World Health Organization Criteria Research Articles

Prognostic value of body mass index for first-line chemoimmunotherapy combinations in advanced non-small cell lung cancer in Chinese population.

BackgroundFew studies have examined the correlation between body mass index (BMI) and effectiveness of first-line chemoimmunotherapy in patients with advanced non-small cell lung cancer (NSCLC); moreover, the conclusion remains elusive and no such studies have been conducted in the Chinese population. Our study aimed to validate the predictive significance of BMI in Chinese patients with advanced NSCLC receiving first-line chemoimmunotherapy combinations. MethodsData of patients with advanced NSCLC treated with first-line chemoimmunotherapy between June 2018 and February 2022 at three centers were retrieved retrospectively. The association between baseline BMI with progression-free survival (PFS) and overall survival (OS) was evaluated using the Kaplan–Meier method and Cox regression models. BMI was categorized according to the World Health Organization criteria. ResultsOf the included 805 patients, 5.3% were underweight, 63.4% had normal weight, 27.8% were overweight, and 3.5% were obese. Survival analysis showed that patients in the high BMI group had significantly better PFS (p=0.012) and OS (p=0.014) than those in the low BMI group. Further, patients in the overweight subgroup had better PFS (p=0.036) and OS (p=0.043) compared to the normal weight population. The results of Cox regression analysis confirmed the correlations between BMI and prognosis of advanced NSCLC patients receiving first-line chemoimmunotherapy combinations. ConclusionsBaseline BMI affected the clinical outcomes of first-line chemoimmunotherapy combinations in patients with advanced NSCLC, and was especially favorable for the overweight subgroup.

Treatment with immunosuppressants did not increase the risk of COVID-19 in pemphigus patients: A single-center survey-based study

BackgroundThe prevalence and outcomes of coronavirus 2019 (COVID-19) among patients using glucocorticoids and immunosuppressants remain controversial. AimThe study aims to investigate the impact of immunosuppressants especially glucocorticoids on patients in the Autoimmune Bullous Diseases Cohort of West China Hospital (AIBDWCH) during COVID-19. MethodsWe conducted a cross-sectional survey from December 7, 2022, to February 8, 2023, using questionnaires administered either face-to-face or by phone. COVID-19 cases were classified as confirmed, probable, or suspected according to World Health Organization criteria. Patients were divided into Group A (confirmed and probable cases) and Group B (suspected and other cases). The impact of glucocorticoids and immunosuppressive agents on COVID-19 disease and progression was evaluated with logistic regression models. ResultsThis study included 111 patients with pemphigus. Overweight patients had a reduced risk of confirmed COVID-19 (odds ratio [OR] 0.35 [95 % CI 0.13–0.97], p = 0.045). Patients treated with a medium dose of prednisone during the pandemic had a lower incidence of COVID-19 compared to those on low doses, though the difference was not statistically significant. No independent effects of age, sex, comorbidities, and therapies were observed. No significant differences were found in COVID-19 symptoms among different therapy groups. ConclusionsTreatment with immunosuppressants, particularly glucocorticoids at low-to-medium doses, did not elevate COVID-19 risk in pemphigus patients. Consistent outcomes across treatments confirm the safety of these therapies during the pandemic.

A Case of Long-Term Survival After Glioblastoma, IDH-Wild Type.

