Severity Of Thedisease Research Articles

Stimulus-induced arousal with transient electroencephalographic improvement distinguishes nonictal from ictal generalized periodic discharges.

In the case of suspicion of nonconvulsive status epilepticus (NCSE), reactivity on electroencephalograms (EEGs) can provide valuable diagnostic information. Reactivity refers to responses to auditory or somatosensory stimulation, with changes in amplitude and frequency of background activity. Because of self-perpetuating processes and the failure of self-terminating mechanisms, status epilepticus is unlikely to cease when patients spontaneously move, and it cannot typically be stopped by external stimulation (i.e., auditory and tactile stimuli). The defining EEG characteristic of absence status epilepticus is the presence of bilateral, synchronous, symmetric, rhythmic paroxysmal activity that shows little or no reactivity to sensory stimulation. On the other hand, in metabolic/toxic or multifactorial encephalopathies, triphasic waves (TWs) are influenced by the level of vigilance. TWs may be transiently abolished when patients increase their level of alertness from a drowsy/lethargic state to a state of wakefulness. This reactivity is only observed when patients can be aroused by a somatosensory or auditory stimulus. This reactivity tends to disappear with increasing severity of the disease and in comatose patients. In patients without preexisting developmental and epileptic encephalopathy, this pattern of stimulus-induced wakefulness with transient improvement of the EEG is a major criterion in determining that the EEG patterns are not ictal. This criterion of reactivity on EEGs, beyond the classical clinical/EEG criteria of NCSE (Salzburg criteria), should now be systematically added.

Analysis of EEG characteristics in Alzheimer’s disease

Alzheimer’s disease (AD) brings a heavy burden to society and families because of the high misdiagnosis rate, prevalence rate, and disability rate. At present, the treatment of AD still faces great challenges. Early intervention can effectively delay the disease progression and improve the burden of symptom care. However, the key to early intervention is accurately identifying and assessing the disease. The examination is difficult to be widely used because of its high invasive cost. There is an urgent need for a simple, convenient, and non-invasive diagnosis of AD. Studies have shown that the brain number of AD patients is slower than that of healthy people, and the complexity of EEG is disturbed. Clinical practice has proved that the specificity and sensitivity of α, β, δ, θ absolute power and α/θ absolute power ratio, especially θ absolute power and α/θ absolute power ratio in the model, are important electrophysiological indexes for AD diagnosis EEG. Non-invasive and economical electrophysiological techniques can characterize and identify the EEG characteristics of AD patients from different angles. They are relatively simple to implement, and patients have a high degree of cooperation. Therefore, EEG, as a diagnostic method of AD, can improve the accuracy of differential diagnosis and early detection of AD and quantify the severity of the disease. It has the advantage of non-invasive convenience and price, which is of great significance for early diagnosis of AD.

Clinical characteristics of ulcerative colitis patients with different types of Helicobacter pylori infection.

The number of patients with ulcerative colitis (UC) has increased dramatically worldwide, posing a global public health challenge, There has been a suggestion of a potential protective effect of Helicobacter pylori in the development of UC. Virulence factor is an important factor in H. pylori, but high-quality clinical evidence is lacking. This study comprehensively analyzed the clinical characteristics of UC patients with different types of H. pylori infection. Infections with the highly virulent type I H. pylori are found to be negatively correlated with the severity of the disease as well as extraintestinal manifestations, whereas infections with the less virulent type II H. pylori demonstrate a negative correlation solely with disease severity. These results suggest that the virulence factors of H. pylori play a pivotal role in UC. Consequently, virulence factors should be taken into consideration when targeting H. pylori eradication in clinical practice, particularly in UC patients. It is crucial to evaluate the individual benefits to optimize personalized eradication therapies.

Correlation of pre-existing comorbidities with disease severity in individuals infected with SARS-COV-2 virus.

