Severity Of Thedisease Research Articles

Eye diseases in chronic kidney disease: A nationwide longitudinal case–control study in Sweden

AbstractBackgroundChronic kidney disease (CKD) is a growing health issue that is becoming more prevalent globally, increasing financial cost on healthcare systems. The purpose of this study is to investigate the incidence of eye diseases in patients diagnosed with CKD in Sweden and to evaluate which eye diseases are most likely to develop.MethodsA longitudinal population‐based retrospective case–control study was conducted including all individuals diagnosed with chronic kidney disease during the time period 2001–2019. A total of 19 455 cases and 38 890 controls were included. For each case, two controls were matched with the same sex, age, and county of residence.ResultsCKD patients had a significantly higher risk of contracting any eye disease compared to individuals without kidney disease HR 1.73 (CI 1.67–1.79), with an elevated risk for all blocks of diagnoses except for glaucoma HR 0.95 (CI 0.85–1.06). However, this condition developed earlier in cases than in controls. Subanalyses showed an increased risk for chronic eye disease patients to develop cataract HR 1.70 (CI 1.63–1.78), other retinal disorders HR 1.86 (CI 1.72–2.02), and retinal vascular occlusions HR 2.08 (CI 1.73–2.51). In general, diagnosis of an eye disease occurred earlier in cases than controls.ConclusionsThe results from this study suggest that CKD patients have an increased risk to develop eye disease. Ocular disease seems to develop considerably earlier in CKD, even without staging the severity of the disease, with particularly high risk of developing retinal diseases and cataracts. Screening for eye disease in CKD should be considered.

Effects of Topical Polymyxin Neomycin Hydrocortison in Patients with Non-Allergic Rhinitis, a Randomized Clinical Trial

Background: Bacterial infection is involved in the pathogenesis of inflammatory non-allergic rhinitis(NAR), and a broad-spectrum antibiotic should reduce the severity of the disease by eliminating themucosal biofilm. The purpose of this study is to assess the efficacy of a topical mixture of polymyxin,neomycin, and hydrocortisone in patients with NAR. Methods: This double-blind phase 3 randomized clinical trial was conducted on 90 patients with non- allergic rhinitis (NAR) in Mashhad, Iran. The subjects experienced symptoms for more than two weeks, and the pretrial course of topical corticosteroids was ineffective. Patients were randomly assigned to treatment groups receiving polymyxin NH, hydrocortisone, or saline. The drug was administered as nasal drops three times daily for a treatment course of two weeks, and the containers were identical. The primary outcome was nasal obstruction. Results: The pretrial comparison showed no significant difference between groups in terms of clinical findings. However, after the trial, nasal obstruction, as the primary outcome, significantly decreased from 20 subjects (66%) to 7 subjects (23%) in the Polymyxin NH group, along with other secondary outcomes, including palatal itching (56% to 23%), sneezing (76% to 40%), mucosal inflammation (100% to 75%), post-nasal drip (PND) (96% to 63%), and concha swelling (96% to 73%). In the other groups, sneezing was the only significant improvement observed in the saline group. Cytology of nasal discharge showed a reduction in nasal neutrophil counts in the Polymyxin NH group (68±16.7% to 46±27.6%) compared to the hydrocortisone and saline-treated groups. Conclusion: Topical intranasal polymyxin NH is effective in treating patients with non-allergic rhinitis.

Maximizing Survival in Pediatric Congenital Cardiac Surgery Using Machine Learning, Explainability, and Simulation Techniques