Glioblastoma is a uniformly lethal primary central nervous system neoplasm. Despite the increased understanding of its pathophysiology and treatment advancements, median overall survival for patients with glioblastoma, IDH-wild type remains 14 to 21 months from diagnosis. We present the case of a 48-year-old female who presented with a focal seizure and was found to have a right frontal lobe mass on the brain magnetic resonance imaging. She underwent gross total resection and received a histological diagnosis of glioblastoma. She received radiotherapy and 6 cycles of carmustine (BCNU). Seventeen months later, she developed left hemiparesis. Imaging was concerning for tumor progression, and she was treated with 1 cycle of mechlorethamine, vincristine (oncovin), procarbazine, and prednisone (MOPP). Subsequent surveillance imaging demonstrated a therapeutic response. Twenty-seven years after her glioblastoma diagnosis, she developed status epilepticus and died from respiratory failure. Neuropathology on autopsy demonstrated extensive treatment-related changes but no evidence of recurrent glioblastoma. Genomic testing performed over 30 years after her original diagnosis revealed a profile diagnostic of glioblastoma, IDH-wild type per 2021 World Health Organization criteria. This patient is one of the longest-known survivors of glioblastoma, IDH-wild type, with pathologic confirmation of glioblastoma at the time of her resection and no evidence of residual disease 26 years after her last treatment. She presented with multiple factors associated with long-term glioblastoma survivorship, including female sex, young age, high Karnofsky score, and multimodal therapy. This case shows that long-term survival after glioblastoma diagnosis is possible and likely mediated through a combination of individual, tumor, and treatment factors.

Autoimmunity and epithelial dysplasia in patients with oral lichenoid diseases.

The primary objective of this study was to explore relationship between autoimmunity and epithelial dysplasia in patients with oral lichenoid diseases. A total of 66 patients with oral lichen planus (OLP), 35 with oral lichenoid lesion (OLL), and 85 with oral lichenoid drug reaction (OLDR) were enrolled. OLP, OLL, and OLDR were diagnosed following the definitions of the modified World Health Organization criteria, except for the absence of epithelial dysplasia. All patients underwent diagnostic incisional biopsy and adjunctive direct immunofluorescence assays. An indirect immunofluorescence assay was conducted to determine the antinuclear antibody (ANA) positivity. OLP and OLDR patients with epithelial dysplasia demonstrated higher prevalence of serum ANA positivity compared to those without epithelial dysplasia. Elevated serum levels of high sensitivity-C reactive proteins were observed in the OLP, OLL, and OLDR patients with epithelial dysplasia. In the DIF analysis, patients with epithelial dysplasia in the OLP exhibited a higher prevalence of C3 deposition in the basement membrane zone. This study proposed that autoimmunity may contribute to elevating levels of focal and chronic systemic inflammation, potentially influencing abnormal wound healing and development of dysplastic changes in the oral epithelium among patients with oral lichenoid disease.

The evaluation effect of nanoliposome-loaded Mito-Tempo on sperm parameters during human sperm cryopreservation.

The aim of this study is the evaluation effect of nanoliposome-loaded Mito-Tempo on sperm parameters during human sperm cryopreservation. Semen samples of 50 Asthenoteratozoospermia men (random) were collected. Sperm parameters were analyzed based on World Health Organization (WHO, 2010) criteria (2021) and each sample was divided into 5 groups (E1-E5). E1 (control group): the sperm was cryopreserved without nanoliposome, and Mito-Tempo. E2: sperm cryopreservation with Mito-Tempo-loaded nanoliposome (Mito-Tempo 0.1 mM) + freezing medium. E3: sperm cryopreservation with Mito-Tempo-loaded nanoliposome (Mito-Tempo 0.2 mM) + freezing medium. E4: in this group, the cryopreservation sperm with Mito-Tempo 0.3 mM + freezing medium. E5: the cryopreservation sperm with Mito-Tempo 0.2 mM + freezing medium. The result of this study indicated that sperm parameters and total antioxidant capacity (TAC) significantly increase in E3 and E4 groups, compared to E1, E2, and E5 groups respectively (P < 0.05). The percentage of abnormal morphology, DNA fragmentation index (DFI), malondialdehyde (MDA), and the levels of ROS significantly decrease in E3 and E4 groups, compared to E1, E2, and E5 groups (P < 0.05). In addition, the sperm parameters and stress oxidative factors significantly improve in E3 group compared to other groups (P < 0.05). In conclusion, the combination of Mito-Tempo with nanoliposome due to its ability to cooperate with lipid layers may lead to significant performance in reducing oxidative stress damage and increasing the quality of sperm parameters.

Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential.

Up until now, no research has been reported on the association between the clinical growth rate of multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and computed tomography (CT) imaging characteristics. Our study sought to examine the correlation between them, with the objective of distinguishing unique features of MCRNLMP from renal cysts and exploring effective management strategies. To investigate optimal management strategies of MCRNLMP. We retrospectively collected and analyzed data from 1520 patients, comprising 1444 with renal cysts and 76 with MCRNLMP, who underwent renal cyst decompression, radical nephrectomy, or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution. Detection of MCRNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology. Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP. Precisely, it comprises 1.48% of all cases involving simple renal cysts, 5.26% of those with complex renal cysts, and a noteworthy 12.11% of renal tumors coexisting with renal cysts, indicating a statistically significant difference (P = 0.001). Moreover, MCRNLMP constituted a significant 22.37% of the patient population whose cysts demonstrated a rapid growth rate of ≥ 2.0 cm/year, whereas it only represented 0.66% among those with a growth rate below 2.0 cm/year. Of the 76 MCRNLMP cases studied, none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis. In the remaining 67 patients, who were actively monitored over a 3-year postoperative period, only one showed suspicious recurrence on CT scans. MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators. In treating MCRNLMP, partial nephrectomy is preferred, while radical nephrectomy should be minimized. After surgery, active monitoring is advisable to prevent unnecessary nephrectomy.

Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review.

To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes. We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed. The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons. Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

The Observation at Mean Oedema Index Variations with Location and Histological subtypes in Supratentorial WHO G-I Meningiomas

Background: The term meningioma is the noncommittal, all-encompassing name coined by Harvey Cushing for this tumor of meninges which is usually benign. The severity and variety of the peritumoral brain oedema may limit operative exposure and increase the difficulties of intraoperative procedures; however, its pathogenesis is not clearly documented. Several factors, such as tumor size, location and histology, mechanical compression of draining vein by the tumor have been proposed as mechanism of peritumoral brain oedema Aims: The objective of this study was to determination of mean oedema index in different locations and histological subtypes in patients with supratentorial WHO GI meningiomas Methods: The study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from September, 2016 to March, 2018. This study was a cross sectional study. Data collection sheets were used to collect necessary information. Total 75 cases were selected consistent with inclusion and exclusion criteria. Tumor volume and localization and the presence of peritumoral brain oedema (PTBOe) were determined by MRI (Magnetic Resonance Image). All patients underwent microsurgical removal of tumor. Surgically resected meningiomas were classified histopathologically based on criteria of the new World Health Organization (WHO) classification. Regarding location and histological subtypes of tumor the study population were divided into 6 groups and 8 groups respectively.Statistical analyses were done by Statistical Packages for Social Sciences (SPSS-v.25). Results: A total 75 cases were selected consistent with inclusion and exclusion criteria from September, 2016 to March, 2018. Regarding location; the mean oedema index for each of the six groups was calculated and recorded. The F value was 5.97 and the P-value was 0.0001 which was less than 0.05. This result signifies that there was association between perilesional oedema in supratentorial meningioma to its location. So, Mean Oedema Index in Intracranial Supratentorial Meningiomas vary with its location. On the other hand, regarding histopathological subtypes, meningiomaswere divided into eight groups-the mean oedema index of each of the eight groups was calculated and recorded. The F value was 1.62 and P-value was 0.145 which was more than 0.05. This result signifies that there was no association between perilesional oedema in supratentorial meningioma to its histological subtypes. So mean oedema index in intracranial supratentorial meningiomas does not vary with its histological subtypes. Conclusion: Mean Oedema Index in Intracranial Supratentorial Meningiomas vary with its location but does not vary with histological subtypes Bang. J Neurosurgery 2023; 13(1): 10-13

Association of testosterone with myocardial infarction and severity of coronary artery disease among male patients

