Time Of Diagnosis In Patients Research Articles

Is sarcopenia effective on survival in patients with metastatic gastric cancer?

Sarcopenia is a progressively diminishing state characterized by the reduction of muscle mass and density, which is frequently observed in malignancies of solid organs. To assess how sarcopenia affects the overall survival of individuals who have been diagnosed with metastatic gastric cancer. The study retrospectively included individuals who had been diagnosed with metastatic gastric cancer between January 2008 and December 2020. Sarcopenia was identified through the calculation of the average Hounsfield units (HUAC) using computed tomography (CT) images taken at the time of diagnosis in patients. A total of 118 patients with metastatic gastric cancer were evaluated. Sarcopenia was detected in 29 patients (24.6%). The median survival of all patients was 8 (1-43) mo. The median survival of patients with sarcopenia was 2 mo, while it was 10 mo for those without sarcopenia (P < 0.001). A significant relationship was found between sarcopenia and survival. Sarcopenia has been observed to impact survival outcomes in various types of solid tumor cancers. Sarcopenic patients can be identified in a short time, easily and inexpensively, by HUAC measurements from CT images used for diagnosis, and survival could be promoted with nutritional support.

İnflamatuvar Bağırsak Hastalığında Tanı Anındaki Fekal Kalprotektin Komplikasyon Varlığını Gösterebilir

Aim: We aimed to investigate the relationship between the presence of complications at the time of diagnosis or during follow-up and fecal calprotectin in patients with inflammatory bowel disease. Materials and Methods: Fecal calprotectin level was studied by the chromatographic lateral flow immunoassay method. Results: A total of 76 patients, 26 (34%) with Crohn's disease and 50 (66%) with ulcerative colitis, were included in the study. At the time of diagnosis and during follow-up, complications were observed in 17 (22%) and 20 (26%) patients, respectively. At the time of diagnosis, fecal calprotectin level was low (&amp;lt;50 mg/kg) in 26 (34%) patients, borderline (50-100 mg/kg) in 16 (21%) patients, and high (&amp;gt;100 mg/kg) in 34 (45%) patients. Hemoglobin and albumin levels were lower (p=0.013, p=0.012, respectively), and platelet count, eryrocyte sedimentation rate, and C-reactive protein levels were higher (p&amp;lt;0.001, p=0.004, p&amp;lt;0.001, respectively) in patients with high fecal calprotectin level than patients with low fecal calprotectin level. At the time of diagnosis and during follow-up, complications were higher in patients with high fecal calprotectin level than patients with low and borderline fecal calprotectin levels (p=0.001). The risk of developing complications was found to be 26 times higher at the time of diagnosis in patients with fecal calprotectin level &amp;gt;100 µg/g than patients with fecal calprotectin level below this value and 8 times higher during follow-up (p=0.006, p=0.015, respectively). Conclusion: The use of fecal calprotectin level together with tests showing acute inflammation in inflammatory bowel disease may predict the development of complications.

The prognostic value of atrial fibrillation in patients with cardiac sarcoidosis

Abstract Background/Introduction The prognostic value of the presence of atrial fibrillation (AF) at the time of diagnosis in patients with cardiac sarcoidosis (CS) is unknown. Purpose The aim of this study is to investigate the association between the presence of AF at the time of diagnosis of CS and prognosis. Methods This study is a post-hoc analysis of ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients With Cardiac Sarcoidosis), a multicenter, retrospective, and observational study that evaluated the clinical characteristics and prognosis of cardiac sarcoidosis. The primary endpoint was the combined endpoint of all-cause death and heart failure hospitalization. Results After excluding 32 patients with missing data about the presence of AF, 480 patients with CS (61.6±11.4 years, 36% men) diagnosed according to current guidelines were analyzed, and 86 primary endpoints were observed during a median follow-up period of 3.3 (interquartile range, 1.8-6.0) years. Patients with AF were associated with older age, higher levels of brain natriuretic peptide (BNP), and the prevalence of heart failure admission compared to those without AF. Kaplan-Meier curve analysis indicated that AF was significantly associated with a high incidence of primary endpoints (log-rank P=0.002), and this association was retained even after adjusting for known risk factors including log-transformed BNP and left ventiricular ejection fraction (LVEF) (hazard ratio, 2.10 [95% CI, 1.16-3.82]; P=0.015). Conclusion The presence of atrial fibrillation at the time of diagnosis in patients with cardiac sarcoidosis is independently associated with adverse events.

