Disease Severity Research Articles

Assessing the long-term economic impact of wheezing episodes after severe RSV disease in children from Argentina: a cost of illness analysis

IntroductionThere is lack of available data on the economic burden of wheezing episodes after severe respiratory syncytial virus (RSV) infection. This study aimed to assess the cost incurred for wheezing...

Macrophage-Stimulating 1 Polymorphism rs3197999 in Pediatric Patients with Inflammatory Bowel Disease

Background and Objectives: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), often necessitates long-term treatment and hospitalizations and also may require surgery. The macrophage-stimulating 1 (MST1) rs3197999 polymorphism is strongly associated with the risk of IBD but its exact clinical correlates remain under investigation. We aimed to characterize the relationships between the MST1 rs3197999 genotype and the clinical characteristics in children and adolescents with IBD within a multi-center cross-sectional study. Materials and Methods: Clinical data included serum C-reactive protein (CRP), albumin, activity indices (PUCAI, PCDAI), anthropometric data, pharmacotherapy details, surgery, and disease severity. Genotyping for rs3197999 was carried out using TaqMan hydrolysis probes. Results: The study included 367 pediatric patients, 197 with Crohn’s disease (CD) (40.6% female; a median age of 15.2 years [interquartile range 13.2–17.0]) and 170 with ulcerative colitis (UC) (45.8% female; a median age of 15.1 years [11.6–16.8]). No significant relationships were found between MST1 genotypes and age upon first biologic use, time from diagnosis to biological therapy introduction, PUCAI, PCDAI, or hospitalizations for IBD flares. However, in IBD, the height Z-score at the worst flare was negatively associated with the CC genotype (p = 0.016; CC: −0.4 [−1.2–0.4], CT: −0.1 [−0.7–0.8], TT: 0.0 [−1.2–0.7)]). The TT genotype was associated with higher C-reactive protein upon diagnosis (p = 0.023; CC: 4.3 mg/dL [0.7–21.8], CT 5.3 mg/dL [1.3–17.9], TT 12.2 mg/dL [3.0–32.9]). Conclusions: This study identified links between MST1 rs3197999 and the clinical characteristics of pediatric IBD: height Z-score and CRP. Further studies of the associations between genetics and the course of IBD are still warranted, with a focus on more extensive phenotyping.

Mild-moderate alcohol consumption and diabetes are associated with liver fibrosis in patients with biopsy-proven MASLD

BackgroundIt is unclear whether patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are allowed variable low levels of alcohol. This study aimed to evaluate the effect of mild-moderate alcohol consumption on the biochemical and histological characteristics of patients with MASLD.MethodsAlcohol consumption was assessed in 713 patients with steatotic liver disease (SLD) who underwent liver biopsy. Non-drinking, mild-moderate drinking, and excessive drinking were defined as 0 g/day, 1-<20 g/day, and >20 g/day for women and 0 g/day, 1-<30 g/day, and >30 g/day for men, respectively. Liver biopsies were scored according to the NASH CRN system.ResultsA total of 713 participants (median age 39.0 years and 77.1% male) with biopsy-proven SLD were enrolled, including 239 nondrinkers, 269 mild-moderate drinkers and 205 excessive drinkers. Excessive drinking was associated with increased risks for lobular inflammation and liver fibrosis compared to nondrinkers and mild-moderate drinkers. Compared with non-drinkers, mild-moderate drinkers had significantly lower odds for steatosis (OR = 0.60, 95% CI = 0.38–0.93, p = 0.025), hepatocellular ballooning (OR = 0.52, 95% CI = 0.29–0.91, p = 0.020) and fibrosis (OR = 0.50, 95% CI = 0.31–0.81, p = 0.005). However, in non-excessive drinkers with type 2 diabetes mellitus (T2DM), there was no association between mild-moderate alcohol consumption and liver fibrosis (OR = 0.562, 95% CI = 0.207–1.530, p = 0.257).ConclusionsMild-moderate alcohol consumption might be protective against liver fibrosis in MASLD patients, which is modified by the presence of T2DM. However, further longitudinal studies are needed to determine the effect of ongoing alcohol consumption on disease severity.

