Patients In Severe Group Research Articles

Analysis of hemodynamics and outcomes of pregnant women with congenital heart disease-pulmonary arterial hypertension

Objective: To observe and analysis the changes of hemodynamic parameters and outcomes of pregnant women combined with congenital heart disease-pulmonary arterial hypertension (CHD-PAH). Methods: A prospective analysis of hemodynamic parameters of patients combined with CHD-PAH in Beijing Anzhen Hospital from January 2015 to December 2017 was carried out. Total 99 cases were divided into 4 groups based on systolic pulmonary arterial pressure (SPAP): mild group (SPAP 25-49 mmHg, 1 mmHg=0.133 kPa), moderate group (SPAP 50-79 mmHg), severe group (SPAP≥80 mmHg) and Eisenmenger syndrome group. Results: (1) SPAP of all groups increased during gestation, and the growth rates had no statistical differences (P>0.05). The SPAP in each group decreased after termination but was still higher than the early pregnancy's SPAP. (2) CHD-PAH patients in moderate [2 cm(2) (1-5 cm(2)), 1.0 cm (-2.0 - 2.0 cm)], severe [5 cm(2) (3-9 cm(2)), -3.5 cm (-6.0 - 1.0 cm)] or Eisenmenger syndrome [5 cm(2) (3-6 cm(2)), -1.0 cm (-5.5 - 2.0 cm)] group had larger right atrium area and smaller left ventricular end-diastolic diameter than patients in mild group [1 cm(2) (-1 - 4 cm(2)), 3.0 cm (1.0-6.0 cm)], the differences were statistically significant (all P<0.05). (3) Each group's SPAP/brachial arterial-systolic (BSAP) pressure continously increased during gestation. The SPAP/BSAP only decreased in patients in mild or moderate group after termination. However, the SPAP/BSAP kept rising in patients in severe group or Eisenmenger syndrome group. (4) CHD-PAH patients in severe or Eisenmenger syndrome group had worse cardiac function, in which the rates of Ⅲ-Ⅳ cardiac function were 61%(14/23) and 12/17, compared with patients in mild [8% (2/26)] and moderate [12%(4/33)] group, the differences were statistically significant (all P<0.05). (5) The rates of medicine treatment, cesarean section were higher, the weeks of gestational termination were earlier and the newborn's weights were lower in patients in severe or Eisenmenger syndrome group, the differences were statistically significant (all P<0.05). Conclusions: (1) SPAP keeps rising during gestation in all patients with CHD-PAH, and the SPAP decreases after termination but it's still higher than the early pregnancy's SPAP. This suggests that pregnancy would exacerbate these patients' heart problems, the risk should be fully considered before and during pregnancy. (2) Patients with severe CHD-PAH or combined with Eisenmenger syndrome have lager right atrium area, smaller left ventricular end-diastolic diameter, worse cardiac function, and bigger changes of hemodynamic, the incidence of adverse outcomes of mothers and children is also high, pregnancy should be avoided.

Choice of the Acetabular Component Placement in Dysplastic Hip Patients

Abstract Total hip arthroplasty (THA) in patients with hip dysplasia is a challenging surgical operation. Many orthopedic surgeons concur that the anatomical placement of the acetabular components of endoprostheses (AC-EPs) during THA yields the best result. However, there are advocates of the high rotation center of the hip joint after replacement surgery. In our study, we compared the outcomes of THA based on the placement of acetabular cups to identify the most favorable site for AC-EPs in patients with varying grades of dysplastic osteoarthritis. Our study included 88 patients with dysplastic hip osteoarthritis who underwent 106 THAs during a three-year period using cementless fixation endoprostheses. Functional results were assessed by Merle d’Aubigne and Postel’s method and by instrumental gait analysis (IGA). Gait deviation index was calculated based on IGA to compare results in different acetabular component placement groups. Functional assessment of patients by Merle d’Aubigne and Postel’s grading method and IGA showed no significant difference in results due to the placement of the acetabular component. Most complications were found in the severe dysplasia patients group with the anatomical placement of the AC-EP. The appropriate location of cementless acetabular cups during THA in dysplastic hips depends on the grade of dysplasia, expected elongation of the leg, and the potential for adequate bone coverage for the AC-EP. In cases of severe dysplasia, the placement of the AC-EP in the secondary socket can provide a good functional outcome and reduce the risk of complications.