The Relation of Lifestyle with Inflammation at the Time of Diagnosis in Patients with Colorectal Cancer.

Colorectal cancer is one of the most common lifestyle-related types of cancer. The exact pathophysiologic mechanism in the relation between (visceral) adipose tissue, systemic inflammation and colorectal cancer remains unknown. This study aimed to assess the association of lifestyle with markers of systemic inflammation at the time of diagnosis in stage I-III colorectal cancer patients. Patients (n = 298) with stage I-III colorectal cancer from three Dutch hospitals were included at diagnosis. Several lifestyle-related variables (MUST nutritional status score, WCRF/AICR healthy lifestyle score, active smoking, alcohol consumption and BMI) and inflammatory markers (plasma levels of IL-6, IL-8, IL-10, TNFα and 'high sensitive' hsCRP) were measured at the time of diagnosis. Confounder-adjusted multivariable linear regression models were used to analyse how the lifestyle variables were associated with the inflammatory markers. Statistically significant associations were found between a better WCRF/AICR lifestyle score and lower levels of IL-6 and hsCRP. A medium and high risk of malnutrition according to the MUST score was associated with elevated levels of both IL-8 and hsCRP. An overall unhealthier lifestyle indicated by a lower WCRF/AICR lifestyle score and a higher risk of malnutrition according to the MUST score at the time of diagnosis was associated with elevated levels of inflammatory markers. These findings can contribute to formulating lifestyle advice to improve treatment outcomes and prognosis in patients having CRC in the future.

Assessment Of Serum Cyanocobalamin Level And Importance In Patients With Hematological Malignancies

ABSTRACT&#x0D; Aim: In our study, we planned to investigate the effect of serum cyanocobalamin (Vitamin B12) levels at the time of diagnosis in patients with various hematological malignancies. &#x0D; Patients and Methods: Two hundred and one patients between 18-75 years old diagnosed with various hematological malignancies and 30 healthy controls applying to outpatient and inpatient clinics of Hematology Department in Necmettin Erbakan University Meram Faculty of Medicine between 2010-2014 years were included in the study. Demographic and clinical data and laboratory findings of the patients included in the study were recorded retrospectively. &#x0D; Results: A total of 231 patients, 132 men (57.1%) and 99 women (42.9%), were included in our study, of which 201 were patients and 30 were healthy controls. The mean serum vitamin B12 concentration of all patients was found as 344.9 ± 279.0 pg/mL. When vitamin B12 levels were analyzed according to diagnostic groups, it was found to be highest in CML (596.0 ± 428.3 pg / mL) and ALL (524.5 ± 442.6 pg / mL) patients and lowest in AML patients (240.9 ± 178, 0 pg / mL); the difference was statistically significant (p

Evaluation of Lipocalin-2 and -10 Levels at Time of Diagnosis in Patients with Acute Pulmonary Embolism

Evaluation of Lipocalin-2 and -10 Levels at Time of Diagnosis in Patients with Acute Pulmonary Embolism

Relationship between Spinopelvic Parameters and Hip Function in Patients with Femoroacetabular Impingement at Diagnosis: A Cross-Sectional Study.