Evaluation of Serum Inflammatory Markers and Their Relationship to Treatment Response in Alopecia Areata Patients

Introduction: Alopecia areata is a type of non-scarring alopecia, which is thought to be associated with T-cell mediated immune response. Objective: This study aims to compare the levels of serum inflammatory markers before and after treatment in patients with alopecia areata. The study will explore the utility of the systemic immune-inflammation index (SII) in assessing the severity and treatment response in alopecia areata patients. Methods: The study included 60 alopecia areata patients and 40 control patients diagnosed with tinea unguium, aged between 18 and 65 years. Sociodemographic characteristics such as age, gender, and medical history were recorded for both groups. For alopecia areata patients, serum inflammatory markers were recorded before and at the third month of treatment. Serum inflammatory markers for the control group were also recorded. Furthermore, the Severity of Alopecia Tool (SALT) score was calculated for alopecia areata patients before and at the third month of treatment. Results: The alopecia areata group had a significantly higher neutrophil-lymphocyte ratio, mean platelet volume, and SII values compared to the control group, while high-density lipoprotein (HDL) values were significantly lower. Serum inflammatory markers, assessed at the third month of treatment in the alopecia areata group, were lower and HDL values were significantly higher compared to pre-treatment levels. A statistically significant correlation was observed between disease severity and the SII. Conclusion: The SII is a cost-effective marker that can be utilized in assessing the severity of alopecia areata and treatment response.

Copeptin as a surrogate marker for arginine vasopressin: analytical insights, current utility, and emerging applications.

Copeptin is a 39-amino-acid long glycosylated peptide with a leucine-rich core segment in the C-terminal part of pre-pro-vasopressin. It exhibits a rapid response comparable to arginine vasopressin (AVP) in response to osmotic, hemodynamic, and nonspecific stress-related stimuli. This similarity can be attributed to equimolar production of copeptin alongside AVP. However, there are markedly different decay kinetics for both peptides, with an estimated initial half-life of copeptin being approximately two times longer than that of AVP. Like AVP, copeptin correlates strongly over a wide osmolality range in healthy individuals, making it a useful alternative to AVP measurement. While copeptin does not appear to be significantly affected by food intake, small amounts of oral fluid intake may result in a significant decrease in copeptin levels. Compared to AVP, copeptin is considerably more stable in vitro. An automated immunofluorescent assay is now available and has been used in recent landmark trials. However, separate validation studies are required before copeptin thresholds from these studies are applied to other assays. The biological variation of copeptin in presumably healthy subjects has been recently reported, which could assist in defining analytical performance specifications for this measurand. An established diagnostic utility of copeptin is in the investigation of polyuria-polydipsia syndrome and copeptin-based testing protocols have been explored in recent years. A single baseline plasma copeptin >21.4 pmol/L differentiates AVP resistance (formerly known as nephrogenic diabetes insipidus) from other causes with 100% sensitivity and specificity, rendering water deprivation testing unnecessary in such cases. In a recent study among adult patients with polyuria-polydipsia syndrome, AVP deficiency (formerly known as central diabetes insipidus) was more accurately diagnosed with hypertonic saline-stimulated copeptin than with arginine-stimulated copeptin. Glucagon-stimulated copeptin has been proposed as a potentially safe and precise test in the investigation of polyuria-polydipsia syndrome. Furthermore, copeptin could reliably identify those with AVP deficiency among patients with severe hypernatremia, though its diagnostic utility is reportedly limited in the differential diagnosis of profound hyponatremia. Copeptin measurement may be a useful tool for early goal-directed management of post-operative AVP deficiency. Additionally, the potential prognostic utility of copeptin has been explored in other diseases. There is an interest in examining the role of the AVP system (with copeptin as a marker) in the pathogenesis of insulin resistance and diabetes mellitus. Copeptin has been found to be independently associated with an increased risk of incident stroke and cardiovascular disease mortality in men with diabetes mellitus. Increased levels of copeptin have been reported to be independently predictive of a decline in estimated glomerular filtration rate and a greater risk of new-onset chronic kidney disease. Furthermore, copeptin is associated with disease severity in patients with autosomal dominant polycystic kidney disease. Copeptin predicts the development of coronary artery disease and cardiovascular mortality in the older population. Moreover, the predictive value of copeptin was found to be comparable with that of N-terminal pro-brain natriuretic peptide for all-cause mortality in patients with heart failure. Whether the measurement of copeptin in these conditions alters clinical management remains to be demonstrated in future studies.

Chronic Lymphocytic Leukemia in Pregnancy: A Review of the Available Literature and the Pharmacological Challenges in Management.