Background: Pediatric and congenital heart surgery (PCHS) is highly risky. Complications associated with this surgical procedure are mainly caused by the severity of the disease or the unnecessary, late, or premature execution of the procedure, which can be fatal. In this context, prognostic models are crucial to reduce the uncertainty of the decision to perform surgery; however, these models alone are insufficient to maximize the probability of success or to reverse a future scenario of patient death. Method: A new approach is proposed to reverse the prognosis of death in PCHS through the use of (1) machine learning (ML) models to predict the outcome of surgery; (2) an explainability technique (ET) to determine the impact of main risk factors; and (3) a simulation method to design health scenarios that potentially reverse a negative prognosis. Results: Accuracy levels of 96% in the prediction of mortality and survival were achieved using a dataset of 565 patients undergoing PCHS and assessing 10 risk factors. Three case studies confirmed that the ET known as LIME provides explanations that are consistent with the observed results, and the simulation of one real case managed to reverse the initial prognosis of death to one of survival. Conclusions: An innovative method that integrates ML models, ETs, and Simulation has been developed to reverse the prognosis of death in patients undergoing PCHS. The experimental results validate the relevance of this approach in medical decision-making, demonstrating its ability to reverse negative prognoses and provide a solid basis for more informed and personalized medical decisions.

Evaluation of the minor clinical features of Hanifin and Rajka amongst children with atopic dermatitis, visiting a tertiary care hospital in North Eastern India

Atopic Dermatitis (AD) is a commonly encountered, extremely itchy, chronic and relapsing skin disorder, which is characterized by inflammation in the skin. It typically has its onset in childhood, presenting with eczematous lesions; and can also be associated with personal or family history of “atopy”, usually most often. The criterion put by Hanifin and Rajka, encompassing 4 major plus 23 minor criteria, is not infrequently used as a diagnostic criterion for this disease in a hospital setup; however, the frequency of occurrence of the minor criteria usually varies in the population.The study aims at estimating the frequency of the minor diagnostic criteria of the Hanifin and Rajka in children with AD. This was a hospital-based cross-sectional study, that was conducted on 70 children (less than 18yrs of age) by taking their history, doing clinical and ophthalmological examination and some basic tests.The most common occurrence amongst the minor criteria estimated from our study was xerosis i.e., in 45(64.2%). The other common minor criteria observed were pityriasis alba (42.8%) facial erythema (40%), orbital darkening (37.14%) Early age of onset was seen in children (35.7%). There is variation in the clinical features of AD according to geography and population. The prevalence and severity of the disease are dependent on several factors like ethnicity/race and environment. Hence, it is important for dermatologists to know the usual and common ways the disease presents, in a given population for the diagnosis so as to diagnose and treat the patients at an earlier stage and before significant discomfort.

Healthcare costs in relation to kidney function among older people: the SCOPE study.

In this study, a comprehensive analysis of costs of chronic kidney disease (CKD) was performed, to understand factors associated with the economic burden of the disease in a multicentre international framework. The impact on costs of demographics, socio-economics, clinical, and functional variables was tested in 2204 subjects aged 75years or more attending outpatient clinics in Europe using a multicentre 2-year prospective cohort study. By means of collected resources consumption and unit cost data a comprehensive cost database was built and then investigated using multilevel regression modeling. Overall, hospitalization, medications and specialist visits were the main cost items, with a notable variability among countries. Estimated yearly costs were 4478€ ± 9804€, rising up to 6683€ ± 10,953€ for subjects with estimated Glomerular Filtration Rate (eGFR) < 30. Costs increased significantly according to the severity of the disease, gender and age. Clinical and functional covariates were also significantly associated with CKD-related total costs, even after correcting for the inter-country variability. Findings corroborate the importance of multidimensional assessment of participants with CKD, as multimorbidity and functional disability produce a detrimental impact on participant's prognosis and cost of care. Preservation of functional impairment and adequate management of comorbidities may thus help decreasing the overall consumption on health care resources in CKD patients, especially in older people.