BackgroundCoronary heart disease (CHD) remains a leading cause of morbidity and mortality, particularly in aging populations. Men typically exhibit higher rates of CHD compared to women, with testosterone levels inversely associated with cardiovascular risk. This study investigates the relationship between testosterone levels and angiographically confirmed CHD, disease severity, and myocardial infarction (MI) among CHD cases. MethodsA cohort of 1724 male patients undergoing diagnostic or interventional coronary angiography was examined. Demographic, clinical, and biochemical data were collected, including serum total testosterone levels. The severity of CHD was assessed using the Gensini score, and MI cases were diagnosed according to World Health Organization criteria. ResultsResults revealed significant differences in testosterone levels among CHD subtypes, particularly between MI and unstable angina/stable angina groups (p < 0.001). Testosterone levels were inversely correlated with CHD severity, as evidenced by the Gensini score (Pearson coefficient = −0.062, P = 0.004). Cross-validation random forest analysis demonstrated the significant contribution of testosterone to CHD severity discrimination (p < 0.05). ConclusionsThere is an association between testosterone and a predisposition to severe CAD indicated by Gensini score and myocardial infarction.

The significance of BAP1 and MTAP/CDKN2A expression in well-differentiated papillary mesothelial tumour: a series of 21 cases and a review of the literature

The nomenclature and diagnostic criteria of well-differentiated papillary mesothelial tumour (WDPMT) have been changed in the 2021 World Health Organization (WHO) classification of thoracic tumours, and a new entity, mesothelioma in situ (MIS), introduced. Histologically these two entities may be similar. However, MIS is regarded as a precursor to invasive mesothelioma and requires demonstration of loss of BAP1 and/or MTAP/CDKN2A for diagnosis, whereas performance of these ancillary tests is desirable but not essential for a diagnosis of WDPMT, in which the significance of BAP1 and/or MTAP/CDKN2A loss is not well understood or well defined. Against this backdrop, we undertook an investigation of 21 cases of WDPMT, identified from our case files and diagnosed according to 2021 WHO criteria, to explore the relationship between histology and BAP1 and MTAP/CDKN2A expression with clinical features including asbestos exposure, focality of tumours and clinical outcome. There were 18 women and three men, with ages ranging from 23-77 years (median 62 years), in which six had a history of asbestos exposure, two had no exposure, and in 13 exposure history was unavailable. Of 20 peritoneal tumours and one pleural tumour, 13 were detected incidentally at the time of surgery for unrelated conditions and eight peritoneal tumours were multifocal at the time of diagnosis. BAP1 immunohistochemistry (IHC) was performed in all 21 tumours, with nine tumours showing BAP1 expression loss. MTAP/CDKN2A testing was performed in 14 tumours, comprising MTAP IHC in 12 and CDKN2A fluorescence in situ hybridisation (FISH) in two, with three tumours showing MTAP/CDKN2A expression loss. Two tumours with MTAP/CDKN2A loss also showed BAP1 expression loss. Four patients progressed to invasive mesothelioma, including one male with a pleural tumour and asbestos exposure, and three females with multifocal peritoneal tumours, two with asbestos exposure and one without exposure. BAP1 expression loss was seen in all tumours from the four patients who progressed to invasive mesothelioma, whilst two of these tumours showed retained MTAP IHC and two were not tested. There was one patient with a tumour with MTAP loss and retained BAP1 who died from unrelated causes 5 months after diagnosis. Eight patients received WDPMT-specific treatment in addition to the initial excision. Survival for all patients ranged from 4-218 months, with one patient dying of mesothelioma at 49 months. Based on our results in this series of 21 patients with WDPMT diagnosed according to 2021 WHO criteria, we propose that WDPMT with BAP1 expression loss may best be regarded as papillary MIS and that a history of asbestos exposure and the presence of multifocal tumours in patients diagnosed with WDPMT should prompt ancillary testing with BAP1 IHC. Further we propose that BAP1 IHC should be essential in the diagnosis of WDPMT, with the diagnosis restricted to those tumours which show retained BAP1 expression. However more studies in larger cohorts of patients are needed to explore the relationship between BAP1 expression and MTAP loss in WDPMT, which will help to define this entity and separate it more clearly from MIS and invasive mesothelioma.