Chronic Lymphocytic Leukemia (CLL) is a rare hematologic malignancy to occur in pregnancy, with an estimated incidence of 1 in 75,000 pregnancies. This review aimed to summarize the current evidence regarding the diagnosis, prognosis, and treatment of CLL in pregnant cases. A comprehensive search strategy was employed across multiple databases, yielding 14 case reports for inclusion. The cases were divided based on CLL diagnosis onset, either before or during pregnancy. Patients diagnosed during pregnancy (n=5) were mostly asymptomatic at diagnosis, with management ranging from supportive care to leukapheresis and transfusions. Postpartum treatment varied, with some patients requiring no additional therapy and others receiving chemotherapy. Pregnancy outcomes were generally favorable, with most neonates born healthy at term. However, one case of Richter transformation resulted in maternal death despite treatment. Among patients with pre-existing CLL (n=9), the majority experienced an indolent course during pregnancy, with only supportive care required. A few cases necessitated treatment due to progressive disease or complications, including chemotherapy, leukapheresis, and splenectomy. Overall, this review highlights the heterogeneous nature of CLL in pregnancy and the importance of individualized management based on disease severity, gestational age, and maternal-fetal risks. Close monitoring, supportive care, and a multidisciplinary approach are essential for optimizing outcomes in this rare and complex clinical scenario.

Efficacy of Leflunomide Compared to Methotrexate in the Treatment of Moderate to Severe Plaques Psoriasis: A Randomized Controlled Clinical Trial

Introduction: Psoriasis is a chronic inflammatory autoimmune skin disease. Several treatment options are available including topical and systemic options. Methotrexate was the main systemic medication in treating severe psoriasis, yet adverse events can limit its use. Leflunomide is an isoxazole derivative that inhibits the synthesis of pyrimidines, and subsequently inhibits RNA and DNA synthesis. Objective: As available data directly comparing MTX to leflunomide in psoriasis are lacking, this double blinded study was designed to compare the efficacy of methotrexate versus leflunomide in the treatment of moderate to severe psoriasis. Methods: The study included 40 patients (25 males and 15 females) with chronic plaque psoriasis, s. Patients were randomly assigned to one of two equal groups, group A for subcutaneous methotrexate injections and group B for leflunomide (loading dose 100mg daily for the first 3 days then 20 mg daily for 3 months. Disease severity was determined by psoriasis area and severity index (PASI) score before and at the end of treatment The treatment response was evaluated at the baseline and weeks 4, 8 and 12 PASI score. Results: Both groups were matching at the baseline in aspects of gender, age, disease duration and PASI scores Both medications yielded comparable results with no significant difference between both groups in PASI score neither in side effects.. Conclusion: Leflunomide can be as effective as methotrexate in treatment of moderate to severe psoriasis.

Understanding the relevance of immunological markers in severe multisystem inflammatory syndrome in children through machine learning

Objectives: Multisystem inflammatory syndrome in children (MIS-C) is a late manifestation of SARS-CoV-2 infection, which presents with symptoms ranging from milder mucocutaneous and gastrointestinal symptoms to severe cardiovascular and neurological manifestations. We studied the clinical, biochemical, hematological, and immunological characteristics of MIS-C patients to understand this disease entity and to identify markers of severe disease. Materials and Methods: Twenty-four MIS-C patients, four acute COVID-19 infections, and ten healthy controls (HC) from a tertiary care pediatric hospital in Mumbai were enrolled in the study. Clinical, biochemical, hematological, and immunological parameters comprising major lymphocyte, neutrophil, and monocyte subpopulations and key activator and inhibitory markers were studied. Statistical Analysis: All parameters were compared between the healthy, COVID and MIS-C groups at Day 0, 7 and 14 using non-parametric statistical tests. Machine learning tools were used for multivariate data analysis to identify the immunological parameters that could help predict severe disease. Results: NKp46pos NK cell (%), CD11 positive eosinophil (%), D-dimer, and Tim3pos Tc (%) were identified as the most important markers that could help predict severe disease, with NKp46pos NK cells as the top contributor. A disease severity metric utilizing these markers can be used to identify patients who are likely to have a severe course of disease. Conclusions: NK cells directly contribute to disease severity in MIS-C. As the JAK-STAT pathway is known to be important for NK cell development, maturation, and function, ruxolitinib, which is a JAK1/JAK2 inhibitor, might be beneficial in the management of this condition.