The aim of this study was to determine correlation between the spinopelvic parameters in sitting and standing positions (sacral slope [SS], lumbar lordosis [LL], spinopelvic tilt [SPT], pelvic incidence [PI], and pelvic femoral angle [PFA]), with hip function assessed using the modified Harris hip scores (mHHs) in patients with symptomatic femoroacetabular impingement (FAI) at diagnosis. A retrospective study of 52 patients diagnosed with symptomatic FAI was conducted. Evaluation of the spinopelvic complex in terms of SS, LL, SPT, PI and PFA was performed using lateral radiographs of the pelvis and lumbosacral spine in standing and sitting positions. Assessment of hip function at diagnosis was performed using the mHHs. Calculation of spinopelvic mobility was based on the difference (Δ) between measurements performed in standing and sitting position. The median time of pain evolution was 11 months (interquartile range [IQR], 5-24 months) with a median mHHs of 66.0 points (IQR, 46.0-73.0) at diagnosis. The mean change of LL, SS, SPT, and PFA was 20.9±11.2°, 14.2±8.6°, 15.5±9.0°, and 70.7±9.5°, respectively. No statistically significant correlation was observed between spinopelvic parameters and the mHHs (P>0.05). Radiological parameters of the spinopelvic complex did not show correlation with hip function at the time of diagnosis in patients with symptomatic FAI. Conduct of further studies will be required in the effort to understand the effect of the spinopelvic complex and its compensatory mechanics, primarily between the hip and spine, in patients with FAI before and after hip arthroscopy.

Odds of Stage IV Bone Cancer Diagnosis Based on Socioeconomic and Geographical Factors: A National Cancer Database (NCDB) Review.

There are significant differences in prognosis for osteosarcoma, Ewing sarcoma, chondrosarcoma, and chordomas based on the stage at diagnosis. The five-year survival of these bone cancers varies from 75-87% at an early stage of diagnosis and falls to 27-55% at a late stage of diagnosis. This study retrospectively evaluated the odds of stage I vs stage IV cancer at the time of diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma and chordoma) diagnosed in the National Cancer Database (NCDB) between 2004 and 2018. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of different socioeconomic and geographical characteristics between patients with stage I vs stage IV cancer. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer at the time of diagnosis. Statistical significance was set at α = 0.05. 8882 patients with stage I and 3063 with stage IV primary malignant bone tumors were identified. The odds of stage IV bone cancer at diagnosis are increased for patients on Medicaid (odds ratio [OR] = 1.298, 95% confidence interval [CI]: 1.043-1.616) or Medicare (OR= 1.795, 1.411-2.284). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.733, 0.671-0.800), private insurance (OR= 0.738, 0.601-0.905), and those treated at community cancer programs (OR= 0.542, 0.369-0.797), comprehensive cancer program (OR = 0.312, 0.215-0.452), or academic/research facilities (OR= 0.370, 0.249-0.550). No significant relationship was identified between the stage at diagnosis and race, ethnicity, Charlson-Deyo score, or education level. Stage IV cancer at diagnosis showed was proportionally lower inchondrosarcomas (17.1%) and chordomas (2.1%) than osteosarcomas (45.0%) and Ewing sarcomas (35.8%). Odds of stage IV bone cancer at diagnosis are greater with male sex, Medicaid or Medicare insurance status, or treatment at community cancer programs. Providers should have a low suspicion for additional evaluation when treating patients with symptoms of bone cancer and should be aware of these disparities when treating people in these groups. This is to the authors' knowledge the first such study conducted through the NCDB.

β-hydroxybutyrate as a biomarker of β-cell function in new-onset type 2 diabetes and its association with treatment response at 6 months

AimsIncreasing attention has been paid to the potential metabolic benefits of ketone bodies, but the clinical relevance of ketone bodies in newly diagnosed type 2 diabetes mellitus (T2D) remains unclear. We investigated the clinical implications of ketone bodies at the time of diagnosis in patients with drug-naïve T2D. MethodsClinical data including serum β-hydroxybutyrate (βHB) levels, were collected from 369 patients with newly diagnosed drug-naïve T2D from 2017 to 2021. Subjects were categorized into four βHB groups based on the level of initial serum βHB. The associations of initial serum βHB and urinary ketone levels with glucometabolic indices were analyzed. ResultsHigher serum βHB group was associated with higher levels of glycemic parameters including glycated hemoglobin (HbA1c) with lower levels of indices for insulin secretory function at the point of initial diagnosis of T2D. Nevertheless, higher serum βHB group was an independent determinant of a greater relative improvement in HbA1c after 6 months of anti-diabetic treatment, regardless of the type of anti-diabetic drug. In addition, patients in higher serum βHB group were more likely to have well-controlled HbA1c levels (≤6.5%) after 6 months of anti-diabetic treatment. ConclusionIn patients with newly diagnosed T2D, a higher initial βHB level was a significant predictive marker of greater glycemic improvement after antidiabetic treatment, despite its associations with hyperglycemia and decreased insulin secretion at baseline.

Analysis of Vessel Density Using OCTA in Nonarteritic Anterior Ischemic Optic Neuropathy

Purpose: To investigate the intraocular vessel density in patients with nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA).Methods: Medical records of patients with NAION were retrospectively analyzed. Their age, sex, best corrected visual acuity, color vision results, mean deviation of visual field test were analyzed. Using results of OCT and OCTA that was performed at first visit within 3 weeks of symptom onset, vessel densities in eyes with NAION were evaluated by comparing contralateral unaffected eyes. Furthermore, in only affected eyes, the correlation between visual acuity at the time of diagnosis and anatomical factors such as mean vessel density and retinal nerve fiber layer (RNFL) thickness was investigated.Results: Twenty-five patients (11 males and 14 females) were enrolled in this study and the mean age was 65.92 ± 9.37 years. Whole RNFL thickness in affected eye was significantly lower than that in unaffected eye (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The average peripapillary vessel density was also significantly lower in affected eyes, 45.63% ± 7.60% compared to that in the contralateral eyes, 51.44% ± 3.40% (&lt;i&gt;p&lt;/i&gt; = 0.004). In analysis of only 25 affected eyes, there was no significant correlation between each sectoral peripapillary RNFL thickness and vessel density. There was also no significant correlation between the visual acuity and the vessel density and retinal nerve fiber layer thickness in the ischemic peripapillary hemisphere. However, there was a significant negative correlation between the visual acuity and the un-ischemic peripapillary hemisphere with a coefficient of -0.608 (&lt;i&gt;p&lt;/i&gt; = 0.001).Conclusions: The higher vessel density of nonaffected sector, the better visual acuity at the time of diagnosis in patients with NAION. Patency of blood supply in the preserved peripapillary intraretinal vessel density sector may affect the visual function.

The potential prognostic novel markers PIV and PILE score to predict survival outcomes at hepatocellular cancer.

We aimed at investigating the prognostic significance of a novel immune marker, PIV and PILE score (a score composite from PIV, LDH and ECOG PS), in patients with HCC in a single center. 120 patients who met the criteria were included. PIV and PILE at the time of diagnosis were computed retrospectively. For PIV, the median value of 286.15 was taken as the cut-off. While <286.15 was considered low, ≥286.15 was considered high PIV. The PILE score included PIV (< median vs. ≥ median), lactate dehydrogenase level (<ULN vs. ≥ ULN) and ECOG-PS (0-1 vs. ≥ 2), with 0-1 points being low-risk PILE and 2-3 points being high-risk PILE group. The median first-line PFS and OS in the low PIV group were 10 months (95% CI: 7.77-12.22) and 18 months (95% CI: 10.66-25.33), respectively. The PFS and OS in the high PIV group were 3 months (95% CI: 1.49-4.51) and 4 months (95% CI: 1.47-6.52), respectively (for PFS p=0.001, for OS p<0.001). In the low-risk (0-1) PILE score group, the median first line PFS and OS were 8 months (95% CI: 6.49-9.50) and 17 months (95% CI: 8.19-25.80), respectively. The high-risk (2-3) group, PFS and OS were 3 months (95% CI: 0-5.99), and 3 months (95% CI: 1.02-4.97), respectively (for PFS p=0.02, for OS p<0.001). In multivariate Cox regression analysis, PIV (HR: 1.81, 95% CI: 1.11-2.93, p=0.016) and ECOG PS (HR: 0.72, 95% CI: 1.34-3.19, p=0.01) were independent risk factors for OS. The findings suggest that PIV and PILE score could be used as a prognostic biomarker at the time of diagnosis in patients with HCC. With prospective studies confirming these data, PIV and PILE can be used as a potential standard marker in HCC.

Analysis of factors predicting the efficacy of Imatinib in patients with Chronic Myeloid Leukemia: A retrospective analysis

Objective: Imatinib is a commonly used first generation tyrosine kinase inhibitor for patients with chronic myeloid leukemia (CML). The efficacy has been reported as very high even in recent studies. Material and methods: A retrospective analysis was made of newly diagnosed CML patients treated with Imatinib as a first-line agent from January 2010 to January 2020. The patients were classified as those who obtained an adequate response and those for whom treatment was discontinued due to inadequate efficacy. The two groups were compared to analyze factors predicting the efficacy of the agent. Results: Evaluation was made of a total of 47 CML patients, comprising 20 females (42.6%) and 27 males (57.4%) with a median age of 55 years. Imatinib was discontinued in 19 patients because of inadequate response, and 28 patients were still continuing the treatment at the end of median 33.3 months follow-up duration. At the end of follow-up, there were 44 survivors (93.6%), and 3 non-survivors (6.4%). Median Bcr-Abl (IS, %) at the time of diagnosis in patients with response was higher than patients in discontinued group (67.6 [0.0-291.4] vs 41.9 [0.0-208.5], p=0.022). All other disease and demographic characteristics were similar in both groups (p&gt;0.05). Conclusion: Almost 10 years of follow-up demonstrated that there is still an unmet need to determine factors predicting the response to Imatinib in CML patients. Larger population-based studies are required to specify patients with high risk at the time of diagnosis to monitor closely.

PKIB involved in the metastasis and survival of osteosarcoma.

Osteosarcoma is frequently metastasized at the time of diagnosis in patients. However, the underlying mechanism of osteosarcoma metastasis remains poorly understood. In this study, we evaluated DNA methylation profiles combined with gene expression profiles of 21 patients with metastatic osteosarcoma and 64 patients with non-metastatic osteosarcoma from TARGET database and identified PKIB and AIM2 as hub genes related to the metastasis of osteosarcoma. To verify the effects of PKIB on migration and invasion of osteosarcoma, we performed wound-healing assay and transwell assay. The results showed that PKIB significantly inhibited the migration and invasion of osteosarcoma cells, and the Western blot experiments showed that the protein level of E-cad was upregulated and of VIM was downregulated in 143-B cell recombinant expression PKIB. These results indicate that PKIB inhibit the metastasis of osteosarcoma. CCK-8 assay results showed that PKIB promote the proliferation of osteosarcoma. In addition, the Western blot results showed that the phosphorylation level of Akt was upregulated in 143-B cells overexpressing PKIB, indicating that PKIB promotes the proliferation of osteosarcoma probably through signaling pathway that Akt involved in. These results give us clues that PKIB was a potential target for osteosarcoma therapy. Furthermore, combined clinical profiles analysis showed that the expression of AIM2- and PKIB- related risk scores was significantly related to the overall survival of patients with osteosarcoma. Thus, we constructed a nomogram based on AIM2 and PKIB expression–related risk scores for osteosarcoma prognostic assessment to predict the 1-, 2-, 3-, and 5-year overall survival rate of patients with metastatic osteosarcoma, assisting clinicians in the diagnosis and treatment of metastatic osteosarcoma.

Fever Correlation with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentrations in Patients with Isolated Polymyalgia Rheumatica (PMR): A Retrospective Comparison Study between Hospital and Out-of-Hospital Local Registries.

Background: Polymyalgia rheumatica (PMR) is the most common systemic inflammatory rheumatic disease affecting the elderly. Giant cell arteritis (GCA) is a granulomatous vasculitis affecting the aorta and its branches associated with PMR in up to 20% of cases. In recent studies based on university hospital registries, fever correlated with the erythrocyte sedimentation rate (ESR) but not with C-reactive protein (CRP) concentrations at the time of diagnosis in patients with isolated PMR. A long delay to a PMR diagnosis was suggested to explain this discrepancy, possibly caused by laboratory alterations (for instance, anemia of chronic disease type) that can influence only ESR. We performed a retrospective comparison study between the university hospital and two out-of-hospital public ambulatory databases, searching for any differences in fever/low-grade fever correlation with ESR and CRP. Methods: We identified all patients with newly diagnosed PMR between 2013 and 2020, only including patients who had a body temperature (BT) measurement at the time of diagnosis and a follow-up of at least two years. We considered BT as normal at <37.2 °C. Routine diagnostic tests for differential diagnostics were performed at the time of diagnosis and during follow-ups, indicating the need for more in-depth investigations if required. The GCA was excluded based on the presence of suggestive signs or symptoms and routine ultrasound examination of temporal, axillary, subclavian, and carotid arteries by experienced ultrasonographers. Patients with malignancies, chronic renal disease, bacterial infections, and body mass index (BMI) > 30 kg/m2 were excluded, as these conditions can increase CRP and/or ESR. Finally, we used the Cumulative Illness Rating Scale (CIRS) for quantifying the burden of comorbidities and excluded patients with a CIRS index > 4 as an additional interfering factor. Results: We evaluated data from 169 (73 from hospital and 96 from territorial registries) patients with newly diagnosed isolated PMR. Among these, 77.7% were female, and 61.5% of patients had normal BT at the time of diagnosis. We divided the 169 patients into two cohorts (hospital and territorial) according to the first diagnostic referral. Age at diagnosis, ESR, CRP, median hemoglobin (HB), and diagnostic delay (days from first manifestations to final diagnosis) were statistically significantly different between the two cohorts. However, when we assessed these data according to BT in the territorial cohort, we found a statistical difference only between ESR and BT (46.39 ± 19.31 vs. 57.50 ± 28.16; p = 0.026). Conclusions: ESR but not CRP correlates with fever/low-grade fever at the time of diagnosis in PMR patients with a short diagnosis delay regardless of HB levels. ESR was the only variable having a statistically significant correlation with BT in a multilevel regression analysis adjusted for cohorts (β = 0.312; p = 0.014).

Coagulation Abnormalities and Risk Assessment in Acute Promyelocytic Leukemia: An Experience From a Resource-Constraint Country.

IntroductionThe objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation.Patients and methodsThis was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study.ResultsA total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding.ConclusionThe results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.

Current Status of Contrast Computed Tomography Examination for Diagnosing Acute Pulmonary Thromboembolism.

The purpose of this study was to identify instances of unnecessary contrast-enhanced computed tomography (CT) scans performed at the time of diagnosis in patients with pulmonary thromboembolism at the emergency department of Saiseikai Kumamoto Hospital in Kumamoto Prefecture, Japan, between April 1, 2015, and March 31, 2020. The decision criteria for unnecessary contrast-enhanced CT scans included a Wells score of low or moderate risk, a D-dimer level <1.0 μg/mL, and no shock symptoms, or a negative finding for pulmonary thromboembolism. Consequently, 27 patients were considered to have undergone unnecessary contrast-enhanced CT scans. This equated to approximately 15.6% of the study population.

The BDNF Val66Met Polymorphism (rs6265) Modulates Inflammation and Neurodegeneration in the Early Phases of Multiple Sclerosis

The clinical course of multiple sclerosis (MS) is critically influenced by the interplay between inflammatory and neurodegenerative processes. The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism (rs6265), one of the most studied single-nucleotide polymorphisms (SNPs), influences brain functioning and neurodegenerative processes in healthy individuals and in several neuropsychiatric diseases. However, the role of this polymorphism in MS is still controversial. In 218 relapsing–remitting (RR)-MS patients, we explored, at the time of diagnosis, the associations between the Val66Met polymorphism, clinical characteristics, and the cerebrospinal fluid (CSF) levels of a large set of pro-inflammatory and anti-inflammatory molecules. In addition, associations between Val66Met and structural MRI measures were assessed. We identified an association between the presence of Met and a combination of cytokines, identified by principal component analysis (PCA), including the pro-inflammatory molecules MCP-1, IL-8, TNF, Eotaxin, and MIP-1b. No significant associations emerged with clinical characteristics. Analysis of MRI measures evidenced reduced cortical thickness at the time of diagnosis in patients with Val66Met. We report for the first time an association between the Val66Met polymorphism and central inflammation in MS patients at the time of diagnosis. The role of this polymorphism in both inflammatory and neurodegenerative processes may explain its complex influence on the MS course.

Development of the Severity of Esophageal Anastomotic Leak (SEAL) score: a tool to predict mortality at time of diagnosis in patients with anastomotic leakage after esophagectomy

Background: Anastomotic leakage (AL) is a common and severe complication after esophagectomy, but it is largely unknown how to assess leakage severity at the time of diagnosis. We aimed to develop the Severity of Esophageal Anastomotic Leak (SEAL) score, a tool to determine leak severity at diagnosis of AL.

Minimal Change Disease Is Associated with Mitochondrial Injury and STING Pathway Activation.

We hypothesized that minimal change disease (MCD) pathogenesis may be associated with mitochondrial injury, and that the degree of mitochondrial injury at the time of diagnosis may serve as a valuable prognostic marker. We compared urinary mitochondrial DNA (mtDNA) at the time of diagnosis in patients with MCD and age- and sex-matched healthy controls (MHC) (n = 10 each). We analyzed the site and signal intensity of immunohistochemical (IHC) staining of stimulator of interferon genes (STING) using kidney tissues at the time of diagnosis in patients with MCD. Patients with MCD were divided into high (n = 6) and low-intensity (n = 14) subgroups according to the signal intensity. Urinary mtDNA levels were elevated in the MCD groups more than in the MHC group (p < 0.001). Time-averaged proteinuria and frequency of relapses during the follow-up period were higher in the high-intensity than in the low-intensity subgroup (1.18 ± 0.54 vs. 0.57 ± 0.45 g/day, p = 0.022; and 0.72 ± 0.60 vs. 0.09 ± 0.22 episodes/year, p = 0.022, respectively). Mitochondrial injury may be associated with MCD pathogenesis, and the signal intensity of STING IHC staining at the time of diagnosis could be used as a valuable prognostic marker in MCD.

Significance of chest computed tomography scan findings at time of diagnosis in patients with COVID-19 pneumonia

Background and objectives: Many published reports demonstrated the cardinal hallmark of COVID-19 infection, such as bilateral ground glass opacities (GGO) with or without consolidation in posterior and peripheral lungs fields. Various CT algorithms including CT scoring system were used to assess quantitively and qualitatively the severity of COVID-19 pneumonia. The aim of this study was to summarize the significance of certain radiological features in evaluating Covid-19 pneumonia severity in Iraqi patients. Materials and methods: This was a cross sectional study conducted in Erbil tertiary hospitals in Iraq from June 2020, until August 2020. Review of chest CT scan for 132 patients was done and the main chest CT manifestations of patients with COVID-19 infection was reported. Then, CT scoring system was implicated in a quantitative comparison with radiological findings observed in chest CT examinations of patients having different disease severity at time of diagnosis. Results: The mean age of study sample was 51.08 ±14.2 years. The typical CT findings were consistent with mainly GGOs (78.8%) followed by consolidation. Atypical CT patterns according to previous reports were also observed including tree in bud, crazy paving, bronchiectasis, round organizing pneumonia, pulmonary nodules, mediastinal lymphadenopathy, cavitation and pleural thickening. Lung involvement was significantly more in the lower lobes than upper lobes. CT severity score was significantly higher in the lower lobes as well. Chest CT severity score (CT-SS) was significantly higher in cases with most common pathological lung changes (p < 0.001) except for tree in bud, crazy paving and cavitation. Conclusion: CT-SS is an essential examination tool in the diagnosis, disease severity evaluation and lobar extension of COVID-19 infection. High CT-SS are significantly associated with certain chest CT findings like GGOs, consolidation, bronchiectasis and interlobular septa thickening which reflects the seriousness of such CT findings in COVID-19 at time of diagnosis.