Mahidol Scoring for Assessing Various Grades of β Thalassemia Intermedia

To determine the effectiveness of Mahidol Scoring for assessing various grades of β thalassemia intermedia. Cross-sectional study. Fatima Memorial Hospital, Shadman, Lahore, from August 2016 to August 2017. A total of 150 patients, both inpatient and outpatient diagnosed as thalassaemia intermedia fulfilling inclusion criteria, were enrolled, interviewed and examined after an informed consent. All patients were assessed by using Mahidol Scoring system. Their scores were documented on a predesigned evaluation porforma. Patients were labelled as mild, moderate or severe diseased. In a total of 150 patients, 88 (58.7%) were males and 62 (41.3%) were females. Using Mahidol Scoring, 88 (58.7%) were labelled as mild, 53 (35.3%) as moderate and 9 (6%) as severe diseased. Patient who were labelled as mild diseased according to Mahidol Scoring, had no blood transfusions and showed good response to hydroxyurea. Patients with moderate score, were infrequently transfused and showed variable response to hydroxyurea. Patients in severe group received first transfusion at an early age, maintained lower Hb levels, showed growth retardation, splenomegaly, and had poor response to hydroxyurea. Mahidol Scoring system is an easy, safe and effective way for classification of thalassaemia Intermedia severity. The grades according to Mahidol Scoring system will aid in the management of patients as the score can be quickly calculated, and can assist the clinician in an initial evaluation for disease severity in patients of thalassaemia intermedia.

Clinical influence of maternal serum homocysteine, folate and vitamin B12 in the development of pre-eclampsia

Abstract Background: The aim of this study was to investigate the correlation between maternal serum homocysteine (Hcy), folate, vitamin B12 (VitB12) and the development of pre-eclampsia (PE). Methods: Seventy-eight normal pregnant women (without hypertension and proteinuria during their pregnancy (control group)), 66 cases of gestational hypertension (GH group) and 82 cases of pre-eclampsia (PE group, with 56 cases of mild disease and 26 cases of severe disease) were include in this study. The maternal serum Hcy, folate and VitB12 level of the included cases were examined between 11 to 13 weeks gestation and compared between each group. Results: The serum levels of VitB12 were significantly different between the control, GH and PE groups (p&lt;0.05). The serum levels of Hcy in the PE group were significantly higher than those of the control group (p&lt;0.05). However, the serum levels of folate in the PE group were significantly lower than those of control group (p&lt;0.05). Significant statistical differences in the maternal serum Hcy and folate were found between mild and severe PE patient groups (p&lt;0.05). A significant correlation was found between maternal serum Hcy and VitB12 (r=-0.34, p=0.001). Conclusion: Hcy, folate and VitB12 may play an important role in the development of PE and could be potential serological biomarkers for early PE diagnosis.

The clinical study of five-step sequential method for the treatment of hemorrhagic radiation cystitis

Objective To investigate the clinical effect of five-step sequential method for hemorrhagic radiation cystitis. Methods From April 2015 to April 2018, 512 cases of hemorrhagic radiation cystitis patients in 6 provincial tumor hospital were retrospectively analyzed. 12 cases were male patients, and 497 cases were female. Patients' average age was (60.1 ±8.2) years (53-71 years). Hematuria appeared in 2.9 years on average after radiotherapy(ranged 0.5 to 13 years). According to the severity of hematuria, 480 patients were classified as mild and 32 patients as severe. The step 1 was drug conservative symptomatic treatment. Thrombin solution or sodium hyaluronate was used for bladder perfusion in step 2.The step 3 was transurethral electrocoagulation.The step 4 was interventional embolization. The step 5 was hyperbaric oxygen therapy. Mild patients were treated from the first step, and the severe patients were treated from step 3, and combined with step 1. Overactive bladder symptom score (OABSS) was used to assess the improvement of patients' symptoms. Results No obvious complications occurred in step 1, 2, 3, 5. Mild hip pain occurred at step 4. Recurrent hemorrhage rate were 6.7%(2/30)in mild patients group and 10.5%(2/19)in severe respectively in step 4. The total effective rate of step 1 in mild patients group was 65.2%(313/480), step 1+ 2 was 84.2%(404/480), step 1+ 2+ 3 was 95.6% (459/480), step 1+ 2+ 3+ 4 was 98.3% (472/480), and step 1+ 2+ 3+ 4 + 5 was 100%(480/480). The effective rate of step 3+ 1 treatment was 59.4%(19/32)in severe patients group, step 3+ 1+ 4 was 68.8%(22/32), and step 3+ 1+ 4+ 5 was 100%(32/32). The OABSS scores of mild and severe patients decreased after treatment(P<0.01). Conclusion Five-step sequential therapy could be an effective method for the treatment of hemorrhagic radiation cystitis. Key words: Radioactive cystitis; Transurethral electrocoagulation; Intervene embolize therapy; Hyperbaric oxygen