The Impact of Statins on Disease Severity and Quality of Life in Patients with Psoriasis: A Systematic Review and Meta-Analysis

Background: Psoriasis, a chronic autoimmune condition, imposes significant burdens on patients’ well-being. While corticosteroid medications are commonly used, their prolonged use presents risks. Statins, known for their immunoregulatory and anti-inflammatory properties, have emerged as potential alternatives. Previous reviews indicated that statins might improve psoriasis symptoms but showed inconsistent results and lacked meta-analyses that generated pooled effect estimates. Therefore, this study addresses this gap by providing a comprehensive overview of the impact of statins on psoriasis severity and quality of life (QoL) for patients with psoriasis. Methods: A thorough search of four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct) was conducted for relevant studies published before April 2024. Results: Seven studies involving 369 patients were included. This meta-analysis showed a statistically significant reduction in PASI scores at week 8 with statin treatment (MD = −1.96, 95% CI [−3.14, −0.77], p = 0.001). However, no statistically significant difference was found between statins and placebo at week 12 (MD = 0.19, 95% CI [−0.18, 0.55]). Additionally, DLQI scores indicated a significant improvement in quality of life with statins compared to placebo (MD = −3.16, 95% CI [−5.55, −0.77]). Conclusions: Statins can improve disease severity and quality of life in psoriasis patients, suggesting the potential benefits of statin therapy. However, further research is needed to determine the optimal treatment duration, address outcome heterogeneity, and explore additional benefits such as cholesterol and triglyceride reduction.

Predictive factors for COVID-19 severity and mortality in hospitalized children

BackgroundUnderstanding the factors influencing disease progression and severity in pediatric COVID-19 cases is essential for effective management and intervention strategies. This study aimed to evaluate the discriminative ability of clinical and laboratory parameters to identify predictors of COVID-19 severity and mortality in hospitalized children.MethodsIn this multicenter retrospective cohort study, we included 468 pediatric patients with COVID-19. We developed a predictive model using their demographic, clinical, and laboratory data. The performance of the model was assessed using various metrics including sensitivity, specificity, positive predictive value rates, and receiver operating characteristics (ROC).ResultsOur findings demonstrated strong discriminatory power, with an area under the curve (AUC) of 0.818 for severity and 0.873 for mortality prediction. Key risk factors for severe COVID-19 in children include low albumin levels, elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), and underlying medical conditions. Furthermore, ROC curve analysis highlights the predictive value of CRP, LDH, and albumin, with AUC values of 0.789, 0.752, and 0.758, respectively.ConclusionOur study indicates that laboratory values are valuable in predicting COVID-19 severity in children. Various factors, including CRP, LDH, and albumin levels, demonstrated statistically significant differences between patient groups, suggesting their potential as predictive markers for disease severity. Implementing predictive analyses based on these markers could aid clinicians in making informed decisions regarding patient management.

Dual-task performance and brain morphologic characteristics in Parkinson's disease.

Introduction Parkinson's disease (PD) reduces an individual's capacity for automaticity which limits their ability to perform two tasks simultaneously, negatively impacting daily function. Understanding the neural correlates of dual-tasks (DT) may pave the way for targeted therapies. To better understand automaticity in PD, we aimed to explore whether individuals with differing DT performances possessed differences in brain morphologic characteristics. Methods Data were obtained from 34 individuals with PD and 47 healthy older adults including: 1) demographics (age, sex), 2) disease severity (Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn & Yahr, levodopa equivalent daily dose (LEDD)), 3) cognition (Montreal Cognitive Assessment), 4) Levodopa Equivalent Daily Dose, 5) single task- and DT- performance during a DT-Timed-Up-and-Go test utilizing a serial-subtraction task, and 6) Cortical thicknesses and subcortical volumes obtained from volumetric MRI. Participants were categorized as low or high DT performers if their combined DT-effect was greater than the previously determined mean value for healthy older adults (μ=74.2). Nonparametric testing using Quade's ANCOVA was conducted to compare cortical thicknesses and brain volumes between the highDT and lowDT groups while controlling for covariates: age, sex, MDS-UPDRS part III, LEDD, and intracranial volume. Secondarily, similar comparisons were made between the healthy older adult group the highDT and lowDT groups. Lastly, a hierarchical linear regression model was conducted regressing combined DT-effect on covariates (block one) and cortical thicknesses (block 2) in stepwise fashion. Results The highDT group had thicker cortices than the lowDT group in the right primary somatosensory (p=0.001), bilateral primary motor (p=<0.001, left; p=0.002, right), bilateral supplementary motor area (p=0.001, left; p<0.001, right), and mean of the bilateral hemispheres (p=0.001, left; p<0.001, right). Of note, left primary cortex thickness (p=0.002), left prefrontal cortex thickness (p<0.001), and right supplementary motor area thickness (p=0.003) differed when adding a healthy comparison group. Additionally, the regression analysis found that the left paracentral lobule thickness explained 20.8% of the variability in combined DT-effect (p=0.011) beyond the influence of covariates. Conclusions These results suggest regions underlying dual-task performance; specifically, a convergence of neural control relying sensorimotor integration, motor planning, and motor activation to achieve higher levels of DT performance for individuals with PD.