Shortly after the first publication on the new disease called Coronavirus Disease 2019 (Covid-19), studies on the causal consequences of this disease began to emerge, initially focusing only on transmission methods, and later on its consequences analyzed in terms of gender, age, and the presence of comorbidities. The aim of our research is to determine which comorbidities have the greatest negative impact on the worsening of the disease, namely which comorbidities indicate a predisposition to severe Covid-19, and to understand the gender and age representation of participants and comorbidities. The results of our study show that the dominant gender is male at 54.4% and the age of 65 and older. The most common comorbidities are arterial hypertension, diabetes mellitus, and cardiovascular diseases. The dominant group is recovered participants aged 65 and older, with comorbidities most frequently present in this group. The highest correlation between patients with different severity of the disease was found with cardiovascular diseases, while the coefficient is slightly lower for the relationship between patients with different disease severity and urinary system diseases and hypertension. According to the regression analysis results, we showed that urinary system diseases have the greatest negative impact on the worsening of Covid-19, with the tested coefficient b being statistically significant as it is 0.030 < 0.05. An increase in cardiovascular diseases affects the worsening of Covid-19, with the tested coefficient b being statistically significant as it is 0.030 < 0.05. When it comes to arterial hypertension, it has a small impact on the worsening of Covid-19, but its tested coefficient b is not statistically significant as it is 0.169 > 0.05. The same applies to diabetes mellitus, which also has a small impact on the worsening of Covid-19, but its tested coefficient b is not statistically significant as it is 0.336 > 0.05. Our study has shown that comorbidities such as urinary system diseases and cardiovascular diseases tend to have a negative impact on Covid-19, leading to a poor outcome resulting in death, while diabetes mellitus and hypertension have an impact but without statistical significance.

Analyzing the Relationship Between COVID-19 Susceptibility and Blood Group Variations: A Comprehensive Investigation into the Impact of ABO Blood Types on the Incidence, Severity, and Clinical Outcomes of the Disease

Background: The covid-19 pandemic, originating from a new strain of coronavirus (SARS-CoV-2), is of concern to the global health arena as no crisis comparable to this has happened in the past. The investigation of not only the genetic components which may predispose for such a disease but also determine the severity of the illness has turned into a pressing research issue in modern days. Although it is desirable for the formulation of effective community health policy which provide tailor-made solutions concerning treatments, it is important that people have a clear understanding of the role played by blood type differences in this regard.&#x0D; Methodology: The research was done at Baghdad Medical City Hospital during the period of June and August of 2021 using the patients with verified COVID-19 cases as their base. The data contained not only demographic information but also a blood type, disorder severity level, as well as the details were about the procedure. Various statistics organizations, include but not limited to the Pearson correlation, Chi-square and data visualization were applied using SPSS to establish the association between different blood types and the aftermath of COVID-19 infections. Results: The study demonstrated that among the many characteristics of COVID-19, blood types tested out to be assciating with a statistically significant number of them. Noteworthy is the significant negative association that connects blood types with the severity of the disease, and this factor also determines the period for recovery. It became clear that the recovery duration and the treatment response didn’t depend on age when the results were adjusted for any statistically insignificant variations that could be attributed to age. This evidences us that it is likely that the age factor is not considered as a premier factor in the progress of the COVID-19 in the analyzed patients. when goes to a green process, the human error disappears.&#x0D; Conclusion: Obtained results of patients with diversified ABO blood types allowed us the data that confirmed disease incidence and severity can be modified during COVID-19. Given this fact, the doctors in the health care institutions and in the government agencies responsible for public health should gain this information. Also, the organizations need this information to develop a disease prevention and control policy. In a wider plan of the research and response strategy to the pandemic, COVID-19, the results reveal that on the genetic side the blood type must be borne in mind, amongst other hereditary features.

Lessons from prospective longitudinal follow-up of a French APECED cohort.

APECED syndrome is a rare disease caused by biallelic mutations of the AIRE gene, usually presenting with the triad "hypoparathyroidism-adrenal failure-chronic mucocutaneous candidiasis (CMC)" and non-endocrine manifestations. The aim of this study was to determine the molecular profile of the AIRE gene, the prevalence of rare manifestations and to characterize immunological disturbances in a French cohort. A national, multicenter prospective observational study to collect genetic, clinical, biological and immunological data (NCT03751683). 25 patients (23 families) were enrolled. Eleven distinct AIRE variants were identified, two of which were not previously reported: an intronic variant, c.653-70G > A, and a c.1066del (p.Arg356GlyfsX22) variant (exon 9). The most common was the Finnish variant c.769C > T (16 alleles), followed by the variant c.967_979del13 (15 alleles), which seemed associated with a less severe phenotype. 17/25 patients were homozygote. The median number of clinical manifestations was seven; 19/25 patients presented with the hypoparathyroidism-adrenal failure-CMC triad, 8/13 showed pulmonary involvement, 20/25 had ectodermal dystrophy, 8/25 had malabsorption, and 6/23 had asplenia. Fifteen out of 19 patients had NK cell lymphopenia with an increase in CD4+ and CD8+ T lymphocytes and an age-dependent alteration of B lymphocyte homeostasis compared with matched controls (p < 0.001), related to the severity of the disease. All tested sera (n = 18) were positive for anti-interferon-α, 15/18 for anti-interleukin-22 antibodies, and 13/18 for anti-interleukin-17F antibodies, without clear phenotypic correlation other than with CMC. This first prospective cohort showed a high AIRE genotype variability, with two new gene variants. The prevalence of potentially life-threatening non-endocrine manifestations, was higher with systematic screening. These manifestations could, along with age-dependent B-cell lymphopenia, contribute to disease severity. Systematic screening for all the manifestations of the syndrome would allow earlier diagnosis, supporting vaccination, and targeted therapeutic approaches.