Graph theory analysis reveals how sickle cell disease impacts neural networks of patients with more severe disease.

Sickle cell disease (SCD) is a hereditary blood disorder associated with many life-threatening comorbidities including cerebral stroke and chronic pain. The long-term effects of this disease may therefore affect the global brain network which is not clearly understood. We performed graph theory analysis of functional networks using non-invasive fMRI and high resolution EEG on thirty-one SCD patients and sixteen healthy controls. Resting state data were analyzed to determine differences between controls and patients with less severe and more severe sickle cell related pain. fMRI results showed that patients with higher pain severity had lower clustering coefficients and local efficiency. The neural network of the more severe patient group behaved like a random network when performing a targeted attack network analysis. EEG results showed the beta1 band had similar results to fMRI resting state data. Our data show that SCD affects the brain on a global level and that graph theory analysis can differentiate between patients with different levels of pain severity.

Utility of nintedanib for severe idiopathic pulmonary fibrosis: a single-center retrospective study.

IntroductionThe INPULSIS-ON trial demonstrated that nintedanib reduced decline in forced vital capacity (FVC) and low pulmonary function (%FVC < 50%) of patients with idiopathic pulmonary fibrosis (IPF). However, there is no sufficient evidence in real world.ObjectivesReveal the utility and adverse events of nintedanib for severe IPF patients.MethodsThis was a single-center retrospective study. Patients who met the eligibility criteria of the INPULSIS trial (%FVC ≥ 50%; %DLCO [diffusing capacity of the lung carbon monoxide % predicted] ≥ 30%) were classified as Mild to Moderate Group (n = 34); patients who did not meet the criteria were classified as Severe Group (n=17).ResultsThe body mass index (24.7 ± 3.4 vs 22.4 ± 3.6 kg/m2; P = 0.021) were significantly low in Severe Group. Main adverse events (diarrhea, nausea, liver disorder, and acute exacerbation) tended to be more in Severe Group than in Mild to Moderate Group; however, the difference was not significant (P = 0.76, 0.14, 0.18, and 0.67, respectively). The continuation rates over 12 months tended to be higher in Mild to Moderate Group than in Severe Group (77% vs 44%; P = 0.027). Log-rank test revealed that the prognosis was significantly better in Mild to Moderate Group than in Severe Group (P = 0.014). In the Severe Group, patients who were able to continue nintedanib for more than 3 months had significantly better prognosis compared to those who could not (P = 0.007).ConclusionThe benefit from nintedanib was reduced in patients in Severe Group when compared to those in Mild to Moderate Group; however, the prognosis is expected to improve with control of side effects and long-term administration. It is more important to control the side effects in Severe Group.

Correlation between coronary artery lesion quantitative score and OSAHS and relative risk factors.