Assessing the Severity of Connective Tissue-Related Interstitial Lung Disease Using Computed Tomography Quantitative Analysis Parameters

Objectives The aims of the study are to predict lung function impairment in patients with connective tissue disease (CTD)-associated interstitial lung disease (ILD) through computed tomography (CT) quantitative analysis parameters based on CT deep learning model and density threshold method and to assess the severity of the disease in patients with CTD-ILD. Methods We retrospectively collected chest high-resolution CT images and pulmonary function test results from 105 patients with CTD-ILD between January 2021 and December 2023 (patients staged according to the gender-age-physiology [GAP] system), including 46 males and 59 females, with a median age of 64 years. Additionally, we selected 80 healthy controls (HCs) with matched sex and age, who showed no abnormalities in their chest high-resolution CT. Based on our previously developed RDNet analysis model, the proportion of the lung occupied by reticulation, honeycombing, and total interstitial abnormalities in CTD-ILD patients (ILD% = total interstitial abnormal volume/total lung volume) were calculated. Using the Pulmo-3D software with a threshold segmentation method of −260 to −600, the overall interstitial abnormal proportion (AA%) and mean lung density were obtained. The correlations between CT quantitative analysis parameters and pulmonary function indices were evaluated using Spearman or Pearson correlation coefficients. Stepwise multiple linear regression analysis was used to identify the best CT quantitative predictors for different pulmonary function parameters. Independent risk factors for GAP staging were determined using multifactorial logistic regression. The area under the ROC curve (AUC) differentiated between the CTD-ILD groups and HCs, as well as among GAP stages. The Kruskal-Wallis test was used to compare the differences in pulmonary function indices and CT quantitative analysis parameters among CTD-ILD groups. Results Among 105 CTD-ILD patients (58 in GAP I, 36 in GAP II, and 11 in GAP III), results indicated that AA% distinguished between CTD-ILD patients and HCs with the highest AUC value of 0.974 (95% confidence interval: 0.955–0.993). With a threshold set at 9.7%, a sensitivity of 98.7% and a specificity of 89.5% were observed. Both honeycombing and ILD% showed statistically significant correlations with pulmonary function parameters, with honeycombing displaying the highest correlation coefficient with Composite Physiologic Index (CPI, r = 0.612). Multiple linear regression results indicated honeycombing was the best predictor for both the Dlco% and the CPI. Furthermore, multivariable logistic regression analysis identified honeycombing as an independent risk factor for GAP staging. Honeycombing differentiated between GAP I and GAP II + III with the highest AUC value of 0.729 (95% confidence interval: 0.634–0.811). With a threshold set at 8.0%, a sensitivity of 79.3% and a specificity of 57.4% were observed. Significant differences in honeycombing and ILD% were also noted among the disease groups (P &lt; 0.05). Conclusions An AA% of 9.7% was the optimal threshold for differentiating CTD-ILD patients from HCs. Honeycombing can preliminarily predict lung function impairment and was an independent risk factor for GAP staging, offering significant clinical guidance for assessing the severity of the patient's disease.

A Comparative Evaluation of the Genetic Variant Spectrum in the USH2A Gene in Russian Patients with Isolated and Syndromic Forms of Retinitis Pigmentosa

Pathogenic variants in the USH2A gene are the primary cause of both non-syndromic autosomal recessive inherited retinitis pigmentosa (RP) and the syndromic form, characterized by retinal degeneration and sensorineural hearing loss. This study presents a comparative assessment of the genetic variant spectrum in the USH2A gene among Russian patients in two clinical groups. A retrospective analysis was conducted on massive parallel panel sequencing data from 2415 blood samples of unrelated patients suspected of having hereditary retinal diseases. The copy number of USH2A exons was determined using the quantitative MLPA method with the MRC-Holland SALSA MLPA kit. Biallelic pathogenic and likely pathogenic variants in the USH2A gene were identified in 69 patients (8.7%). In the group of patients with isolated hereditary RP (55 patients), the most frequent pathogenic variants were p.(Glu4445_Ser4449delinsAspLeu) (20.9%), p.(Trp3955*) (15.5%), and p.(Cys934Trp) (5.5%). In patients with the syndromic form (14 patients), the most frequent variants were p.(Trp3955*) (35.7%) and c.8682-9A&gt;G (17.9%). It was found that patients with isolated vision impairment rarely had two “null” variants (17.8%), whereas this was common among patients with both hearing and vision impairment (71.4%) (p ≤ 0.05), explaining the severity of the disease and the earlier onset of clinical symptoms in the syndromic form of RP. Ten previously undescribed loss-of-function variants were identified. The estimated prevalence of USH2A-associated retinal dystrophy in Russia was 1.9 per 100,000 individuals. The obtained data on the differences in the spectra of genetic variants in the USH2A gene in the two studied groups highlight the importance of establishing genotype–phenotype correlations and predicting disease severity, aiming at potential early cochlear implantation and selection of target therapy.

