severe MR (HR=0.18, p<0.001). Propensity-adjusted models demonstrated a stronger AVR impact with increasing MR degree (p-for-interaction=0.044). Severe MR in paradoxical LFLGAS is associated with adverse outcomes and distinctive LV remodeling. Aortic valve replacement improves survival across all MR grades, with greater impact in severe MR.

Effectiveness of 0.3 % nifedipine gel combined with 2.0 % lidocaine and BTA 80 U in treatment of chronic anal fissure. Pilot randomized study. Preliminary results

AIM: to improve the results of chronic anal fissure treatment. PATIENTS AND METHODS: the study included 22 patients randomized by random numbers generation method into 2 groups. Eleven patients were included in main group and were treated with 0.3 % nifedipine + 2.0 % lidocaine gel, 11 patients of the control group received injections of botulinum toxin A into the internal anal sphincter at a dose of 80 U (BTA 80). RESULTS: by day 30, there was a decrease of maximal resting pressure in anal canal (MRPAC) in both the main and control groups [p = 0.015 and p = 0.004, respectively] and the average resting pressure in anal canal (ARPAC) [p = 0.01 and p = 0.02, respectively]. There was no difference between the groups in pain severity both after stool and during the day (p = 0.5 and p = 0.6, respectively). On day 60, the defect was epithelized in 6/11 (54.6 %) patients of the study group and in 9/11 (81.8 %) patients of the BTA 80 group [p = 0.36], respectively. The reason of treatment failure in 4/11 (36.4 %) patients of the main group and 2/11 (18.2 %) patients of the control group was a preserved internal sphincter spasm. It was found that these patients used a lower amount of the drug product — 2.2 (1.8; 2.5) mg/day compared to 2.4 (1.9; 2.7) mg/day in other patients. On the day 30 after surgical treatment, complaints about gas incontinence were registered in 1/11 (9.1 %) patients of the main group and 1/11 (9.1 %) patients of the control group [p = 1]. Such a complication as external hemorrhoid thrombosis occurred only in 1/11 (9.1 %) patients in the BTA 80 group [p = 0.87]. CONCLUSION: the study results show that gel containing 0.3 % nifedipine and 2 % lidocaine produces an effect on the tone of the internal sphincter comparable to BTA. However, the lack of accurate dosage of the drug product and/or low patient compliance reduce the effectiveness of treatment and make the use of BTA preferable for medical relaxation of the internal sphincter.

Estimation of Serum Malondialdehyde (a Marker of Oxidative Stress) as a Predictive Biomarker for the Severity of Coronary Artery Disease (CAD) and Cardiovascular Outcomes.

Background Coronary artery disease (CAD) is influenced by oxidative stress, which is a critical yet often overlooked factor in disease progression. While traditional biomarkers such as cholesterol levels and blood pressure are commonly used, they do not fully capture oxidative damage. Malondialdehyde (MDA), a byproduct of lipid peroxidation, offers additional insights into oxidative stress and CAD severity. Unlike conventional markers, such as low-density lipoprotein (LDL) cholesterol, which primarily reflects lipid levels, and high-sensitivity C-reactive protein (hs-CRP), which indicates inflammation, MDA directly measures oxidative damage. This makes MDA a potentially valuable complement to these traditional biomarkers, providing a more nuanced understanding of CAD risk. Despite its potential, the role of MDA in clinical assessments remains underexplored. This study aims to address this gap by evaluating MDA's effectiveness as a complementary biomarker, enhancing the assessment of CAD risk and progression beyond what is provided by existing markers. Objective This study aims to assess serum MDA levels in relation to CAD severity to explore its potential as a non-invasive biomarker for disease progression and cardiovascular outcomes. Methodology This cross-sectional study was conducted at the Department of Cardiology, Mardan Medical Complex Teaching Hospital, Pakistan, from June 2023 to May 2024. Patients were divided into different groups with varying severity of CAD. The one-way ANOVA was used to assess differences among groups, and Pearson's correlation coefficient explored relationships between MDA and all study variables. Simple linear regression analyzed associations between MDA levels, patient groups, and other variables, controlling for covariates. MDA's potential as a predictive biomarker was assessed through ROC curve analysis, with statistical significance set at a p-value < 0.05. Results A total of 133 patients were included in the study, categorized based on CAD severity into mild (n=71), moderate (n=39), and severe (n=23) groups. Serum MDA levels significantly increased with the severity of CAD. Specifically, MDA levels were 116.61 ± 41.95in the mild group, 253.45 ± 180.29in the moderate group, and peaked at 459.91 ± 149.80in the severe group. The differences in MDA levels among these groups were statistically significant (p < 0.01), supporting the association between higher MDA levels and increased CAD severity. Factors such as BMI, heart rate, blood pressure, and smoking status also significantly influenced MDA levels. Receiver operating characteristic (ROC) curve analysis demonstrated high diagnostic accuracy of MDA for assessing CAD severity, with area under the curve (AUC) values of 0.81 for moderate and 0.94 for severe CAD. Comorbid conditions such as diabetes mellitus were associated with elevated MDA levels. Conclusion Elevated serum MDA serves as a reliable, non-invasive biomarker for predicting CAD severity, with potential applications in clinical risk assessment and management strategies. By identifying patients with elevated oxidative stress early, clinicians can implement timely interventions, potentially slowing disease progression and improving outcomes.