MRI Scoring Systems for Predicting Isocitrate Dehydrogenase Mutation and Chromosome 1p/19q Codeletion in Adult-type Diffuse Glioma Lacking Contrast Enhancement.

Background According to 2021 World Health Organization criteria, adult-type diffuse gliomas include glioblastoma, isocitrate dehydrogenase (IDH)-wildtype; oligodendroglioma, IDH-mutant and 1p/19q-codeleted; and astrocytoma, IDH-mutant, even when contrast enhancement is lacking. Purpose To develop and validate simple scoring systems for predicting IDH and subsequent 1p/19q codeletion status in gliomas without contrast enhancement using standard clinical MRI sequences. Materials and Methods This retrospective study included adult-type diffuse gliomas lacking contrast at contrast-enhanced MRI from two tertiary referral hospitals between January 2012 and April 2022 with diagnoses confirmed at pathology. IDH status was predicted primarily by using T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign, followed by 1p/19q codeletion prediction. A visual rating of MRI features, apparent diffusion coefficient (ADC) ratio, and relative cerebral blood volume was measured. Scoring systems were developed through univariable and multivariable logistic regressions and underwent calibration and discrimination, including internal and external validation. Results For the internal validation cohort, 237 patients were included (mean age, 44.4 years ± 14.4 [SD]; 136 male patients; 193 patients in IDH prediction and 163 patients in 1p/19q prediction). For the external validation cohort, 35 patients were included (46.1 years ± 15.3; 20 male patients; 28 patients in IDH prediction and 24 patients in 1p/19q prediction). The T2-FLAIR mismatch sign demonstrated 100% specificity and 100% positive predictive value for IDH mutation. IDH status prediction scoring system for tumors without mismatch sign included age, ADC ratio, and morphologic characteristics, whereas 1p/19q codeletion prediction for IDH-mutant gliomas included ADC ratio, cortical involvement, and mismatch sign. For IDH status and 1p/19q codeletion prediction, bootstrap-corrected areas under the receiver operating characteristic curve were 0.86 (95% CI: 0.81, 0.90) and 0.73 (95% CI: 0.65, 0.81), respectively, whereas at external validation they were 0.99 (95% CI: 0.98, 1.0) and 0.88 (95% CI: 0.63, 1.0). Conclusion The T2-FLAIR mismatch sign and scoring systems using standard clinical MRI predicted IDH and 1p/19q codeletion status in gliomas lacking contrast enhancement. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Badve and Hodges in this issue.

Fourteen-year trends in overweight, general obesity, and abdominal obesity in Amazonian indigenous peoples.

Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic diseases, malnutrition, and deficiency diseases, such as anemia in children and women of reproductive age), associated with new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemia). Based on this scenario, this study analyzed the nutritional profile of the adult population of seven indigenous peoples from the Brazilian Amazon in the years 2007 and 2021. A total of 598 adults individuals were analyzed in 2007 (319 women and 279 men) and 924 in 2021 (483 women and 441 men), from seven indigenous peoples located in the state of Pará, who were assisted during health actions carried out in 2007 and in 2021. Body mass index classification used the World Health Organization criteria for adults: low weight, < 18.5kg/m2; normal weight, ≥ 18.5 and < 25kg/m2); overweight, ≥ 25 and < 30kg/m2, and obesity, ≥ 30kg/m2. A waist circumference (WC) < 90cm in men and < 80cm in women was considered normal. The data revealed heterogeneous anthropometric profiles, with a low prevalence of nutritional changes in the Araweté, Arara and Parakanã peoples, and high proportions of excess weight and abdominal obesity in the Kararaô, Xikrin do Bacajá, Asurini do Xingu and Gavião peoples, similar to or even higher than the national averages. Different stages of nutritional transition were identified in the indigenous peoples analyzed, despite apparently having been subjected to the same environmental pressures that shaped their nutritional profile in recent decades, which may indicate different genetic susceptibilities to nutritional changes. The evidence shown in this study strongly suggests the need to investigate in greater depth the genetic and environmental factors associated with the nutritional profile of Brazilian indigenous peoples, with assessment of diet, physical activity and sociodemographic and socioeconomic variables that enable the development of appropriate prevention and monitoring measures.