Myocarditis in children. Modern aspects of diagnostics

Introduction. A review of the current literature on the features of the diagnosis of myocarditis in children is presented. Myocarditis is an acute or chronic inflammatory myocardial disease characterized by a variety of clinical manifestations, nonspecific symptoms and physical data. With insufficient number of informative diagnostic tests, there is a challenge for practitioners at all stages of medical care. Aim of the review is to comprehensively present the features of the clinical diagnosis of myocarditis in children. The presence of myocarditis should be assumed in situations where children, regardless of the age, first developed symptoms of heart failure (HF), as well as in the presence of a clinic of viral infections accompanied by respiratory or abdominal symptoms, combined with the development of tachycardia, hypotension or cardiac arrhythmias, even in the absence of cardiomegaly. Myocarditis should be clinically suspected at the stage when the necessary decisions should be made about the patient’s routing, the formation of a complex of diagnostic examinations and the start of therapy. Magnetic resonance imaging (MRI) of the heart is today the non-invasive gold standard for the diagnosis of myocarditis that allows detecting myocarditis within 2–3 weeks after the first symptoms appear. Endomyocardial biopsy can be used for accurate morphological diagnosis of myocarditis in children. Molecular biological and genetic studies that determine the severity and outcome of the disease are important for the diagnosis of myocarditis in children. Conclusion. Based on the literature data and own experience in diagnosing myocarditis, the authors have developed an original diagnostic algorithm to make the right medical decision in case of suspected acute myocarditis in children.

Unlocking insights: Mahout's perceptions and practices in managing Elephant Endotheliotropic Herpesvirus (EEHV) infection among captive Asian elephants in Surin province, Thailand.

Surin, situated in the northeastern region of Thailand, has earned the reputation of being an "elephant village" due to its high captive elephant population and unique tradition of elephant rearing. However, the continuous occurrence of elephant endotheliotropic herpesvirus (EEHV) infection poses a significant threat to elephants, particularly the young ones. This study investigated various aspects of EEHV-related elephant care among ninety-two mahouts at the Surin Elephant Kingdom Project. This study used semi-structured interviews and observations to assess the mahouts' knowledge, attitude, and practice (KAP scores) toward EEHV transmission, prevention, and management. The result revealed knowledge and practice scores below expectations, indicating an insufficient understanding the nature of disease and preventive measures. However, the mahouts exhibited awareness of the severity of the disease and factors contributing to transmission risk. Regarding the relationship among KAP scores, a positive correlation was observed at a low level (p < 0.05) between the knowledge and practice scores. Interestingly, approximately 55% of the survey respondents were confident that their elephants would not receive EEHV, leading to inadequate prevention measures. From the result, it is crucial to provide comprehensive knowledge about the nature of the disease and preventive measures to all mahouts. This education should emphasize the importance of early monitoring signs, appropriate weaning age, and preventing viral transmission practices. The KAP survey offers valuable insights that can identify areas requiring improvement and guide the development of effective and targeted disease prevention programs within the specific population. Therefore, it is recommended that the KAP survey should be employed in other parts of the country where the elephant management system differs.

IMMUNOLOGICAL REACTIVITY AND REACTIVE RESPONSE OF PERIPHERAL BLOOD NEUTROPHILIC GRANULOCYTES IN PATIENTS WITH COVID-19 DEPENDING ON THEIR BLOOD GROUP