Neonatal hyperinsulinism: a retrospective study of presentation and management in a tertiary neonatal intensive care unit in the UK

ObjectiveReports of hyperinsulinism typically focus on infants managed by highly specialised services. However, neonates with hyperinsulinism are initially managed by neonatologists and often not referred to specialists. This study aimed...

Implications of Myocardial Strain in Primary Mitral Regurgitation - A Cardiovascular Magnetic Resonance Study.

Chronic primary mitral regurgitation (MR) results in progressive left ventricular (LV) remodeling. Abnormal myocardial deformation (strain) can be present despite preserved ejection fraction. Cardiovascular magnetic resonance (CMR) feature-tracking techniques allow assessment of global longitudinal strain (GLS) from routine cine-images. The aim of this study was to evaluate the prognostic value of CMR feature-tracking derived GLS in patients with primary MR. Consecutive patients undergoing CMR for chronic MR from January 2012 to June 2018 were enrolled. Patient with LV ejection fraction <50% were excluded. The composite primary outcome aiming to detect decompensation related to MR comprised of 1) referral for mitral surgery due to symptoms or LV systolic dysfunction or 2) cardiovascular death. The secondary outcome was all-cause death. A total of 422 patients were followed for a median of 2.7 years, the primary endpoint was met in 93 patients (34 patients reported symptoms at baseline). On multivariable analysis, GLS≥ -16.6% was associated with primary outcome (hazard ratio 1.90,p=0.01). In moderate MR cohort, patient with GLS≥ -16.6% had worse event-free survival while no significant different in mild or severe MR groups. GLS≥ -16.0% remained associated with all-cause death after adjusting for other covariates including the MR severity (hazard ratio 2.24,p=0.02). In primary MR patients with preserved systolic function, GLS was associated with our composite outcomes and all-cause death. GLS may serve as a marker of cardiac dysfunction in primary MR patients with preserved systolic function allowing identification of patients likely to decompensate during observation.

A latent profile analysis on adolescents' Non-Suicidal Self-Injury related to intrapersonal and interpersonal factors

Non-suicidal self-injury (NSSI) among adolescents continues to be a significant public health concern worldwide. A recent systematic review and meta-analysis found that the global prevalence of NSSI in adolescents aged 12–18 years was 17.2%, with higher rates reported among females (19.7%) than males (14.8%). This behavior has been linked to several negative outcomes, such as depression, anxiety, substance abuse, and suicidal ideation. The present study aimed to classify adolescents based on intrapersonal and interpersonal factors associated with NSSI proposed in Nock’s (2009) integrated model of NSSI, to identify distinct clusters targeting specific risk factors. This encompassed negative cognition, emotional vulnerability, poor coping skill, peer-victimization, family adaptability, and perceived stress. A total of 881 adolescents aged 11–16 years in South Korea completed self-reported questionnaires on automatic thoughts, depression, emotional regulation, peer victimization, family adaptability and perceived stress. Latent profile analysis (LPA) revealed three distinct classes: “the severe group”, “the moderate group”, “the mild group”. Class 3 (“severe group”: N = 127) exhibited greater severity related to NSSI, including negative cognition, emotional vulnerability, poor coping skills, peer victimization, and perceived stress, with weaker levels of factors that can prevent NSSI compared to class 1 (“mild group”: N = 416) and class 2 (“moderated group”: N = 338). The present study emphasizes the importance of considering both intrapersonal (e.g., negative automatic thoughts & emotional dysregulation) and interpersonal factors (i.e., peer victimization) when understanding NSSI - among adolescents. These findings can be utilized to develop interventions aimed at reducing the prevalence and severity of NSSI among adolescents.