Comparing cardiorespiratory fitness, body composition, and muscular endurance of patients with schizophrenia and schizoaffective disorders with a population-based sample

BackgroundThere is an entrenched reverse link between cardiorespiratory fitness (CRF) and earlier deaths. The purpose of our study was to provide a report of CRF elements in a sample of hospitalized patients with schizophrenia and to compare them with a population-based sample.MethodsThis study was performed on 60 subjects (30 in the schizophrenic and schizoaffective group and 30 in the control group). CRF factors such as body mass index (BMI), and body fat, push-up test, curl-up test, VO2 peak, and sit-and-reach test, were compared across two groups. The Positive and Negative Syndrome Scale (PANSS) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) were assessed in the case group.ResultsThe body fat percentage, abdominal circumference, and BMI are more in schizophrenic patients. Also, flexibility, muscle endurance, and maximum aerobic capacity are significantly lower in schizophrenic and schizoaffective patients comparing healthy subjects (P < .001). Moreover, we found that with the increasing severity of the disease, the CRF of the patients became worse (P <.001).ConclusionPatients with schizophrenia and schizoaffective disorders should be evaluated for cardiorespiratory and other factors of CRF. Exercise prescription treatment can be helpful to improve social functioning and decrease the impact of cardiovascular disease in patients with schizophrenia.

Wolbachia-carrying Aedes mosquitoes for preventing dengue infection.

Dengue is a global health problem of high significance, with 3.9 billion people at risk of infection. The geographic expansion of dengue virus (DENV) infection has resulted in increased frequency and severity of the disease, and the number of deaths has increased in recent years. Wolbachia,an intracellular bacterial endosymbiont, has been under investigation for several years as a novel dengue-control strategy. Some dengue vectors (Aedes mosquitoes) can be transinfected with specific strains of Wolbachia, which decreases their fitness (ability to survive and mate) and their ability to reproduce, inhibiting the replication of dengue. Both laboratory and field studies have demonstrated the potential effect of Wolbachia deployments on reducing dengue transmission, and modelling studies have suggested that this may be a self-sustaining strategy for dengue prevention, although long-term effects are yet to be elucidated. To assess the efficacy of Wolbachia-carrying Aedes speciesdeployments (specifically wMel-, wMelPop-, and wAlbB- strains of Wolbachia) for preventing dengue virus infection. We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registries up to 24 January 2024. Randomized controlled trials (RCTs), including cluster-randomized controlled trials (cRCTs), conducted in dengue endemic or epidemic-prone settings were eligible. We sought studies that investigated the impact of Wolbachia-carrying Aedes deployments on epidemiological or entomological dengue-related outcomes, utilizing either the population replacement or population suppression strategy. Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool. We used odds ratios (OR) with the corresponding 95% confidence intervals (CI) as the effect measure for dichotomous outcomes. For count/rate outcomes, we planned to use the rate ratio with 95% CI as the effect measure. We used adjusted measures of effect for cRCTs. We assessed the certainty of evidence using GRADE. One completed cRCT met our inclusion criteria, and we identified two further ongoing cRCTs. The included trial was conducted in an urban setting in Yogyakarta, Indonesia. It utilized a nested test-negative study design, whereby all participants aged three to 45 years who presented at healthcare centres with a fever were enrolled in the study provided they had resided in the study area for the previous 10 nights. The trial showed that wMel-Wolbachia infected Ae aegypti deployments probably reduce the odds of contracting virologically confirmed dengue by 77% (OR 0.23, 95% CI 0.15 to 0.35; 1 trial, 6306 participants; moderate-certainty evidence). The cluster-level prevalence of wMel Wolbachia-carrying mosquitoes remained high over two years in the intervention arm of the trial, reported as 95.8% (interquartile range 91.5 to 97.8) across 27 months in clusters receiving wMel-Wolbachia Ae aegypti deployments, but there were no reliable comparative data for this outcome. Other primary outcomes were the incidence of virologically confirmed dengue, the prevalence of dengue ribonucleic acid in the mosquito population, and mosquito density, but there were no data for these outcomes. Additionally, there were no data on adverse events. The included trial demonstrates the potential significant impact of wMel-Wolbachia-carrying Ae aegypti mosquitoes on preventing dengue infection in an endemic setting, and supports evidence reported in non-randomized and uncontrolled studies. Further trials across a greater diversity of settings are required to confirm whether these findings apply to other locations and country settings, and greater reporting of acceptability and cost are important.