At the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, a potential link between ABO blood type and susceptibility to the disease was reported. The evidence supporting this link is strengthening as the volume and quality of research expand. Recently, interest has shifted from merely examining susceptibility to exploring the severity of the disease and the immune response characteristics of patients in relation to their blood groups. Objective: to investigate the immunological reactivity and reactive response of peripheral blood neutrophilic granulocytes in patients with COVID-19 patients based on their blood group. Materials and methods. This prospective study included 198 patients with COVID-19-associated pneumonia of mild, moderate, and severe degrees. The cohort comprised 50.51% (100) men and 49.49% (98) women, with an average age of 54.18 ± 7.25 years (range: 18 to 80 years). The distribution of blood groups according to the ABO system was as follows: 0 (I) - 37.37% (74 patients), A (II) - 37.37% (74 patients), B (III) - 18.18% (36 patients), and AB (IV) - 7.07% (14 patients). The immunological reactivity and reactive response of neutrophilic granulocytes were assessed through the analysis of 14 integral leukocyte indices, including the leukocyte shift index, the ratio of the absolute number of leukocytes to the erythrocyte sedimentation rate (ESR), the lymphocyte-granulocyte index, the lymphocyte index, the index of immunological resistance, and reactivity, among others. Results. In moderate and severe coronavirus infection, the indices of cellular and total immune reactivity and resistance are significantly lower compared to mild coronavirus infection: 1.35-3.08 times (p≤0.042-0.001) for resistance, 2.02-3.87 times (p&lt;0.001) for reactivity, respectively, showing the highest activity among them in the owners of blood group 0 (I), with significantly lower values for A (Ⅱ), B (Ⅲ) and AB (Ⅳ) group variants by 3.94-19.10%. Whereas, with increasing severity of the disease, the reactive response of neutrophilic granulocytes, on the contrary, increases significantly compared to the mild degree: in moderate disease by 43.79-87.62% (p≤0.018-0.005), in severe disease by 1.62-2.11 times (p≤0.012-0.001), with the highest average value in AB (Ⅳ) blood group owners – by 46.69-68.44% (p≤0.017-0.005). Conclusions. The highest index of immunological reactivity is observed in individuals with blood group AB (IV) experiencing a mild clinical course of the disease. Conversely, the lowest index of immunological reactivity is found in patients with blood group A (II) who have a moderate clinical course. Additionally, the reactive response of neutrophilic granulocytes significantly increases in patients with a severe clinical course, with the highest average value recorded in those with blood group AB (IV).

Quality of Life in Patients with Endodontically Treated Teeth: A Retrospective Study at an Educational Hospital

Background/Objectives: Root canal treatment (RCT) is a crucial procedure for preserving dental health. While its clinical success rates are well documented, patient-reported outcomes regarding quality of life remain less explored. This study aimed to assess the long-term impact of RCT performed in an educational hospital on patients’ oral-health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14). Methods: A total of 1500 patients who underwent non-surgical RCT between April 2018 and February 2023 were called and invited for a follow-up visit. During the visit, all teeth that had undergone RCT were assessed clinically and radiographically by two calibrated examiners to evaluate RCT quality and pre- and post-treatment periapical index (PAI) scores. Demographic information and OHIP-14 responses were collected, and the data were recorded. Results: Patients reported high levels of satisfaction (95%) and no negative impact on their OHRQoL. Statistical analysis revealed that post-operative periapical index (PAI) scores (p &lt; 0.001), patient gender (p = 0.003) and nationality (p = 0.029) significantly influenced OHRQoL perceptions; Conclusion: These findings emphasize the effectiveness of RCT in enhancing patients’ quality of life and highlight the impact of demographic factors—such as gender and whether the patient is a resident or a national of the country, along with post-treatment severity of the disease—on patient-reported outcomes.