Nasal microRNA signatures for disease severity in infants with respiratory syncytial virus bronchiolitis: a multicentre prospective study

BackgroundRespiratory syncytial virus (RSV) bronchiolitis contributes to a large morbidity and mortality burden globally. While emerging evidence suggests that airway microRNA (miRNA) is involved in the pathobiology of RSV infection,...

Interleukin-13 Inhibitors in the Treatment of Atopic Dermatitis: The Role of Tralokinumab

Introduction: The advent of biotechnological drugs has significantly changed the management of atopic dermatitis (AD) and the approach to the moderate-to-severe form of this chronic relapsing disease. Objectives: The aim of our review is to summarize the current literature on anti-interleukin (IL)-13 in atopic dermatitis. Methods: A literature search was organized and a systematic review was performed to summarize the most recent evidence supporting the efficacy and safety of tralokinumab. Results: Tralokinumab (anti-IL-13) 300 mg every 2 weeks subcutaneously has proven effective in several clinical trials in adults and adolescents with moderate to severe atopic dermatitis inadequately controlled with other topical or systemic therapies. Tralokinumab was found to be significantly superior in terms of efficacy in reducing IGA, EASI-75, NRS pruritus, and DLQI scale numbers. During follow-up, tralokinumab was well tolerated with limited severity of adverse events. Conclusion: Tralokinumab leads to statistically significant improvements in disease severity and outcome scores. It represents an effective treatment option for adults with moderate to severe AD, but further large-scale studies are needed to verify long-term superiority over other treatments.

LOCALIZED JUVENILE SCLERODERMA IN ITS LINEAR FORM: A CASE STUDY

Localized juvenile scleroderma is an autoimmune disease with an unknown cause, marked by skin fibrosis and sometimes involving the underlying fascia, muscles, and skeletal tissue. The diseases severity can vary from isolated skin hardening in one area to severe, disabling conditions affecting the skin, subcutaneous tissue, muscles, and bones if diagnosis is delayed. Here, we present a case of localized juvenile scleroderma from the Pediatrics Department at Mohammed VI University Hospital Center in Oujda.

Genomic characteristics of carbapenem-non-susceptible Cronobacter sakazakii isolated from an ICU patient at the Songkhla Hospital, Thailand.

Cronobacter sakazakii is a pathogen that causes severe diseases such as meningitis and necrotizing enterocolitis in infants, associated with the consumption of rehydrated powder infant formula. We report a whole-genome sequence of carbapenem-non-susceptible C. sakazakii isolated from the nasopharynx of the patient admitted to the ICU ward, Songkhla Hospital, Thailand.

Correlation of Quality of Life (QoL) and Self-perception in Patient with Thyroid Eye Disease (TED)