Overweight and Obesity in 10-Year-Old Children in Danang City, Vietnam

Aims This study aimed to determine the prevalence and associated factors of childhood overweight and obesity among 10-year-old schoolchildren in Hoavang, Danang City. Methods From January to May 2023, a cross-sectional study was carried out utilizing a structured self-administered questionnaire to collect data. The height and weight measurements of 518 children were recorded. Body mass index for age Z scores (BAZs) were employed to classify children’s nutritional status following the World Health Organization criteria. Subsequently, the data were analyzed using SPSS version 25. Results The study encompassed a cohort of 518 students, 110 (21.2%) classified as overweight and 64 (12.4%) as obese. Significantly, the adjusted odds ratio (aOR) demonstrated that male subjects exhibited a 3-fold higher risk of overweight and obesity than female subjects (aOR = 2.9, P &lt; .0001). Skipping breakfast and confectionery/sweet food consumption were defined, demonstrating significant associations with elevated odds of being overweight and obese. Conclusion The findings revealed that approximately one-third of primary schoolchildren in Hoavang, Danang City, were affected by overweight and obesity. This alarming prevalence underscores the urgent need for interventions.

Prognostic Value of Hyperglycemia and Insulin Resistance Among Patients with Confirmed COVID-19 Infections at Admission to the Alexandria Fever Hospital, Egypt.

Background: The interaction between COVID-19 infection, hyperglycemia, and insulin resistance (IR) may lead to poor outcome. Methods: This prospective study included 100 adult participants without diabetes attending Alexandria Fever Hospital with confirmed COVID-19 infections. They were classified into four groups according to disease severity using World Health Organization (WHO) criteria. Demographic and clinical parameters were collected. Laboratory investigations were obtained. Another follow-up fasting plasma glucose (FPG) value was measured after 3 months in cured patients. Results: Admission FPG, follow-up FPG, lipid profile, markers of IR, and inflammation were significantly higher in severe and critical cases than in mild and moderate cases with increasing values with increased severity. Furthermore, these parameters were significantly higher in died cases compared with cured cases. Admission FPG, TyG index, and homeostatic model assessment (HOMA)-IR showed significant positive correlations with follow-up FPG. Admission FPG was the only independent mortality predictor in multivariate analysis (P = 0.027) with 1.7-folds increased mortality risk with each 10 mg/dL increments. Values exceeding 117 mg/dL, 2.2, and 6.33 for admission FPG, HOMA-IR, and Fasting Insulin Resistance Index, respectively, were able to predict mortality in the studied sample. Conclusions: These results will help in identifying patients at high risk of severe infection and death at admission and take early actions to improve outcome.

Profile of Multisystem Inflammatory Syndrome in Children (MIS-C) in Infants in North India during the Second Wave of SARS-CoV-2 Pandemic