Impact of COVID-19 pandemic on influenza vaccination rate among health care workers

ABSTRACT Vaccinations against influenza are critical in mitigating the severity of the disease, preventing its transmission, and restricting its dissemination. Concerns about vaccination hesitancy among healthcare workers (HCWs) have been duly recognized during and following the COVID-19 pandemic. To examine the extent to which the COVID-19 pandemic has influenced the adoption of vaccinations among HCWs. A cross-sectional online survey was conducted four years after the COVID-19 pandemic among HCWs in Saudi Arabia. We performed a logistic regression analysis using influenza vaccination uptake as the dependent variable and perceived COVID-19 pandemic’s impact, age, gender, marital status, employment status, education level, monthly income, respondent’s overall health, doctor visits, tobacco use, number of adults in the household, and number of children in the household as independent variables. The study included 574 participants, an 86% response rate. Of the sample, 47% reported they had the influenza vaccination. HCWs who reported a greater negative impact due to the COVID-19 pandemic were 40% more likely to acquire the influenza vaccine (OR = 1.4, 95% CI [1.24, 1.58]). Compared to HCWs without children, HCWs with a child had a 44% lower likelihood of taking the influenza vaccination (OR = 0.34, 95% CI [0.16, 0.69]). The odds of HCWs obtaining the influenza vaccine were 4.5 times higher for those who reported one yearly medical visit, 2.6 times higher for two, and 1.4 times higher for three or more. HCWs who experienced more severe COVID-19 outcomes were more likely to get vaccinated against the virus. However, long-term monitoring of this inclination is necessary.

Effect of Bacillus clausii in attenuating symptoms of DSS-induced ulcerative colitis by modulating NFkB pathway and oxidative stress in mice.

Ulcerative colitis (UC) is a condition characterized by inflammation and ulcer formation in the colon and rectum due to genetic and environmental factors. It is a common condition, with a global prevalence rate exceeding 0.3%. Current treatments have limited efficacy and can cause unwanted side effects, leading to a high recurrence rate and reduced quality of life for patients. This study suggests that Bacillus clausii has a beneficial role in reducing intestinal inflammation and relieving colitis symptoms in mice. The study aimed to examine B. clausii's potential to reduce the progression and pathogenesis of dextran sulphate sodium (DSS)-induced UC. Bacillus clausii was administered to mice as a pre-treatment, post-treatment and adjunct treatment with sulfasalazine for 14 days. The study found that B. clausii effectively reduced the severity of colitis in mice when used preventatively. Administering B. clausii after the onset of colitis also effectively alleviated symptoms. Combining B. clausii with standard sulfasalazine as adjunct therapy was more effective in reducing intestinal inflammation than using a single therapy alone. B. clausii has shown the potential to prevent colon damage and decrease the likelihood and severity of the disease. Immunohistochemistry results revealed a decrease in the expression of pro-inflammatory cytokines such as IL-1β, TNF-α and NFkB in colon tissue. Additionally, mice that received B. clausii showed a significant increase in anti-oxidant levels and improved haematological markers. In conclusion, it must be emphasized that B. clausii possesses the potential to alleviate the symptoms of UC.

Treatment for acute alcoholic-alimentary pancreatitis with peritoneal syndrome

A large number of publications on surgical treatment of acute alcohol-induced pancreatitis (AAP) with peritonitis indicates the importance of the problem and the need for a differentiated approach to treatment. The aim of this study is to determine the optimal treatment policy for acute alcohol-associated pancreatitis with peritonitis. The study included 114 male patients diagnosed with acute alcoholic pancreatitis and peritoneal sepsis, with an average age of 48.6 ± 6.4 years. They were admitted to the surgical departments of clinical hospitals between 2013 and 2023. The diagnosis of AAP was confi med based on clinical, laboratory, and instrumental findings. The classification of acute pancreatitis recommended by the National Clinical Guidelines of the Ministry of Health of the Russian Federation (2015 and 2020) has been applied. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scale has been used to assess the severity and prognosis of the disease, while the Sequential Organ Failure Assessment (SOFA) scale has been used to evaluate organ failure. Based on the results, an algorithm for the treatment of acute alcoholic and alimentary pancreatitis with peritoneal syndrome has been proposed, taking into account the type of pancreatic necrosis, the extent of pancreatic damage, and the nature of fl uid accumulation. For patients with edematous pancreatitis, small-focal sterile pancreatic necrosis, and enzymatic peritonitis, percutaneous ultrasound-guided abdominal and omental drainage is recommended. In severe and moderate acute alcoholic-alimentary pancreatitis, with enzymatic peritonitis (more than 8 points on the APACHE II scale), which is manifested during diagnostic and sanitation laparoscopy by the presence of a hemorrhagic effusion and a large number of plaques of steatonecrosis on the parietal peritoneum and the large omentum, we should use an endovisual method of draining the abdominal cavity and the omentum to minimize anesthesiological and surgical aggression and to form and maintain general cavities, as well as to create good access to the pancreatic area. For patients with large-focal, infected subtotal or total pancreatic necrosis and purulent peritonitis, it is advisable to perform laparotomy, abdominalization of the pancreas, necrectomy, omentobursostomy, and drainage of purulent foci in the abdominal cavity and retroperitoneal tissue.