The purpose of this study was to investigate the relationship of obstructive sleep apnea hypopnea syndrome (OSAHS) with coronary artery lesion quantitative score Syntax Score (SX score) and risk factors for coronary heart disease (CHD). A total of 115 patients with OSAHS admitted to the Department of Cardiology in our hospital from January 2011 to June 2015 were selected. Philips Respironics Alice 5 Polysomnography was used for sleep monitoring. The patients were divided into mild group (n=32), moderate group (n=36) and severe group (n=47) according to apnea hypopnea index (AHI). Coronary angiography was performed for the patients, and SX score was calculated. Fasting venous blood was extracted from all patients with OSAHS and sent for detection of blood routine, coagulation, liver and kidney function, blood lipid and other indexes, and all patients received color Doppler echocardiography. The body weight and body mass index (BMI) of patients with OSAHS in severe group were higher than those in the mild group and moderate group (p<0.05). The content of fibrinogen (FIB) of patients in severe group was higher than that in mild group (p<0.01). The levels of total cholesterol (TC) (p<0.05), blood uric acid (p<0.05), and serum creatinine (p<0.01) of patients in the severe group were significantly higher than those in mild group and moderate group, but there were no differences between mild group and moderate group (p>0.05). Echocardiography suggested that the left atrium diameter 1 (LAD) and pulmonary artery pressure (PAP) of patients in severe group were larger than those in the mild group and moderate group (p<0.01), and the right ventricle anteroposterior diameter (RVD) in the mild group was smaller than those in the moderate group (p<0.05) and severe group (p<0.01). The score of patients with OSAHS in the severe group was higher than those in the mild group and moderate group (p<0.01), and SX score was increased with AHI (r=0.416, p<0.01). Logistic regression analysis showed that AHI and SX score could not be used as indicators to judge the prognosis of patients. There is a positive correlation between AHI and SX score in patients with OSAHS, indicating that with the aggravation of respiratory sleep disorder, SX score is increased significantly and the severity of coronary artery lesion is increased accordingly.

Major Depression and the Degree of Suicidality: Results of the European Group for the Study of Resistant Depression (GSRD).

BackgroundThis European multicenter study aimed to elucidate suicidality in major depressive disorder. Previous surveys suggest a prevalence of suicidality in major depressive disorder of ≥50%, but little is known about the association of different degrees of suicidality with socio-demographic, psychosocial, and clinical characteristics.MethodsWe stratified 1410 major depressive disorder patients into 3 categories of suicidality based on the Hamilton Rating Scale for Depression item 3 (suicidality) ratings (0=no suicidality; 1–2=mild/moderate suicidality; 3–4=severe suicidality). Chi-squared tests, analyses of covariance, and Spearman correlation analyses were applied for the data analyses.ResultsThe prevalence rate of suicidality in major depressive disorder amounted to 46.67% (Hamilton Rating Scale for Depression item 3 score ≥1). 53.33% were allocated into the no, 38.44% into the mild/moderate, and 8.23% into the severe suicidality patient group. Due to the stratification of our major depressive disorder patient sample according to different levels of suicidality, we identified some socio-demographic, psychosocial, and clinical variables differentiating from the patient group without suicidality already in presence of mild/moderate suicidality (depressive symptom severity, treatment resistance, psychotic features, add-on medications in general), whereas others separated only when severe suicidality was manifest (inpatient treatment, augmentation with antipsychotics and benzodiazepines, melancholic features, somatic comorbidities).ConclusionsAs even mild/moderate suicidality is associated with a failure of achieving treatment response, adequate recognition of this condition should be ensured in the clinical practice.

Cardiotrophin-1 and leptin as cardiovascular risk markers in male patients with obstructive sleep apnea syndrome.

IntroductionElevated cardiotrophin-1 (CT-1) and leptin levels are important risk factors for cardiovascular diseases (CVDs). Obstructive sleep apnea syndrome (OSAS) has also been reported to increase this risk. The aim of this study is to evaluate serum concentrations of CT-1 and leptin in patients with OSAS and whether there is a possible association between CT-1, leptin and OSAS severity.Material and methodsFifty newly diagnosed OSAS patients and thirty nonapneic snoring subjects participated in this study. Fasting serum lipid profile markers were evaluated. The measurements of serum CT-1 and leptin levels were carried out using human ELISA kits.ResultsSignificant differences were found in the serum CT-1 and leptin levels between the two groups. Serum median CT-1 levels in patient and control groups, respectively, were 19.47; 8.23 pg/ml and leptin levels were 2.07; 1.29 ng/ml (p < 0.001). In the severe patient group, serum median CT-1 level was statistically significantly higher than the median level in the mild/moderate group. There was no correlation between patients’ leptin and lipid profile parameters and CT-1 concentrations were not associated with triglyceride, cholesterol or LDL cholesterol levels except HDL cholesterol: CT-1 levels were positively correlated with HDL levels (p = 0.02).ConclusionsBoth CT-1 and leptin were significantly elevated in the patient group. Furthermore, CT-1 and leptin were associated with OSAS and CT-1 was associated with the disease severity.