Venous Thrombosis in Acute Pancreatitis: What to and Not to Do?

Acute pancreatitis is an acute inflammatory condition of the pancreas that has not only local but systemic effects as well. Venous thrombosis is one such complication which can give rise to thrombosis of the peripheral vasculature in the form of deep vein thrombosis, pulmonary embolism, and splanchnic vein thrombosis. The prevalence of these complications increases with the severity of the disease and adds to the adverse outcomes profile. With better imaging and awareness, more cases are being detected, although many at times it can be an incidental finding. However, it remains understudied and strangely, most of the guidelines on the management of acute pancreatitis are silent on this aspect. This review offers an overview of the incidence, pathophysiology, symptomatology, diagnostic work-up, and management of venous thrombosis that develops in AP.

Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study.

To investigate the sleep and circadian health of critical survivors 12 months after hospital discharge and to evaluate a possible effect of the severity of the disease within this context. Observational, prospective study. Single-center study. Two hundred sixty patients admitted to the ICU due to severe acute respiratory syndrome coronavirus 2 infection. None. The cohort was composed of 260 patients (69.2% males), with a median (quartile 1-quartile 3) age of 61.5 years (52.0-67.0 yr). The median length of ICU stay was 11.0 days (6.00-21.8 d), where 56.2% of the patients required invasive mechanical ventilation (IMV). The Pittsburgh Sleep Quality Index (PSQI) revealed that 43.1% of the cohort presented poor sleep quality 12 months after hospital discharge. Actigraphy data indicated an influence of the disease severity on the fragmentation of the circadian rest-activity rhythm at the 3- and 6-month follow-ups, which was no longer significant in the long term. Still, the length of the ICU stay and the duration of IMV predicted a higher fragmentation of the rhythm at the 12-month follow-up with effect sizes (95% CI) of 0.248 (0.078-0.418) and 0.182 (0.005-0.359), respectively. Relevant associations between the PSQI and the Hospital Anxiety and Depression Scale (rho = 0.55, anxiety; rho = 0.5, depression) as well as between the fragmentation of the rhythm and the diffusing lung capacity for carbon monoxide (rho = -0.35) were observed at this time point. Our findings reveal a great prevalence of critical survivors presenting poor sleep quality 12 months after hospital discharge. Actigraphy data indicated the persistence of circadian alterations and a possible impact of the disease severity on the fragmentation of the circadian rest-activity rhythm, which was attenuated at the 12-month follow-up. This altogether highlights the relevance of considering the sleep and circadian health of critical survivors in the long term.

Immunopathology of emerging and re-emerging viral infections: an updated overview

Humankind has witnessed increased frequency of emerging and re-emerging viral diseases in the past few decades. The major categories of pathogenic emerging and re-emerging viral infections include respiratory, arthropod-borne and bat-borne zoonotic viruses. These viral infections are notorious for causing immune dysregulation and have the potential to mount excessive immune reaction, causing immunopathology that includes tissue injury, systemic inflammation, multi-organ failure and even death. A better understanding of the emerging or re-emerging viral-mediated immunomodulation is necessary for controlling the virus, while preventing severity of the disease associated with exaggerated immune response. In this article, we review the current understanding of emerging and re-emerging respiratory, arboviral and bat-borne zoonotic viruses; and consequent immune dysregulation or immunopathology associated with these viral infections.

Prognostic significance of &lt;I&gt;TLR3&lt;/I&gt; and &lt;I&gt;TLR9&lt;/I&gt; gene polymorphism in assessing the severity of COVID-19

Objective: to study polymorphic variants of TLR3 (rs3775291) and TLR9 (rs352140) genes in patients with COVID-19 depending on the severity of the disease and their significance for determining the risk of severe course of COVID-19.Materials and Methods: genetic analysis of polymorphism of TLR3 (rs3775291) and TLR9 genes (rs352140) was performed in 164 patients with COVID-19, who were divided by degree of severity into three groups: Group 1 with mild, Group 2 with moderate and Group 3 with severe and extremely severe degrees of severity. The control group consisted of 40 healthy donors. Statistical processing of the obtained results was carried out using STATISTICA 12.0 programs (Stat Soft, USA). To assess the difference of groups by qualitative characteristics, the χ2 criterion with Yates correction was used, and in case of violation of its conditions, the χ2 criterion was applied. Yates correction, and if the conditions of its applicability were violated, the two-sided Fisher’s two-sided criterion (RF). The difference between the groups was considered statistically significant at р&lt;0,05. The strength of associations was evaluated in the values of the odds ratio index odds ratio (OR) and 95% confidence interval.&gt; ˂ 0,05. The strength of associations was evaluated in the values of the odds ratio index odds ratio (OR) and 95% confidence interval.Results: the frequency of the ST genotype was significantly higher and the frequency of the TT genotype of the rs3775291 allele of the TLR3 gene was significantly lower in patients with the manifest form of COVID-19 compared with the control group. Frequency analysis of TLR9 (rs352140) in COVID-19 patients showed significantly higher values of the ST genotype and lower values of the CC genotype compared to healthy individuals. Comparative analysis between groups of hospitalized patients depending on severity revealed higher frequency of ST genotype and lower frequency of TT genotype of TLR3 (rs3775291) and TLR9 (rs352140) genes in patients with severe and extremely severe condition.Conclusion: reliable differences in the frequency of occurrence of genotypes of TLR3 (rs3775291) and TLR9 (rs352140) genes in patients with the manifest form of COVID-19 compared to healthy people were revealed. The analysis of nucleotide sequence variants of the studied genes in hospitalized patients depending on the degree of severity also showed significant differences in the frequency of genotypes. Thus, in patients with severe and extremely severe COVID-19, a significant difference in the frequency of occurrence of ST and TT genotypes of TLR3 (rs3775291) and TLR9 (rs352140) genes was revealed compared to patients with mild and moderate COVID-19, which may further have prognostic value in assessing the severity of the disease.

MICRONUTRIENT STATUS (VITAMINS A AND D) AND ITS EFFECT ON THE SEVERITY OF THE COURSE OF COVID-19 IN CHILDREN

A strong immune response is important during recovery from COVID-19, and its status is infl uenced by several micronutrients. Vitamin D is important in regulating the immune response and protecting against respiratory infections. Vitamin A also has immunomodulatory eff ects, inhibiting viral replication and enhancing immune responses, thereby reducing morbidity and mortality from COVID-19. The aim of research was to study the levels of vitamins A, D, and retinol- binding protein 4 in children with COVID-19, and their associations with the severity of the disease.Material and Methods. 112 children aged 1 month to 18 years with COVID-19 confi rmed by polymerase chain reaction (PCR)in nasal swabs or by a positive serologic test (IgM and IgG or IgM). In all children, vitamin D levels were determined by thecolorimetric enzyme- linked immunosorbent assay (ELISA) using the Monobind test system. Vitamin A and retinol binding protein 4 (RBP4) levels were determined by the colorimetric enzyme- linked immunosorbent assay (ELISA) using the Elabscience test system. Statistical analysis was performed using Stat Plus (its 95 % confi dence interval (95 % CI) was calculated for the mean values, and the Kruskal- Wallis test (H-test) was used as the reliability criterion for checking the equality of the medians of several samples). The level of statistical signifi cance was set at P&lt;0.05). The study was conducted in accordance with the rules of patient safety and ethical principles of scientifi c medical research involving human subjects (2000). The permission to conduct this study was granted by the Bioethics Commission (Protocol No. 73, dated April 3, 2023). The parents (legal representatives) of the patients gave their written consent to the conduct of this study. This study is a fragment of research work «Optimizing the diagnosis of clinical and pathogenetic characteristics of the COVID-19 coronavirus infection in children with comorbid pathology and treatment features» (state registration No. 0123U100064, 2023-2025).Results. The mean age of the children was (7.04±5.75) years (95 % CI 5.96-8.12). According to the severity of the disease,57 children (50.89 %) had a mild course, 43 children (38.39 %) had a moderate course, and 12 children (10.72 %) had a severe course. The concentration of vitamin D in children with mild course of COVID-19 was 30.91 ng/ml, in children with moderate course – 29.10 ng/ml, in children with severe course – 22.42 ng/ml (Р&lt;0.05). The level of vitamin A also varied in children with diff erent severity of the disease: in mild COVID-19 it was 456.10 ng/ml, in moderate – 347.30 ng/ml, and in severe – 242.90 ng/ ml (Р &lt;0.001). At the same time, the level of retinol binding protein 4 was 30.66 ng/ml in mild disease, 33.07 ng/ml in moderate disease and 23.28 ng/ml in severe disease.Conclusions. Children with moderate and severe COVID-19 have signifi cantly lower levels of vitamins A, D, and RBP4compared to uninfected individuals. Vitamin A and RBP4 levels were age-dependent, and vitamin D levels did not show agerelated patterns. Lower levels of vitamins A and D are associated with higher levels of pro-infl ammatory markers – CRP,leukocytes and ESR.

Current treatment options for dry eye syndrome in children

AIM: To analyze personalized therapy for dry eye syndrome (DES) in children, depending on the etiopathogenesis and severity of the disease.&#x0D; MATERIAL AND METHODS: In total, 187 children aged 3–17 years with DES were treated. Ophthalmic medicines registered in Russia from the group of local rehydrants replacing tear fluid and stabilizing tear film were used, and a comparative analysis of their effectiveness was carried out.&#x0D; RESULTS: An individual approach was implemented, and personalized therapy focused on the individual tolerability and effectiveness of medicines was developed. The principle of DES therapy is to replenish the lacrimal fluid deficiency and stabilize all layers of the tear film, considering the etiopathogenesis and severity of clinical symptoms. At this stage, the lipid layer of the tear film was normalized with the help of hypotonic oil-based preparations that can stabilize the lipid layer. All rehydrants of low, medium, and high viscosities contributed to the restoration of the water layer of the joint venture. The deficiency of the mucin layer of the tear film was compensated by hyaluronic acid and carboxymethylcellulose, which are part of the preparations that replace the tear film. The severity of DES associated with the intensity of the clinical changes in the conjunctiva and cornea was considered when designing the DES treatment regimen in children. In cases of mild and extremely severe severity, tear-replacement medicines of low viscosity showed the greatest therapeutic effectiveness. High-viscosity preparations and gels have been proven to be effective in moderate to severe DES. During the desquamation of the conjunctival and corneal epithelium, medicines with regenerating pharmacological action related to tissue repair simulators were included in the treatment regimen. Reparants included in the combined composition of tear-replacement medicines or monopreparations were used.&#x0D; CONCLUSION: The effectiveness of the DES treatment algorithm in children with various nosologies and features of etiopathogenesis was analyzed considering disease severity. The proposed schemes of personalized tear-replacement and reparative therapy make it possible to prevent a chronic disease course and occurrence of complications and preserve or restore visual acuity.

Identifying nutrition risk in emergency patients: What is the most appropriate screening tool?

The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.

A pregnant woman with amyotrophic lateral sclerosis from Iran: a case report

Introduction and Importance: Amyotrophic Lateral Sclerosis (ALS) is a progressive motor neuron disease, which is extremely rare during pregnancy. The severity of the disease affects the pregnancy outcome. The present study reports the first Iranian case of a woman with ALS overlapping pregnancy. Case Presentation: The 27-year-old lady in her second pregnancy was admitted to the emergency department with labor pain at the 37th gestation week. Following a multidisciplinary team meeting, including a neurologist, maternal-fetal medicine specialist, and anesthesiologist, a decision was made for an emergent cesarean section under spinal anesthesia. The delivery was successful without any maternal or fetal complications. A five-month follow-up revealed the stable neurologic status of the mother. Clinical Discussion: The combination of ALS and pregnancy is very rare because the disease is more common in elderly men. ALS management involves a multidisciplinary approach. Riluzole is a drug that can increase the survival of the patients. ALS does not affect on motor and sensory nerves of the uterus, so vaginal delivery might be possible. The main cause of cesarean section in patients with ALS is respiratory compromise, but four patients with uncomplicated vaginal deliveries have been reported. The neonatal outcome of most cases resulted in normal healthy infants. Conclusion: Management of ALS in pregnancy is challenging because of respiratory concerns, so multidisciplinary team management is important.

A Retrospective Study Comparing Mortality Rates between Vaccinated and Unvaccinated Kidney Transplant Recipients

Background: With the emergence of vaccines for COVID-19, mortality and severity of disease have decreased. However, patients with certain comorbidities, such as immunosuppression, CKD, and renal transplant, still have higher mortality rates as compared to the general population. Current data suggests that the risk of developing COVID-19 among transplant patients was reported to be about 5%, which is significantly higher than the risk rate of 0.3% in the general population. Studies utilizing larger sample sizes (i.e., multiple cohorts, sites, hospitals) comparing COVID-19 outcomes among renal transplant patients with a control group are lacking. background: Coronaviruses belong to a family of Viruses that can cause range of illnesses ranging from the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) (1,2). In 2019 a new Coronavirus was identified and was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) which belongs to the genus beta-CoV which also includes Severe Acute Respiratory Syndrome CoV (SARS-CoV), and Middle Eastern Respiratory Syndrome CoV (MERS-CoV) (2). World Health Organization (WHO) later announced an alternative name for the disease caused by SARS-CoV-2: CoV disease (COVID-19) (2). As of May 25, 2022 an estimated 524,339,768 cases of COVID-19 were reported to World health organization including 6,281,260 deaths related to COVID globally. However, the disease affects patients with certain risk factors disproportionally. Recent data has shown chronic comorbidities, such as acute kidney injury, COPD, diabetes, hypertension, CVD, cancer, increased D-dimer, along with demographic variables such as male gender, older age, current smoker, and obesity are clinical risk factors for a fatal outcome associated with coronavirus [3]. With the emergence of COVID-19 vaccines, severity and mortality of the disease decreased and has contributed in controlling the pandemic that has claimed so many lives across the globe (4). Even with the emergence of vaccine, the disease continued to claim a disproportionate number of lives, particularly among immunocompromised individuals Objective: The purpose of this descriptive study was to compare the mortality rate between vaccinated and unvaccinated kidney transplant recipients. objective: The purpose of this study is to provide a descriptive overview of clinical outcomes between vaccinated and unvaccinated kidney transplant recipients in a single transplant center in West Texas Methods: Participants were recruited at a community-based transplant clinic in West Texas. Results Among the group of participants who tested positive for COVID-19 between 2020 and 2022, higher mortality rates and longer hospital stays were noted among those unvaccinated (72% unvaccinated had greater than 5-day length of stay vs. 33% vaccinated). method: Retrospective Data was collected from Kidney Transplant Clinic at a Medical Center located in El Paso, Texas. Data was gathered between January 2020 and January 2022 from the transplant database. Data was extrapolated for demographics including age, race, gender. Other data included vaccinated vs. unvaccinated status, comorbidities, immunosuppression status, outcomes such as length of stay in the hospital and mortality rate. A total of 38 patients were included in the study between the year 2020 and 2022. In cases where the patient died, missing data was collected from the next of kin. Inclusion criteria included aged 18 and older, being a kidney transplant recipient (deceased and living) and had a current functioning transplanted kidney. We included all patients who tested positive for COVID-19 during January 2020 to December 2022. Patient whose data could not be obtained since they were deceased and/or did not have next of kin were excluded from the study. Patients were also excluded from the study if their missing data could not be obtained or validated by patient or next of kin. Conclusion: Our study suggests that vaccination against COVID-19 decreases mortality rates in kidney transplant recipients. result: Among the 38 patients included in the data set 94.7% identified as Hispanic vs 5.2% were non-Hispanics and 71% were male vs 28.9% were females. The majority of the patients were vaccinated (71% vs 28.9% non-vaccinated). The data also showed higher rates of death in Unvaccinated population as opposed to vaccinated patients (90.9% vs 14.8%). 72% of unvaccinated transplant recipients had a length of stay greater than 5 days compared to 33% of vaccinated patients. All of the patients evaluated in the cohort had two or more comorbidities such as HTN, atrial fibrillation and DM2 (100%). Among patients included in the cohort 84.2% were deceased renal transplant recipients while 15.7% living renal transplant recipients. Furthermore, increased mortality rates were seen among patients treated with higher induction doses (greater than 350mg). A total of 20 patients in the cohort received greater than 350 mg of induction doses out of which 9 were unvaccinated (45%) and 12 were vaccinated (60%). Out of the 9 unvaccinated patients 8 patients died (88%) while 1 patient survived (11.1). Respiratory failure was the main cause of death among patients that passed away, regardless of vaccine status (90.9% Vaccinated vs 14.8% unvaccinated). conclusion: Large phase 3 clinical trials are still currently underway worldwide to study the effects of vaccine on transplant patient. Our study suggests that vaccination against COVID 19 decreases mortality rates in Kidney Transplant recipient. Our retrospective study compared mortality rates between vaccinated and unvaccinated Kidney transplant recipients in a small clinic setting. It is important to have a large prospective double-blind study on the use of vaccinations in renal transplant recipients would be useful to study the effectiveness on this population.

COVID-19 admissions: Trying to define the real impact of infection in hospitalized patients

Introduction and objectiveSeveral studies have suggested that the hospitalization rate for COVID-19 in children and adolescents may reflect the prevalence of the infection rather than the severity of the disease. The aim of this study was to describe the clinical features of hospitalised paediatric patients with SARS-CoV-2 infection in order to understand if the infection was the reason for admission. MethodsRetrospective cohort study including patients aged 0–18 years with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) admitted to a tertiary care children’s hospital in Spain between 01/01/2020 and 12/31/2021. Results228 patients were included, corresponding to 150 cases of COVID-related admission (SARS-CoV-2 infection as main cause of hospitalization) and 78 of non-COVID-related admission (SARS-CoV-2 infection unrelated to the hospitalization).In the group of COVID-related admissions, 58 patients had comorbidities. Forty-nine patients had acute respiratory disease (pneumonia, bronchospasm or bronchiolitis). Multisystem inflammatory syndrome in children was diagnosed in 27 and was significantly more frequent in the first year of the pandemic (wild type virus). Eighty percent of patients with acute respiratory disease needed respiratory support, mostly low-flow oxygen therapy. The severity of the disease was similar in all virus variants. Two patients (both with severe comorbidities) died from COVID-related conditions. ConclusionsIn our study, one third of the patients were admitted with SARS-CoV-2 infection but not because of it. Acute respiratory disease was less frequent and had a better prognosis compared to the adult population, while MIS-C was a major cause of morbidity and hospitalization. The fatality rate was extremely low.

Anti-COVID-19 Potential of Withaferin-A and Caffeic Acid Phenethyl Ester.

The recent COVID-19 (coronavirus disease 2019) pandemic triggered research on the development of new vaccines/drugs, repurposing of clinically approved drugs, and assessment of natural anti-COVID-19 compounds. Based on the gender difference in the severity of the disease, such as a higher number of men hospitalized and in intense care units, variations in sex hormones have been predicted to play a role in disease susceptibility. Cell surface receptors (Angiotensin-Converting Enzyme 2; ACE2 and a connected transmembrane protease serine 2- TMPSS2) are upregulated by androgens. Conversely, androgen antagonists have also been shown to lower ACE2 levels, implying their usefulness in COVID-19 management. In this study, we performed computational and cell-based assays to investigate the anti-- COVID-19 potential of Withaferin-A and Caffeic acid phenethyl ester, natural compounds from Withania somnifera and honeybee propolis, respectively. Structure-based computational approach was adopted to predict binding stability, interactions, and dynamics of the two test compounds to three target proteins (androgen receptor, ACE2, and TMPRSS2). Further, in vitro, cell-based experimental approaches were used to investigate the effect of compounds on target protein expression and SARS-CoV-2 replication. Computation and experimental analyses revealed that (i) CAPE, but not Wi-A, can act as androgen antagonist and hence inhibit the transcriptional activation function of androgen receptor, (ii) while both Wi-A and CAPE could interact with ACE2 and TMPRSS2, Wi-A showed higher binding affinity, and (iii) combination of Wi-A and CAPE (Wi-ACAPE) caused strong downregulation of ACE2 and TMPRSS2 expression and inhibition of virus infection. Wi-A and CAPE possess multimodal anti-COVID-19 potential, and their combination (Wi-ACAPE) is expected to provide better activity and hence warrant further attention in the laboratory and clinic.

Predictive Role of Platelet and Inflammation Markers for Severe COVID-19 by Propensity Score Matching.

This study aims to ascertain the predictive value of platelet and inflammation markers in severe cases of COVID-19. A retrospective real-world cohort study was conducted using propensity score matching (PSM). Patients were classified into severe and non-severe COVID-19 groups based on the severity of the disease, and the correlation between severe COVID-19 and laboratory parameters at admission was analyzed. The study included 397 adult patients, comprising 212 (53%) males and 185 (47%) females. Among these, 309 were non-severe and 88 were severe cases. The severe group had a higher median age than the non-severe group (60 vs. 42 years, p < 0.001). Independent risk factors for severe COVID-19 included age, diabetes comorbidity, fever, respiratory symptoms, platelet count, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and the ratio of arterial oxygen partial pressure (PaO2) to the fraction of inspired oxygen (FiO2) (P/F ratio). After one-to-one PSM, adjusted for age, diabetes comorbidities, fever, and respiratory symptoms, significant differences in laboratory parameters at admission were observed. Compared to the non-severe group (n = 71), in the severe group (n = 71), elevated levels of hsCRP (median: 27.1 mg/L vs. 14.6 mg/L, p = 0.005) and IL-6 (median: 16.2 pg/mL vs. 15.3 pg/mL, p = 0.005) were observed, while platelet count (164 ± 36 × 109 vs. 180 ± 50 × 109, p = 0.02) and P/F ratio (median: 351 vs. 397, p = 0.001) were reduced. Elevated levels of hsCRP and IL-6, along with reduced platelet count and P/F ratio at admission, were significantly associated with severe COVID-19 and may serve as predictive indicators.