Abstract Introduction Tyroid eye disease (TED) is an autoimmune disorder representing the commonest extrathyroidal manifestation of Graves’ disease (GD), with a prevalence of 10 per 10,000 persons in the European population. Although most frequently associated with hyperthyroidism secondary to GD, about 10% of patients with TED are euthyroid or hypothyroid. Patients with Graves orbitopathy (GO) have a significantly lower life quality, both regarding vision problems and worsened appearance, compared to a healthy person. It has been associated with increased rates of anxiety, depression, social isolation and decreased self-confidence. Materials and Methods The results of standard treatments in this disease are often unsatisfactory, but outcomes often do not correlate well with patient reports of how visible they feel their TED is, and the impact on their lives. The present study was designed to correlate QoL and self-perception of well-being with the different clinical and surgical approaches recommended by EUGOGO. The aim is to determine whether there were differences between treatment options in determining patient perception of well-being and satisfaction with treatment received, and whether they would recommend the treatment they had experienced to people with the same condition. Results Scheduled patients undergone medical or surgical treatments based on presence or not of inflammation signs. Evaluation of clinically relevant improvements in each clinical variable was carried out 6 months and one year after treatment. Later, patients were asked a set of general questions about improvement (or worsening) of symptoms, health condition before and after the treatment, degree of limitations of daily activities caused by the pathology, overall satisfaction. After one-year, visual acuity unchanged in all the cases, and exophthalmos’ absolute values improved. Daily activities limitations and heath conditions improved in most patients. In this study we demonstrate that although the majority of patients were satisfied with the treatment they received, patients presenting most severe disease at presentation and received most invasive procedures (such orbital decompression) were less satisfied due to an unrealistic expectation about the impact of surgery on their appearance, including expecting to return to a pre-morbid appearance. Conclusion This study highlights the importance of healthcare professionals eliciting and managing patients’ expectations, in order to optimize surgical outcomes.

Economic burden of chronic obstructive pulmonary disease and post-tuberculosis sequelae in low- and middle-income countries: a database compiled from a systematic review and meta-analysis

BackgroundChronic obstructive pulmonary disease (COPD) and tuberculosis (TB) impose a substantial economic burden globally. This systematic review summarised the evidence on the costs of COPD, including post-TB diseases in low-...

Colletotrichum aeschynomenes Causing Anthracnose in Combretum indicum in Guangxi, China.

Combretum indicum（L.）Jongkind, distributed in Southeast Asia, is widely planted in southern China for its ornamental and medicinal value. In February 2023, anthracnose symptoms were observed on C. indicum leaves in Nanning Garden Expo (N22°43', E108°28'), Guangxi, China, causing severe defoliation of infected plants with a foliar disease incidence ranging from 40 to 60% (n = 100) in a 2 ha field. Disease symptoms began with small red spots (2 to 3 mm by 2 to 3 mm) on the leaves and gradually enlarged to larger irregular light grey lesions with yellowish halos (3 to 5 mm by 2 to 8 mm). In the late stage, spots merged into larger irregular lesions (5 to 15 mm by 6 to 13 mm) and the necrotic lesions abscised. Three diseased samples in total were collected from plants in three different locations. Symptomatic leaves were cut into small pieces (3×3 mm), disinfected with 75% ethanol solution for 10 s, 2% NaClO for 1 min followed by three washes in sterile distilled water. Tissue pieces were separately plated on potato dextrose agar (PDA) and incubated at 25°C for five days. One representative isolate from each sample (SJ-1, SJ2-1 and SJ3-1) were chosen for further analysis. Colonies were villiform, initially white, later turning gray in 7 days on PDA at 25℃. The average diameter for colonies were 8.1 cm, 8.0 cm and 8.1 cm for SJ1-1, SJ2-1 and SJ3-1, respectively. Conidia were aseptate, hyaline, cylindroid, and averaged 11.94 μm × 5.04 μm, 11.78 μm × 5.14 μm and 11.74 μm × 4.59 μm (n=90) for SJ1-1, SJ2-1 and SJ3-1, respectively. The characteristics were close to the descriptions of Colletotrichum spp. (Weir et al. 2012). Genomic DNA was extracted from 7-day-old aerial mycelia of these isolates. The internal transcribed spacer (ITS), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), actin (ACT), β-tubulin (TUB2), chitin synthase (CHS-1), calmodulin (CAL) and the intergenic region between apn2 and MAT1-2-1 (ApMat) were amplified using primers ITS1/ITS4 (White et al. 1990), GDF/GDR, ACT-512F/ACT-783R, T1/Bt2b, CHS-79F/CHS-354R, CL1C/CL2C (Weir et al. 2012) and AM-F/AM-R (Silva et al. 2012), respectively. Sequences were deposited in GenBank (ITS: OR540240-OR540242; GAPDH: PP328968-PP328970; ACT: PP328959-PP328961; TUB2: PP328971-PP328973; CHS-1: PP328965-PP328967; CAL: PP328962-PP328964 and ApMat: OR548253-OR548255). A phylogenetic analysis was made via Bayesian inference based on the concatenated sequences (ITS, GAPDH, ACT, TUB2, CHS-1, CAL and ApMat). According to morphology and phylogenetic analysis, SJ1-1, SJ2-1 and SJ3-1 were identified as C. aeschynomenes. Pathogenicity was confirmed on leaves with and without wounds of 24 one-year-old C. indicum plants in a greenhouse in Nanning, Guangxi Province. The wound was made with a sterilized needle. Wounded and unwounded leaves were inoculated with 20 μl of conidial suspension (106 spores/ml in 0.1% sterile Tween 20) of the three isolates and control plants were inoculated with water containing 0.1% sterile Tween 20 (6 leaves/plant, 3 plants/treatment). All plants were covered with plastic bags to maintain a high humidity environment and placed in a 28°C growth chamber with constant light. After 7 days of incubation, necrotic lesions were observed on inoculated wounded leaves, whereas unwounded leaves and control plants showed no symptoms. The fungi were re-isolated from symptomatic leaves, completing Koch's postulates. These species can cause severe diseases in a variety of plants worldwide, such as Manihot esculenta, Theobroma cacao and Myrciaria dubia (Sangpueak et al. 2018; Nascimento et al. 2019; Matos et al. 2020). To our knowledge, this is the first report of C. aeschynomenes causing C. indicum leaf anthracnose in China. The results will provide valuable information for management of anthracnose in C. indicum.

Lung ultrasound among Expert operator’S: ScOring and iNter-rater reliability analysis (LESSON study) a secondary COWS study analysis from ITALUS group

BackgroundLung ultrasonography (LUS) is a non-invasive imaging method used to diagnose and monitor conditions such as pulmonary edema, pneumonia, and pneumothorax. It is precious where other imaging techniques like CT scan or chest X-rays are of limited access, especially in low- and middle-income countries with reduced resources. Furthermore, LUS reduces radiation exposure and its related blood cancer adverse events, which is particularly relevant in children and young subjects. The score obtained with LUS allows semi-quantification of regional loss of aeration, and it can provide a valuable and reliable assessment of the severity of most respiratory diseases. However, inter-observer reliability of the score has never been systematically assessed. This study aims to assess experienced LUS operators’ agreement on a sample of video clips showing predefined findings.MethodsTwenty-five anonymized video clips comprehensively depicting the different values of LUS score were shown to renowned LUS experts blinded to patients’ clinical data and the study’s aims using an online form. Clips were acquired from five different ultrasound machines. Fleiss-Cohen weighted kappa was used to evaluate experts’ agreement.ResultsOver a period of 3 months, 20 experienced operators completed the assessment. Most worked in the ICU (10), ED (6), HDU (2), cardiology ward (1), or obstetric/gynecology department (1). The proportional LUS score mean was 15.3 (SD 1.6). Inter-rater agreement varied: 6 clips had full agreement, 3 had 19 out of 20 raters agreeing, and 3 had 18 agreeing, while the remaining 13 had 17 or fewer people agreeing on the assigned score. Scores 0 and score 3 were more reproducible than scores 1 and 2. Fleiss’ Kappa for overall answers was 0.87 (95% CI 0.815–0.931, p < 0.001).ConclusionsThe inter-rater agreement between experienced LUS operators is very high, although not perfect. The strong agreement and the small variance enable us to say that a 20% tolerance around a measured value of a LUS score is a reliable estimate of the patient's true LUS score, resulting in reduced variability in score interpretation and greater confidence in its clinical use.

A hybrid contextual framework to predict severity of infectious disease: COVID-19 case study

Infectious disease is a particular type of disorder triggered by organisms and transmitted directly or indirectly from an infected one like COVID-19. The global economy and public health are immensely affected by COVID-19, a recently emerging infectious disease. Artificial Intelligence can be helpful to predict the severity rating of COVID-19 which assists authorities to take appropriate measures to mitigate its spread in different regions, hence it results in economic reopening and reduces the degree of mortality. In this paper, a hybrid contextual framework is proposed which incorporates content embedding of Standard Operating Procedure’s (SOPs) auxiliary description along with COVID-19 temporal features of the respective region as side information. The word embedding techniques are incorporated to generate distributed representation of SOPs auxiliary description. The higher representation of auxiliary description is obtained by utilizing content embedding and then combined with temporal features to build counties profiles. These county profiles are fed into a profile learner based on an ensemble algorithm to predict the severity level of COVID-19 in different regions. The proposed contextual framework is evaluated on public datasets provided by healthdata.gov and the National Centers for Environmental Information. A comparison of the proposed contextual framework with other state-of-the-art approaches has demonstrated its ability to accurately predict the severity level of COVID-19 in different regions.