Can we predict severity of acute cholecystitis at admission?

Background and Objective:Acute cholecystitis (AC) is an inflammation of the gallbladder. Tokyo Guidelines (TGs) for the diagnosis of AC classified this condition according to severity as mild, moderate and severe. Therapeutic intervention regulated according to the type of severity. This study aimed to determine laboratory parameters that predict the severity of AC at hospital admission.Methods:One-hundred and ten patients with AC were retrospectively reviewed. These patients were treated in our department of surgery within a one-year period (2015–2016). Three patient groups were formed depending on the severity of Acute cholecystitis.Results:The baseline mean values for white blood cell count (WBC), blood urea nitrogen (BUN), creatinine and international normalized ratio (INR) were higher in the severe patient group at a significant level compared to the mild patient group. The WBC level was also significantly higher in the moderate group than the mild group. However, none of the laboratory parameters differentiated the severe group from the moderate group.Conclusion:Acute cholecystitis patients with high WBC, BUN, creatinine and INR levels at admission should be referred to an advanced care center for management.

Impact of Nutritional State on Critical Limb Ischemia Early Outcomes (DENUCRITICC Study)

Despite current progress, the prognosis of critical limb ischemia (CLI) remains poor. The ageing of the population, the increasing prevalence of diabetes mellitus, and the stability of tobacco use will increase the prevalence of CLI. CLI patients have risk factors for malnutrition, and the impact of malnutrition on morbidity and mortality has been demonstrated in the general population. However, we have little information on the consequences of undernutrition in the CLI population. The aim of this study is to assess the impact of malnutrition on the early outcomes in CLI patients. This is a double-center prospective study that included all consecutive hospitalized patients with CLI. All patients were screened for malnutrition and divided into 2 groups: severe malnourished patients (group A) and moderate malnourished and well-nourished (group B). This distribution was based on age-indexed clinical and biological data and the patient's general condition: the Nutritional Risk Index for patients younger than 75years, the Mini Nutritional Assessment, or the Geriatric Nutritional Risk Index for those older than 75years. The primary end point was defined as the rate of 30-day death. Outcomes were compared in a univariate analysis. Stepwise logistic regression was used for the multivariate analysis. Variables with a P value <0.2 in the univariate analysis were introduced in the multivariate model. We included 106 patients. The prevalence of malnutrition was 75.5%, divided into moderate malnutrition (51.9%) and severe malnutrition (23.6%). Six patients (24%) died in group A compared with 8 in group B (4.9%) (P=0.01). By univariate analysis, severe malnutrition was the only factor associated with death at 30days. By stepwise logistic regression, severe malnutrition (odds ratio 6.1, 95% confidence interval 1.6-23.7, P=0.006) was found to be the significant risk factors for death at 30days. This study is the first to demonstrate prospectively the major importance of malnutrition in the early prognosis of CLI patients.

The association between toll-like receptor 7 single nucleotide polymorphisms and severity of hand, foot and mouth disease caused by enterovirus 71 infection

Objective To explore the association between toll-like receptor 7 (TLR7) single nucleotide polymorphisms (SNP) and susceptibility of hand, foot and mouth disease caused by enterovirus (EV)71 infection. Methods The genotype of SNP (rs179019 and rs3853839) was determined in 775 EV7l-infected cases (including 439 mild cases and 336 severe cases) and 748 healthy control cases with TaqMan assay. The difference of allele frequencies was compared. The difference of TLR7 mRNA expression in peripheral blood mononuclear cells (PBMCs) derived from different SNP genotype carriers was detected. PBMCs derived from different SNP genotype carriers were stimulated by imiquimod and the TLR7-specific interferon-α(IFN-α) and interleukin-6 (IL-6) secretions were detected. Logistic regression was used to analyze for genotype frequency. Results The frequencies of rs3853839 genotype CC and CG in female patients of severe group were significantly higher than mild group (rs3853839 GC: OR=0.36, 95%CI: 0.14-0.82, P=0.01; rs3853839 CC: OR=0.19, 95%CI: 0.11-0.69, P=0.01). In addition, the frequency of rs3853839 genotype C in severe male group was significantly higher compared with that in mild group (OR=0.35, 95%CI: 0.19-0.63, P=0.01). Female carriers with rs3853839 genotype CC had significantly lower TLR7 mRNA expression than genotype GC and GG (CC vs GG: P=0.005; CC vs GC: P=0.016). Male carriers with rs3853839 genotype C also had significantly lower TLR7 mRNA expression than genotype G (C vs G: P=0.004). After stimulation of imiquimod, the expression of IFN-α (CC vs GG, P=0.001; CC vs GC: P=0.026) and IL-6 productions (CC vs GG: P=0.001; CC vs GC: P=0.011) were significantly lower in female carriers with rs3853839 genotype CC. The same patterns were observed in male carriers with rs3853839 genotype CC (IFN-α: P=0.003; IL-6: P=0.018). Conclusions The rs3853839C allele is the risk factor of severe infection of EV71, which may be due to specific cytokine profiles in rs3853839C allele carriers in children. Key words: Toll-like receptor 7; Polymorphism, single nucleotide; Human enterovirus 71

Cognitive Function Among Obstructive Sleep Apnea Patients in North East Malaysia

IntroductionObstructive sleep apnea patients may develop deficits in the cognitive domains of attention, concentration, executive function, verbal and visuospatial memory, constructional abilities, and psychomotor functioning. As cognitive performance will improve with the treatment, early screening for cognitive dysfunction should be done to prevent further deterioration. ObjectiveWe aim to evaluate the cognitive function of obstructive sleep apnea patients by using the ‘Mini Mental State Examination’. MethodologyThis was a cross sectional study to evaluate the cognitive function of moderate and severe obstructive sleep apnea patients with age ranged from 18 to 60 old who attended our sleep clinic. These patients were confirmed to have moderate and severe obstructive sleep apnea by Type 1 polysomnography (attended full overnight study). The age, gender and ethnicity were noted and other relevant data such as weight, height, body mass index and apnea and hypopnoea index were recorded accordingly. The cognitive function was evaluated using validated Malay version of Mini Mental State Examination which measured 5 areas of cognitive functions comprising orientation, registration, attention and calculation, word recall and language abilities, and visuospatial. ResultsA total of 38 patients participated in this study. All 19 patients of moderate group and 14 patients of severe group had normal cognitive function while only 5 patients in severe group had mild cognitive function impairment. There was a statistically significant difference between the moderate group and severe group on cognitive performance (p value = 0.042). ConclusionsSevere obstructive sleep apnea patients may have impaired cognitive function. Mini Mental State Examination is useful in the screening of cognitive function of obstructive sleep apnea patients but in normal score, more sophisticated test batteries are required as it is unable to identify in ‘very minimal’ or ‘extremely severe’ cognitive dysfunction.

Evaluation of the subjective efficacy of nasal surgery.

This study aimed to evaluate subjective symptom changes in obstructive sleep apnoea hypopnea syndrome patients following nasal surgery, and to explore treatment efficacy in improving patient quality of life. Patients with nasal blockage accompanied by habitual snoring were stratified into four groups. Their subjective symptoms were evaluated before and after nasal surgery. There was a significant decrease in the nasal blockage symptom visual analogue scale, Epworth Sleepiness Scale, Snore Outcomes Survey, Spouse/Bed Partners Survey and Sino-Nasal Outcome Test 20 scores for all patients at six months after surgery. The visual analogue scale score for subjective olfactory function was significantly improved in the severe obstructive sleep apnoea hypopnea syndrome patient group. Nasal surgery can effectively improve the subjective symptoms of patients with simple snoring accompanied by nasal blockage and of patients with obstructive sleep apnoea hypopnea syndrome, thus improving their quality of life.

Reversible splenial lesion syndrome in children: Retrospective study and summary of case series

ObjectiveTo describe clinical features of reversible splenial lesion syndrome (RESLES) in children. MethodsRetrospectively analyzed clinical features of RESLES in children and compared differences between severe and non-severe group, classified by clinical global impression-scale; summarized clinical features of children with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) from case series. Results16 episodes of RESLES occurring in 15 Chinese children were analyzed, with 13 episodes having MERS and 3 episodes with epilepsy. 10 episodes were associated with various pathogens including rotavirus (n=5), adenovirus (n=1), influenza A (n=1), mycoplasma (n=2), and jejunum campylobacter (n=1). The common neurological symptoms included seizure, behavioral changes, altered consciousness and motor deterioration. The lesions of splenium of corpus callosum (SCC), extra-SCC (n=2) or extra-CC (n=1) showed T2-weight and FLAIR hyper-intensity, with the corresponding reduced diffusion. All had complete resolution of radiological changes except 1 episode with small residual. 8 episodes had EEG abnormalities, while elevated white blood count, increased hs-CRP, and hyponatremia were commonly revealed. 7 episodes were given steroid plus therapy, while 3 episodes were treated with antiepileptic drugs. Compared with non-severe group, the number of patients with altered consciousness, EEG abnormalities, motor deterioration, or extra-SCC lesions in severe group was significantly increased. The patients in severe group tended to need longer hospital stay interval. No case caused neurological sequelae, except 1 patient in severe group with recurrent episode and extra-CC lesions having intellectual disability (ID). Five pediatric MERS case series were summarized, including 67 episodes (40 male and 27 female; age ranging 10 m∼13y) from 65 patients, with 33 episodes in Japan, 27 in China, and 7 in Caucasian Australian children, and all patients have a good prognosis except 1 patient with ID (current study). ConclusionAlthough RESLES in children tend to be a good outcome, the prognosis of patient in severe group, especially with extra-CC lesions, might have neurological sequelae.

HMGB1 Is a Potential Biomarker for Severe Viral Hemorrhagic Fevers.

Hemorrhagic fever with renal syndrome (HFRS) and Crimean-Congo hemorrhagic fever (CCHF) are common representatives of viral hemorrhagic fevers still often neglected in some parts of the world. Infection with Dobrava or Puumala virus (HFRS) and Crimean-Congo hemorrhagic fever virus (CCHFV) can result in a mild, nonspecific febrile illness or as a severe disease with hemorrhaging and high fatality rate. An important factor in optimizing survival rate in patients with VHF is instant recognition of the severe form of the disease for which significant biomarkers need to be elucidated. To determine the prognostic value of High Mobility Group Box 1 (HMGB1) as a biomarker for disease severity, we tested acute serum samples of patients with HFRS or CCHF. Our results showed that HMGB1 levels are increased in patients with CCHFV, DOBV or PUUV infection. Above that, concentration of HMGB1 is higher in patients with severe disease progression when compared to the mild clinical course of the disease. Our results indicate that HMGB1 could be a useful prognostic biomarker for disease severity in PUUV and CCHFV infection, where the difference between the mild and severe patients group was highly significant. Even in patients with severe DOBV infection concentrations of HMGB1 were 2.8–times higher than in the mild group, but the difference was not statistically significant. Our results indicated HMGB1 as a potential biomarker for severe hemorrhagic fevers.

Multiplicity of infection and genetic diversity of Plasmodium falciparum isolates from patients with uncomplicated and severe malaria in Gezira State, Sudan.

BackgroundMultiplicity and genetic diversity of Plasmodium falciparum infection might play a role in determining the clinical outcome of malaria infection and could be a fair reflection of the disease transmission rate. This study investigated the genetic diversity of P. falciparum and multiplicity of infection in relation to the severity of malaria and age of patients in Gezira State, Sudan.MethodsA cross-sectional health facilities-based survey was conducted in Gezira State, Sudan in January 2012. A total of 140 P. falciparum malaria patients diagnosed with microscopy and confirmed using nested PCR were recruited and classified into uncomplicated malaria and severe malaria states according to the standard WHO criteria. DNA was extracted and MSP1 and MSP2 allelic families were determined using nested PCR.ResultsThe overall multiplicity of infection (MOI) was 2.25 and 2.30 and 2.15 for uncomplicated and severe malaria respectively. There were no statistically significant differences between uncomplicated and severe malaria (SM) patient groups in MOI with regard to MSP1, MSP2 and overall MOI (Mann-Whitney U-test; all P < 0.05). The predominant MSP1 allelic families were MAD20 for uncomplicated malaria and RO33 for severe malaria. The distribution of both FC27 and IC1/3D7 MSP2 allelic families were approximately the same across disease severity. One hundred and eleven P. falciparum isolates (81 %) consisted of multiple genotypes; 71/90 (78.9 %) in uncomplicated malaria and 40/50 (85.1 %) in severe malaria patient groups. Neither MSP1 nor MSP2 allelic families showed association with malaria severity. No statistically significant differences in multiplicity of infection were observed between different age groups.ConclusionIn this study the majority of P. falciparum isolates from uncomplicated and severe malaria patients consisted of multiple genotypes. Further molecular epidemiological studies delineate the link between P. falciparum genotype with the malaria phenotype in different regions are encouraged.

Evaluation of cochlear functions in children with Familial Mediterranean Fever

ObjectivesTo evaluate cochlear functions in patients with Familial Mediterranean Fever in relation to the disease severity score and treatment duration. Methods50 patients (4–18 years) who had been followed-up with the diagnosis of FMF and regularly receiving appropriate colchicine treatment and 39 healthy controls were included in the study. All the patients and controls were evaluated by audiologic evaluation, including high-frequency pure-tone audiometry and distortion product otoacoustic emission tests (DPOAE). The disease severity was determined by scoring system developed by Pras et al. ResultsFifty patients (52% female, 48% male; mean age12.2 ± 4.1 years) and 39 controls (58.9% female, 41.1% male, mean age 11.1 ± 3.4 years) were enrolled the study.The pure tone average of FMF patients was significantly higher than that of the control group at 500, 4000, and 8000 Hz frequencies. The patients' DPOAE signal values at 6 kHz, 8 kHz frequencies and SNR values at 8 kHz were significantly higher than control group.The patients' audiometry and DPOAE results were compared with the disease severity scores. Pure tone average was significantly higher in severe and moderate patient groups compared to the mild patient group at 2000 Hz frequency. DPOAE signal values showed statistically significant differences between the patient severity scores at 1.4 and 2.8 kHz frequencies. The mean colchicine treatment duration was found to be 5.1 ± 3.7 years. There were significant differences at 250 and 500 Hz frequencies when patients' audiometry results were compared with the treatment periods. ConclusionsFMF affects cochlear functions particularly at high frequencies.

Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients.

Obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis and alterations in glucose metabolism with increased risk for type 2 diabetes. The aim of the current study was to compare morning plasma cortisol levels and glucose metabolism parameters between moderate (apnea-hypopnea index (AHI): 15-30events/h) and severe OSA patients (AHI >30events/h), with respective controls. A total of 56 male OSA patients, 24 moderate (AHI=21.1±5.3) and 32 severe (AHI=49.7±18.1), underwent a full-night polysomnography, oral glucose tolerance test (OGTT), and measurement of morning plasma cortisol levels. These groups were compared to 20 matched subjects in a control group. Morning plasma cortisol levels were statistically lower in severe OSA group than in moderate OSA and control groups (303.7±93.5 vs. 423.9±145.1 vs. 417.5±99.8pmol/L, P<0.001). Significant negative correlations were found between morning plasma cortisol levels and AHI (r=-0.444, P=0.002), as well as oxygen desaturation index (r=-0.381, P=0.011). Fasting plasma glucose (5.0±0.5 vs. 5.4±0.7 vs. 4.9±0.6mmol/L, P=0.009) was higher in the severe OSA group compared to moderate OSA and controls. Homeostasis model assessment insulin resistance (HOMA-IR) was higher in the severe OSA group compared to moderate OSA and controls (4.6±3.7 vs. 2.7±2.0 and 2.2±1.8, respectively, P=0.006). In conclusion, our study showed that morning plasma cortisol levels measured at 8a.m. were significantly lower in severe OSA patients than those in moderate OSA group and controls. Morning plasma cortisol levels showed a negative correlation with AHI and oxygen desaturation index. Additionally, this study confirmed the evidence of glucose metabolism impairment in moderate and severe OSA patients, with more pronounced effect in the severe OSA patients group.