Background: Multisystem inflammatory syndrome in children (MIS-C) secondary to severe acute respiratory syndrome coronavirus-2 has affected not only older children, adolescents, and adults but also infants, more so during the second wave of the global pandemic. Materials and Methods: All sequentially admitted infants hospitalized during 6 months who fulfilled the World Health Organization criteria for MIS-C or American Heart Association 2017 criteria for Kawasaki disease (KD) (and positive coronavirus disease-2019 [COVID-19] serology) were included in the present study. Results: A total of 19 infants were studied. Thirteen (68.3%) had evidence of recent COVID-19 infection. The median age of presentation was 2 months (interquartile range 25–75th, 0.5–3). The most common presenting symptoms were fever (68.4%), gastrointestinal complaints (63.1%), and edema (36.8%). Other predominant signs were shock (78.9%), myocarditis (52.6%), and neurological complaints (26.3%). Incomplete KD was present in 21% of patients. Elevated C-reactive protein, ferritin, D-Dimer, N-terminal prohormone of brain natriuretic peptide, and reduced fibrinogen were markers of severe illness. All subjects received intravenous immunoglobulin (IVIG) (100%), 31.5% received a second dose of IVIG, and 63.1% received pulse intravenous methylprednisolone. A total of 5 (26.3%) died as a result of the disease process. Conclusion: The spectrum of MIS-C in infants can be varied and is different from older children. A high index of suspicion is therefore needed in infants who present with critical illness and do not respond appropriately to conventional antibiotics and supportive care. The addition of IVIG and corticosteroids to the treatment regimen leads to a favorable outcome.

The Systemic Inflammation Index: A New Candidate Minor Criterion in the Diagnosis of Polycythemia Vera.

To investigate inflammation indices and erythropoietin levels for their potential role in distinguishing polycythemia vera from secondary polycythemia and to compare different parameter combinations in terms of the diagnostic accuracy. This retrospective cohort was created from patients assessed for polycythemia from January 2020 to December 2023. Polycythemia vera diagnosis was made according to the 2016 World Health Organization criteria (n = 145). Those who did not fulfill the criteria were defined as having secondary polycythemia (n = 84). The neutrophil lymphocyte ratio, platelet lymphocyte ratio and systemic immune-inflammation index were significantly higher in the polycythemia vera group (p < 0.001 for all). Erythropoietin had the highest area under the curve in the analysis to distinguish groups, followed by the systemic immune-inflammation index. The platelet lymphocyte ratio (≥135) had the highest specificity to detect polycythemia vera, followed closely by the systemic immune-inflammation index. The sensitivity for polycythemia vera detection was highest with the erythropoietin and systemic immune-inflammation index combination, followed by erythropoietin and the neutrophil lymphocyte ratio. All the single and combinatory variables exhibited significant performance in predicting polycythemia vera after adjusting for age and sex. However, the erythropoietin and systemic immune-inflammation index combination had the highest odds ratio, followed by erythropoietin alone. These are promising findings supporting the usability of these biomarkers, especially the systemic immune-inflammation index, as minor criteria in the diagnosis of polycythemia vera. It is especially crucial to note that using erythropoietin in combination with these markers may improve diagnostic accuracy.

Serum Ferritin Level Linked to Male Type-2 Diabetes Mellitus Patients Amongst Residents of Hyderabad, Sindh

Introduction: Diabetes mellitus is a metabolic disorder which is caused by either deficiency of insulin or its disturbed action on peripheral receptors. Globally it is estimated that 451 million peoples were suffering from Diabetes mellitus type 2 in 2017 and this burden will rise to 693million in 2045.The relationship between diabetes mellitus and serum ferritin levels is intricately linked, sharing a common intersection in the liver where both glucose metabolism and iron metabolism converge. Aims and Objectives: To measure the serum ferritin levels among residents of Hyderabad with type 2 Diabetes Mellitus. Place and Duration of study: The study was conducted in the Outpatient Department (OPD) of Liaquat university Hospital from June 2022 to August 2022 (3 months). Material and Methods: The study consists of 100 subjects divided into two groups, a control group consists of 50 normal healthy people with normal fasting glucose below 100mg/dl and a Case group consists of 50 patients with fasting glucose level more than 125 mg/dl according to World Health Organization criteria. Their Serum ferritin levels were evaluated using the ELFA method, employing a commercially available kit supplied by Roche Cobas Integra. The results were analyzed on the software Graph Pad Prism 9, p-value ? 0.05was taken as significant. Results: The frequency of Type 2 Diabetes mellitus was significantly higher in patients with increased serum ferritin levels (P=0.001) with an odds ratio of 1.838 , a sensitivity/specifity value of (0.50/0.56) and a robust likelihood ratio of 2.25. Conclusion: The study underscores a potential link between elevated serum ferritin and Diabetes Mellitus Type-2.