Gestational Pemphigoid—From Molecular Mechanisms to Clinical Outcomes: A Case Report and Review of Literature

Gestational pemphigoid is a rare, autoimmune, subepidermal bullous disease with an incidence of 1 in 50,000 pregnancies, displaying itself through pruritic erythema and urticarial papules and plaques that evolve into tense bullae. Histopathological findings consist of subepidermal vesicles with perivascular eosinophils and lymphocytes, and direct immunofluorescence reveals C3 complement and, more rarely, IgG in a linear band along the basement membrane. The course is usually self-limiting within 6 months after delivery but, later, can be triggered by subsequent pregnancies, menstruation, or treatment with oral contraceptives. The newborn can be affected due to the transplacental passage of the maternal immunoglobulins, but, usually, less than 10% of newborns will develop lesions similar to pemphigoid gestationis. The diagnosis and management pose a difficult challenge and should be guided by the severity of the disease. We, therefore, provide a short literature review and discussion plus a case from our clinic, with a typical presentation but a delayed diagnosis and an undulating evolution, with severe manifestations and particularly difficult management due to unexpected complications.

Integrated Analysis of Remdesivir and Paxlovid in COVID-19 Patients: A Personalized Approach to High-Risk Individuals for Severe Evolution

Background/Objectives: COVID-19 led to a pandemic that has brought misery to millions of people but more so to those with pre-existing conditions. For this infection, several antiviral drugs were employed, including remdesivir (R) and Paxlovid (nirmatrelvir/ritonavir (NR)). Methods: The current study compared the effectiveness of remdesivir and Paxlovid treatment for COVID-19 patients with comorbid conditions. Data from a cohort of 151 adult patients with COVID-19 who also had associated comorbidities were used in this study. These patients were treated with antivirals according to local guidelines. The subjects included 78 case-patients assigned to group R and 73 to group NR. Results: In group NR, a considerable improvement in oxygen saturation was seen in the first 24 h of treatment (p = 0.010), but the levels were significantly higher from the second day of treatment (p &lt; 0.001) in group R of patients. At the end of the 5 days of treatment, the oxygen saturation improved statistically significantly compared to the admission day, but only in the R group (95.11 ± 1.80; 91.76 ± 1.80; p &lt; 0.001). Conclusions: Both drugs can be considered a breakthrough in the current treatment approach to the COVID-19 disease since they provide readily available options that can alleviate the severity of the disease and, hence, the prognosis of patients. That is why their effectiveness relies on the correct administration time and choosing the patient with suitable characteristics regarding the presence of comorbidities and the likelihood of the critical further development of the process.

Could Anemia Impact the Severity of Infections? COVID-19 as an Example

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p&lt;0.001). Intensive care unit (ICU) admission was almost 3 times higher among anemic patients compared to nonanemic (AOR:2.83,95% CI:1.89-4.25, p&lt;0.001). In addition, the overall mortality rate of 2.8% (n=87) was 2.5-fold higher in anemic than nonanemic patients (OR:2.56, CI: 1.49-4.06, p&lt;0.001). Moreover, older age (≥48-year-old) and male gender were independent predictors for severe illness (Age: OR=1.26, CI:1.07-1.51, p=0.006; Gender: OR:1.43,CI:1.15-1.78, p&lt;0.001)) and ICU admission (Age: OR:2.08, CI:1.47-2.94, p&lt;0.001; Gender: OR: 1.83, CI:1.12-3.00, p=0.008) whereas only age ≥48 years old contributed to higher mortality rate (OR:1.60, CI:1.04-2.46, p=0.034). Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Inhibition of Hedgehog Signaling Ameliorates Severity of Chronic Pancreatitis in Experimental Mouse Models.

Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas with no specific cure. Research highlighting the pathogenesis and especially the therapeutic aspect remains limited. Aberrant activation of developmental pathways in adults have been implicated in several diseases. Hedgehog pathway is a notable embryonic signaling pathway, known to promote fibrosis of various organs when over-activated. The aim of this study is to explore the role of hedgehog pathway in the progression of CP and evaluate its inhibition as a novel therapeutic strategy against CP. CP was induced in mice by repeated injections of L-arginine or Caerulein in two separate models. Mice were administered with the FDA approved pharmacological hedgehog pathway inhibitor, Vismodegib during or after establishing the disease condition to inhibit hedgehog signaling. Various parameters of CP were analyzed to determine the effect of hedgehog pathway inhibition on the severity and progression of the disease. Our study shows that hedgehog signaling was over-activated during CP and its inhibition was effective in improving the histopathological parameters associated with CP. Vismodegib administration not only halted the progression of CP but was also able to resolve already established fibrosis. Additionally, inhibition of hedgehog signaling resulted in reversal of pancreatic stellate cell activation ex vivo. Conclusions: Findings from our study justify conducting clinical trials using Vismodegib against CP and thus, could lead to development of novel therapeutic strategy for the treatment of CP.

A Review of an Effective Deep Learning Network for Estimating COVID-19 severity from chest X-ray Imagery: Co Severity-Net

The COVID-19 pandemic has become an integral part of our existence and shows no signs of abating. In 2020, the World Health Organization declared it a pandemic, and its effects have impacted our lives in myriad ways. To detect COVID-19 from Chest X-Ray images, researchers have developed deep learning techniques. Given the severity of the disease, scoring the level of COVID-19 infection can aid in determining the optimal course of treatment and care for patients, as not all COVID-19 positive patients require specialized medical attention. However, the limited availability of a large-scale dataset has resulted in few studies being conducted to estimate the severity of the disease from Chest X-Ray images. Consequently, we propose CoV Severity-Net, a deep learning-based architecture trained on a public COVID-19 dataset curated by experienced radiologists for severity estimation. Our proposal is based on a review of 18 papers from reputable sources such as Google Scholar, PubMed, and Science Direct.

Blood-based MASH diagnostic in candidates for bariatric surgery using mid-infrared spectroscopy: a European multicenter prospective study

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in individuals with obesity. Sexual dimorphism is present in MASLD. A noninvasive test to diagnose the severity of the disease, in particular the presence of Metabolic dysfunction-associated steatohepatitis (MASH), is lacking. This European multicenter prospective study uses a blood test based on mid-infrared (MIR) metabolic fingerprinting of individuals with severe or morbid obesity to diagnose MASH. Three hundred eighty-two individuals with severe or morbid obesity undergoing bariatric surgery were enrolled prospectively. Liver biopsies were obtained during surgery and assessed centrally. An algorithm was defined to calculate a score from the recorded MIR spectrum and to establish a diagnostic threshold to classify patients with MASH. Among the women (n = 217), MASH was diagnosed in 14.3% of cases. For women, the performance in terms of AUC were 0.83 and 0.82 in the calibration and validation groups, respectively. For a threshold of 0.1817, sensitivities were 86% and 70%, specificities were 81% and 75%, PPV were 43% and 32%, NPV were 97% and 94% and ACC were 82% and 74% for the calibration and validation groups, respectively. For men (n = 78; MASH: 33.3%), the performance of the spectral model was poor. The metabolic fingerprint obtained by MIR spectroscopy can rule out MASH in women with severe or morbid obesity. Its value in men needs new studies.Trial registration: ClinicalTrials.gov identifier: ClinicalTrials.gov identifier: NCT03978247 (04/06/2019)