Modified Tal Score as a Predictor of Outcome in Bronchiolitis: A Cross-Sectional Study in Nepal.

Introduction Bronchiolitis is a leading cause of respiratory distress and hospitalizations among infants and young children worldwide. Despite its prevalence, predicting the severity and outcomes of bronchiolitis remains challenging. Standardized criteria for severity assessment are essential for improving patient care and resource allocation. The modified Tal score is a reliable tool for assessing the severity of bronchiolitis. This study examines the relationship between the modified Tal score at presentation and key clinical outcomes in children with bronchiolitis. Methods This cross-sectional study classified children with bronchiolitis into mild, moderate, and severe groups using the modified Tal score at presentation. Patients were followed to record the length of hospital stay, duration of oxygen therapy, and the need for pediatric intensive care unit (PICU) or escalated care. Results Of the 121 children analyzed, the majority (71.9%) were aged three to 11 months, with a mean age of 9.09 months, and 73.6% were male. Oxygen supplementation was required by 60.3% of participants, 10.7% needed PICU admission, and 2.5% required escalated care. The mean duration of oxygen therapy was significantly longer in the severe group compared to the mild and moderate groups (p<0.001). Hospital stays also increased with severity (p<0.001). Linear regression showed that each unit increase in the modified Tal score resulted in a 0.746-day rise in hospital stay, a 10.19-hour increase in oxygen requirement, and a 0.35-day increase in PICU stay (all p<0.001). The score accounted for 66.1% of the variability in hospital stay, 63.0% in oxygen requirement, and 53.3% in PICU stay, but only 9.5% in escalated care. Conclusion A higher modified Tal score at admission was associated with prolonged hospitalization, increased oxygen requirement duration, and greater need for PICU admission in bronchiolitis. However, the modified Tal score was not a strong determinant of the requirement for escalated care.

Anti-Inflammatory Cytokine Profiles in Thrombotic Thrombocytopenic Purpura-Differences Compared to COVID-19.

Thromboinflammation/immunothrombosis plays a role in several diseases including thrombotic thrombocytopenic purpura (TTP) and COVID-19. Unlike the extensive research that has been conducted on COVID-19 cytokine storms, the baseline and acute phase cytokine profiles of TTP are poorly characterized. Moreover, we compared the cytokine profiles of TTP and COVID-19 to identify the disease-specific/general characteristics of thromboinflammation/immunothrombosis. Plasma concentrations of 33 soluble mediators (SMs: cytokines, chemokines, soluble receptors, and growth factors) were measured by multiplex bead-based LEGENDplex™ immunoassay from 32 COVID-19 patients (32 non-vaccinated patients in three severity groups), 32 TTP patients (remission/acute phase pairs of 16 patients), and 15 control samples. Mainly, the levels of innate immunity-related SMs changed in both diseases. In TTP, ten SMs decreased in both remission and acute phases compared to the control, one decreased, and two increased only in the acute phase compared to remission, indicating mostly anti-inflammatory changes. In COVID-19, ten pro-inflammatory SMs increased, whereas one decreased with increasing severity compared to the control. In severe COVID-19, sixteen SMs exceeded acute TTP levels, with only one higher in TTP. PCA identified CXCL10, IL-1RA, and VEGF as the main discriminators among their cytokine profiles. The innate immune response is altered in both diseases. The cytokine profile of TTP suggests a distinct pathomechanism from COVID-19 and supports referring to TTP as thromboinflammatory rather than immunothrombotic, emphasizing thrombosis over inflammation as the driving force of the acute phase.