Thyroid dysfunction and semen quality among males investigated for infertility in Southern Nigeria

The relationship between thyroid and testis is well understood, and the association between changes in thyroid function and male infertility has been reported. However, the contribution of thyroid dysfunction to male infertility is not sufficiently addressed in our setting. This study aims to assess the thyroid hormones level among males undergoing investigation for infertility and to establish correlations between thyroid hormones and sperm indices. Thyroid hormones were determined in 150 infertile males and 50 fertile male controls. Semen analysis was done according to the World Health Organization criteria while thyroid hormones were determined using Enzyme linked Immunosorbent assay technique. The measured anthropometric data, sperm indices and thyroid hormone levels were compared using appropriate statistical tools. Serum triiodothyronine, and thyroxine levels were significantly lower (p &lt; 0.001), while thyroid stimulating hormone was higher among infertile males than control subjects. The body mass index of the infertile subjects was significantly higher (p &lt; 0.011) than control subjects. Of the 150 subjects, 41.33% (62/150) were euthyroid, 7.33% (11/150) had subclinical hypothyroidism while 51.34% (77/150) had overt hypothyroidism. Among the 88 altered thyroid function, 6.82% (6/88) had normozoospermia, 44.32% (39/88) had oligozoospermia while 48.86% (43/88) were azoospermia. The area Under the Curve of T3 (0.858), T4 (0.765) and sperm count (0.875) were able to differentiate fertile men from infertile subjects. Thyroid disorders are prevalent among infertile men and should be considered in the laboratory assessment of male infertility cases. Including thyroid function tests in the investigative panel can help identify and manage potential thyroid-related factors contributing to infertility. This comprehensive approach ensures thorough evaluation and targeted treatment for better reproductive outcomes in affected individuals.

Periodontal Health among Individuals with Intellectual Disabilities Living in a Saudi Institutional Rehabilitation Centre.

The aim of this study was to explore periodontal health among intellectually disabled individuals living in an institutional rehabilitation centre in the Al-Baha Region of Saudi Arabia. A cross-sectional study was conducted from November 2023 to January 2024. Clinical oral examinations were carried out using the World Health Organization criteria for bleeding sites and the presence of periodontal pockets. Simplified oral hygiene and community periodontal indices were employed to evaluate participants' oral health. A total of 89 participants, comprising both males and females with intellectual disabilities, were included in this study. Gender, severity of intellectual disability, type of additional physical disability, tooth brushing habits and oral hygiene status were significantly associated with the presence of periodontal disease. Additionally, poor oral hygiene, not brushing teeth and periodontal pockets of 4-5 mm and 6 mm or more were significantly more prevalent among individuals with severe and moderate intellectual disabilities (p = 0.001, p = 0.001, p = 0.001 and p = 0.001, respectively). The prevalence of periodontal disease among the studied population was 54%. The odds of having periodontal disease were significantly higher in the severe intellectual disability group compared to the mild intellectual disability group (OR = 2.328, 95% CI = 1.430-3.631, p = 0.03). It was also found that intellectually disabled participants with additional physical disabilities suffered more from periodontal disease than those without additional physical disabilities (OR = 0.971, 95% CI = 0.235-4.023, p = 0.025). Overall, individuals with intellectual disabilities had a significant demand for periodontal care. This study highlighted the need for more organised preventive programmes for individuals with intellectual disabilities. Dentists should be vigilant about improving periodontal health, focus on preventive programmes and provide comprehensive dental care with an emphasis on periodic recall and monitoring.

Nutritional quality and level of processing of food items broadcasted on Italian television in advertisements targeted to children

This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations.