World Health Organization Scale Research Articles

Oral mucositis assessment in pediatric and adolescent oncological patients: A systematic review.

Oral mucositis (OM) is a prevalent acute adverse effect of various cancer treatments. Accurate assessment of OM is vital for effective prevention and treatment strategies. However, a lack of validated pediatric instruments for evaluating OM can lead to unreliable data, and hinder interventional and epidemiological research. This study aims to evaluate the methods used for assessing OM in pediatric oncology patients. A systematic review of four databases and a manual search yielded 113 articles. Nine different scales were identified, with the World Health Organization (WHO) scale being the most commonly used (61.9%). The Children's International Mucositis Evaluation Scale (ChIMES) was used in 7.9% of the studies. Of the 8155 pediatric patients evaluated, 47.7% had both hematological malignancies and malignant solid tumors, while 46% had solely hematological malignancies. Despite the prevalence of the WHO scale, it lacks pediatric-specific criteria. Future OM research should incorporate validated tools like ChIMES for improved pediatric assessment.

Composite endpoints in COVID-19 randomized controlled trials: a systematic review.

This study aimed to determine the prevalence of ordinal, binary, and numerical composite endpoints among coronavirus disease 2019 trials and the potential bias attributable to their use. We systematically reviewed the Cochrane COVID-19 Study Register to assess the prevalence, characteristics, and bias associated with using composite endpoints in coronavirus disease 2019 randomized clinical trials. We compared the effect measure (relative risk) of composite outcomes and that of its most critical component (i.e. death) by estimating the Bias Attributable to Composite Outcomes index [ln(relative risk for the composite outcome)/ln(relative risk for death)]. Composite endpoints accounted for 152 out of 417 primary endpoints in coronavirus disease 2019 randomized trials, being more frequent among studies published in high-impact journals. Ordinal endpoints were the most common (54% of all composites), followed by binary or time-to-event (34%), numerical (11%), and hierarchical (1%). Composites predominated among trials enrolling patients with severe disease when compared to trials with a mild or moderate case mix (odds ratio = 1.72). Adaptations of the seven-point World Health Organization scale occurred in 40% of the ordinal primary endpoints, which frequently underwent dichotomization for the statistical analyses. Mortality accounted for a median of 24% (interquartile range: 6%-48%) of all events when included in the composite. The median point estimate of the Bias Attributable to Composite Outcomes index was 0.3 (interquartile range: -0.1 to 0.7), being significantly lower than 1 in 5 of 24 comparisons. Composite endpoints were used in a significant proportion of coronavirus disease 2019 trials, especially those involving severely ill patients. This is likely due to the higher anticipated rates of competing events, such as death, in such studies. Ordinal composites were common but often not fully appreciated, reducing the potential gains in information and statistical efficiency. For studies with binary composites, death was the most frequent component, and, unexpectedly, composite outcome estimates were often closer to the null when compared to those for mortality death. Numerical composites were less common, and only two trials used hierarchical endpoints. These newer approaches may offer advantages over traditional binary and ordinal composites; however, their potential benefits warrant further scrutiny. Composite endpoints accounted for more than a third of coronavirus disease 2019 trials' primary endpoints; their use was more common among studies that included patients with severe disease and their point effect estimates tended to underestimate those for mortality.

6479 Acute Estradiol and Progesterone Therapy In Hospitalized Adults With Moderate COVID-19: A Randomized Control Trial

Abstract Disclosure: D. Lovre: Research Investigator; Self; Novo Nordisk, Corcept Therapeutics. K.M. Bateman: None. L.Y. Saltzman,: None. M. Qadir: None. F. Mauvais-Jarvis: None. Background and Objective: COVID-19 outcomes are less severe in women vs men. Experimental studies show that estradiol (E2) and progesterone (P4) produce anti-inflammatory immune responses and immune tolerance and enhance antibody production. The effect of E2 and P4 combination on COVID-19 severity is unknown. The aim of the study was to evaluate the efficacy of a short systemic E2/P4 combination in mitigating COVID-19 severity in hospitalized men and women. Methods: Phase 2, double blind, placebo-equivalent controlled, single center trial of ten participants (men and women) who were hospitalized for COVID-19, with scores 3 to 5 on the 9-point World Health Organization (WHO) ordinal scale for clinical improvement. Participants were randomized into two arms and treated for five days: 1) E2 Cypionate (5 mg IM once) and micronized P4 (200mg, PO daily); and 2) Placebo-equivalent (normal saline (1ml, IM once) and folate (400mcgs, PO daily), in addition to standard of care (SOC). The primary outcome was the proportion of patients improving to scores 1 or 2 on the WHO scale on the day of discharge. Secondary outcomes included length of hospital stay (LOS), days on oxygen therapy (DOT), readmission rates (RR), adverse events (AEs) and change in inflammatory biomarkers assessed by untargeted proteomics. Findings: There were no significant differences between the treatment groups in COVID-19 severity by WHO score, LOS, DOT, RR or AEs. Patients in the E2/P4 arm exhibited a decrease in inflammatory biomarkers of respiratory and gastrointestinal disease (GI) and significant change in immune and inflammatory responses. Conclusions: Use of short-term systemic E2/P4 is associated with decrease in biomarkers of respiratory and GI disease inflammation and change in biomarkers of immune and inflammatory response. Presentation: 6/3/2024

Serum-derived bovine immunoglobulin treatment in COVID-19 is associated with faster resolution of symptoms: A randomized pilot clinical trial.

Effective treatment to prevent hospitalization and death in people with COVID-19 exists, but people still need interventions that alleviate symptoms without drug interactions. Oral serum-derived bovine immunoglobulins (SBI) may reduce symptoms and time-to-improvement in people with mild-to-moderate COVID-19. In this randomized, open-label, single-site study, participants with mild-to-moderate COVID-19 received SBI 5.0 g bis in die (BID) + Standard of Care (SOC) or SOC alone (2:1) for 2 weeks. After 2 weeks, 78.8% of hospitalized participants on SBI + SOC improved by World Health Organization (WHO) scale of ≥3 compared to 61.1% on SOC alone (odds ratio: OR = 2.4; p = 0.0663), with older participants (>57 years) showing more significant differences between the arms (OR = 6.1; p = 0.0109). Further, more participants on SBI + SOC reported absence of COVID-19 symptoms at Week 2 (74.2%) compared to SOC alone (43.6%; OR = 3.7; p = 0.0031), most notably the absence of dyspnea on exertion (OR = 4.4; p = 0.0047), with women exhibiting the most significant eradication of all symptoms (OR = 5.8; p = 0.0080). No difference in change of IL-6 between arms was observed. Overall, participants with mild-to-moderate COVID-19 on SBI + SOC had a shorter time-to-recovery than on SOC alone, with a significantly higher rate of complete resolution of symptoms. Dyspnea on exertion was the symptom most significantly impacted. For people with mild-to-moderate COVID-19, oral SBI could be a safe and effective intervention, devoid of drug interactions.

THE ROLE OF A HEALTHY LIFESTYLE IN MODERN NATIONAL EDUCATION

The description of a healthy lifestyle is provided in this scientifically grounded article. The sophisticated concepts of global civilizations are organized in this way. The adolescent stage is discussed, and the scientific definition of the importance of aesthetic values in the development of a healthy lifestyle is provided. The role of a healthy lifestyle in national education today was established, the content of its implementation in the educational process was created, and its effectiveness was confirmed in practical and experimental work based on the analysis of indicators of the World Health Organization's scale (WHOQOL-BREF) KAZ. Teenagers comprehend the concept of a healthy lifestyle and accurately assess its social value, which presents an opportunity to form individuals with the proper attitude toward a healthy lifestyle, strong health, beautiful soul, body, and work; In the historical evolution of human development, the concept of health and aesthetic values in the works of great scholars and educators, public figures, and the works of modern scientists are systematized and classified according to educational opportunities;the significance and necessity of aesthetic values for a proper and healthy life of teenagers is more widely propagated and implemented in the content of educational activities of the school; determined the content and system of forming a healthy lifestyle on the basis of aesthetic values through the possibilities of educational activities of the educational process at the main stage of the general education school, and scientifically differentiated the problem of its implementation. It is explained that it is possible to change the inner worldview of students, to educate a person who can deeply understand and maintain a healthy lifestyle.

Adjunctive Statin Therapy in Patients with Covid-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundThe efficacy and safety of adjunctive statin therapy in hospitalized patients with coronavirus disease 2019 (Covid-19) remains uncertain. MethodsWe systematically searched Medline, Embase, Cochrane, and ClinicalTrials.gov databases from inception to late April 2024 for randomized controlled trials (RCTs) comparing statin versus no statin use in patients hospitalized with Covid-19. We pooled risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) applying a random-effects model. R version 4.3.1 was used for statistical analyses. ResultsWe included 7 RCTs comprising 4,262 patients, of whom 2,645 (62%) were randomized to receive statin therapy. Compared with no statin, statin use significantly reduced case-fatality rate (RR 0.88; 95% CI 0.80-0.98; I2 = 0%). In a time-to-event analysis, we found similar results (HR 0.86; 95% CI 0.75-0.99; I2 = 0%). Statin use also significantly reduced World Health Organization (WHO) scale at 14 days (mean difference -0.27; 95% CI -0.54 to -0.01; I2 = 0%). There was no statistically significant difference between the two groups in length of hospital stay, elevation of liver enzymes, and C-reactive protein levels. ConclusionsIn patients hospitalized with Covid-19, statins significantly reduced case-fatality rate and WHO scale score. RegistrationA prospective register was recorded in International Prospective Register of Systematic Reviews (PROSPERO) with the number CRD42023479007.

Phase I study of copaiba aqueous mouthwash in patients with head and neck cancer undergoing radiotherapy.

e24103 Background: Due to the contraindication of low-power laser therapy in the tumor region, the use of copaiba for the management of oral mucositis was proposed, given its anti-inflammatory, antimicrobial and healing properties. This study aimed to evaluate the dose-limiting toxicity/maximum tolerated dose of copaiba aqueous mouthwash solution. Methods: This is a phase I study including patients with cavity or oropharynx cancer (CID-10 C00-C06,10), undergoing radiotherapy alone or associated with chemotherapy. Six successive cohorts were proposed, with a minimum of 3 patients each. The copaiba aqueous mouthwash was used daily starting on the first day of radiotherapy and up to 37 days, associated with Low Power Laser applications (100Mw, 660nm, beam area 0.09842 cm²,1J) in non-tumoral areas. In cohorts 1, 2, and 3, a 10% solution was used, and in cohorts 4, 5, and 6, 15%, 2, 3 and 4 times a day, respectively. Daily assessment was carried out evaluating the presence of oral mucositis lesions (World Health Organization and Oral Mucositis Assessment Scale) and complaints of pain (CTCAE v5.0 and Visual Analogue Pain Scale) and xerostomia (presence or absence). Sialometry was carried out through the collection of unstimulated saliva (by Davies (2002) criteria), once a week. Results: Twenty patients were included (cohort 1 = 5, cohort 2 = 3, cohort 3 = 3, cohort 4 = 3, cohort 5 = 3, cohort 6 = 3) - 1 patient was excluded and 1 discontinued from cohort 1 (due to changes in radiotherapy planning and non-adherence to dentistry appointments). A total of 19 participants used the mouthwash. Most of the participants were women (57.9%), with a median age of 63.2 years, and performance status 1 (84.2%). Most tumors were squamous cell carcinomas (84.2%), 47.4% of them in the palate; 57.9% were staged as IVA. Themedian total radiotherapy dose was 68.0 (60.0-70.0) Gy delivered in 33.0 (30.0-34.5) fractions. Pain in the oral cavity (73.7%) and oropharynx (52.6%) were referred, graded respectively as 4.5 (0.75-7) and 1.5 (0-6). Oral mucositis was classified as grade 3 at most; none of the patients developed grade 4 or had to have radiotherapy interrupted due to toxicity. Ulcerated lesions of oral mucositis developed in the tumor area in 68.4% of patients and non-tumor areas in 84.2%. Patients complained of xerostomia in 73.7% of cases and the median unstimulated sialometry was 0.17mL/min. None of the patients experienced dose-limiting toxicity related to the copaiba solution. Conclusions: Copaiba mouthwash did not trigger dose-limiting toxicity in any of the patients throughout the study, leading to amaximum tolerated dose of 15%, 4 times/day. None of the patients complained of pain or burning related to the use of mouthwash in the absence of oral mucositis lesions, suggesting that it is safe and non-toxic for this use. In this sense, considering the obtained results, the development of a phase II study becomes the next logical step in this research area. Clinical trial information: ID - 34635020.5.0000.5274.

A Study of the association of neurocognition with relapse and quality of life in patients of alcohol dependence

Background: Alcohol is a widely consumed substance associated with around 5.6% of all causes of death. Alcohol use disorder (AUD) is a chronic relapsing and remitting illness and has been known to be associated with impaired executive functions, processing speed, memory, attention, and fluency. It is also associated with impaired quality of life (QoL), which in turn can affect overall prognosis. Aim: To assess neurocognition in patients with alcohol dependence and correlate it with QoL and relapse. Materials and Methods: This study was a prospective, longitudinal study of sixty alcohol dependence patients from January 2020 to June 2021 after appropriate ethical approval. Participants were assessed for baseline alcohol dependence, neurocognition (focused, sustained and divided attention; processing speed; verbal and category fluency; working memory; response inhibition; verbal comprehension; verbal learning and memory; visuospatial construction; visual learning and memory) and QoL using Alcohol Use Disorders Identification Test (AUDIT), National Institute of Mental Health and Neurosciences (NIMHANS) battery for neurocognition and WHO-BREF (WHO-Quality of Life-short-form scale) World Health Organization-scale, respectively. A follow-up was conducted in three months to assess relapse in the patients. Statistical analysis was conducted by International Business Machines Statistical Package for the Social Sciences (IBM SPSS) v16. Results: Mean age of the study participants was 41.3 ± 5.03 years, mean age of onset of alcohol use was 20.88 ± 4.27 years, mean duration of alcohol use of 16.6 ± 7.92 years, and average 14.55 ± 4.86 drinks per day. The mean AUDIT score of the study population was 25.21 ± 7.18. There was significant positive correlation between duration of use and CTT-2; 37 out of 57 participants relapsed to alcohol (three participants had died in follow-up) with mean 37.48 ± 23.27 days of relapse, mean 3.32 ± 1.2 drinking days per week, and mean 6 ± 1.2 drinks per drinking day. There was negative and positive correlation between neurocognition and relapse and between neurocognition and QoL. Conclusion: Alcohol use also resulted in impaired cognitive function of the study participants. There was also significant difference in score for neurocognition test between relapse and abstinent group. The significant correlation between neurocognition and QoL as well as neurocognition and relapse proves the deleterious effect of alcohol in every aspect of life.

Window therapeutic of extraoral photobiomodulation for prevention of oral mucositis in HSCT patients: additional arm.

This study aimed to evaluate the efficacy of 1W extraoral photobiomodulation (EOPBM) and to compare with our previous results of 2W EOPBM and intraoral photobiomodulation (IOPBM) protocols in the management of oral mucositis (OM) related to hematopoietic stem cell transplantation (HSCT). A total of 30 patients underwent autologous or allogenic HSCT. Experimental protocol of 1W EOPBM was performed daily beginning in the first day of the conditioning regimen until 5days after transplantation. The application areas included six points on the face and three points on the cervical area. Additional application of IOPBM was performed if patients had ulcered mucositis. Its severity was assessed daily according to WHO (World Health Organization) and NCI (National Cancer Institute) scales. Oral and oropharynx pains were scored daily by visual analogue scale (VAS). The 1W EOPBM protocol was well tolerated without any complaints. Of total, 13 patients were male and 17 were female and the mean age was 49.3years old. Most patients (21 patients - 70%) received autologous HSCT, and 24 patients (80%) underwent myeloablative conditioning (MAC) regime and 6 patients (20%) reduced intensive conditioning regime. Nineteen patients (63.3%) developed OM according to WHO criteria, 3 patients grade I, 10 grade II and 6 grade III. NCI mucositis grades were similar to WHO grades. OM outcomes of 1W EOPBM were similar when compared to our previous groups and no significant differences were observed. No differences were found between pain and the protocols (1W EOPBM, IOPBM and 2W EOPBM). This 1W EOPBM protocol seemed to be as effective as IOPBM and 2W EOPBM in the prevention of OM in HSCT patients. In addition, we might assume that there is a window of application on EOPBM.

Symptoms of depression, anxiety and stress in health students and impact on quality of life.

to evaluate the association between quality of life and presence of symptoms of depression, anxiety, and stress in college students in the health area. cross-sectional study that included 321 students from undergraduate courses in the health area. Quality of life was measured using the World Health Organization scale, abbreviated version, in the physical, psychological, social relations and environment domains, and symptoms were assessed by the depression, anxiety and stress scale. Multivariate analysis was performed using robust linear regression to evaluate the association between quality of life and symptoms. a negative association was observed between the quality of life and depression symptoms in all domains, while anxiety symptoms showed a negative association in the environment domain, and stress symptoms had a negative association in the psychological domain. Symptom severity was unfavorably associated with quality of life, that is, the greater the symptom severity, the lower the mean scores in all domains. symptoms of depression, anxiety, and stress were prevalent and had a negative impact on students' quality of life, especially in the presence of depressive symptoms. The decrease in scores was significantly associated with the severity of symptoms.

Sintomas de depressão, ansiedade e estresse em estudantes da saúde e impacto na qualidade de vida

Objective: to evaluate the association between quality of life and presence of symptoms of depression, anxiety, and stress in college students in the health area. Method: cross-sectional study that included 321 students from undergraduate courses in the health area. Quality of life was measured using the World Health Organization scale, abbreviated version, in the physical, psychological, social relations and environment domains, and symptoms were assessed by the depression, anxiety and stress scale. Multivariate analysis was performed using robust linear regression to evaluate the association between quality of life and symptoms. Results: a negative association was observed between the quality of life and depression symptoms in all domains, while anxiety symptoms showed a negative association in the environment domain, and stress symptoms had a negative association in the psychological domain. Symptom severity was unfavorably associated with quality of life, that is, the greater the symptom severity, the lower the mean scores in all domains. Conclusion: symptoms of depression, anxiety, and stress were prevalent and had a negative impact on students’ quality of life, especially in the presence of depressive symptoms. The decrease in scores was significantly associated with the severity of symptoms.

Safety and Efficacy of Outpatient Myeloablative Busulfan Conditioning in Allogeneic Stem Cell Transplantation

INTRODUCTION: Busulfan-based regimens are the backbone of myeloablative conditioning (MAC) in allogeneic hematopoietic stem cell transplant (allo-HSCT), particularly for patients (pts) with Acute Myelogenous Leukemia (AML). However, literature on busulfan conditioning administered in the outpatient (OP) setting is limited. Here, we investigate the safety and efficacy of OP busulfan as compared to standard inpatient (IP) administration. METHODS: Pts > 18 years of age who received pharmacokinetically dose adjusted IV busulfan (130 mg/m2 x 4 days) conditioning prior to HSCT between January 2019 and April 2023 at our institution were included in this retrospective analysis. Pts who received non-myeloablative conditioning or who underwent a haploidentical HSCT were excluded. All pts undergoing HSCT were classified as having low-, intermediate-, or high-risk disease by the Disease Risk Index. Pts with AML were classified as having favorable, intermediate, or adverse disease by 2022 ELN classification. CIBMTR guidelines were used to determine neutrophil and platelet engraftment. Oral mucositis was graded per the World Health Organization scale. Clinical grading of acute graft-vs-host disease (AGVHD) was assigned per standard criteria. Adverse events (AEs) were reported in accordance with the CTCAE, v.5. Categorical variables were compared using the Fisher's Exact test. Continuous variables were compared using the Wilcoxon Rank-Sum test. Overall survival (OS) was defined as time from HSCT to time of death from all-cause mortality. Relapse-free survival (RFS) was defined as time from HSCT to time of relapse or non-relapse mortality. The Kaplan-Meier method was used to estimate OS and RFS. Survival differences between cohorts were compared using the Log-rank test. All hypothesis testing was two-sided and conducted at a significance level of 0.05. RESULTS: In total, 54 pts met eligibility criteria; 43 IP and 11 OP. The OP cohort was younger than the IP cohort (35 years vs 47 years median age; p=0.0284). All other patient, disease, and transplant characteristics were similar between cohorts. The majority of pts were male (IP: 56%, OP: 55%) and White/Caucasian (IP: 100%, OP: 91%). AML (IP: 88%, OP: 82%) was the most common indication for HSCT. Most pts were in CR1 (IP: 74%, OP: 89%) and had intermediate risk disease by both DRI (IP: 84%, OP: 64%) and 2022 ELN classification (IP: 62%, OP: 67%). PBSCT (IP: 88%, OP: 91%) and 10/10 MUD (IP: 67%, OP: 45%) were the most common types of HSCT. The majority of pts received a conditioning regimen of Flu/Bu4 (IP: 58%, OP: 55%). The use of PTCy was comparable between groups (p=0.6593). Of the 11 pts who received OP busulfan, 1 had to complete their conditioning IP after experiencing a seizure in the setting of prior meningitis. Between the 2 cohorts, there was no significant difference in the incidence of AEs > grade 2 (p=1), grade 2 AEs (p=0.8695), grade 3 AEs (p=0.7592), grade 4 AEs (p=0.2487), and grade 5 AEs (p=0.6457) within 30 days of conditioning. Incidences of transplant-related GI toxicities, including nausea (p=1), vomiting (p=0.4979), diarrhea/enteritis (p=1), and mucositis (oral: p=0.6102, GI: p=0.2821) were similar. There was no difference in time to neutrophil (p=0.1606) or platelet engraftment (p=0.9742). Length of hospitalization was shorter in the OP vs IP cohort (18 vs 24 days; p<0.0001). During hospitalization, there was no difference in the incidences of neutropenic fever (p=1), infection (p=0.5104), ICU transfer (p=1), or engraftment syndrome (p=0.7076). Number of infections per patient during hospitalization were comparable (p=0.3764). D30 chimerism was similar IP vs OP. Within 180 days of HSCT, there was no difference in the incidence of AGVHD (p=0.5152) or Grade II-IV AGVHD (p=1). Differences in 2-year OS (LR=0.2200) and 4-year RFS (LR=0.3144) were not significant. CONCLUSION: In pts undergoing MAC allo-HSCT with IV busulfan,OP administration shortens the length of hospitalization without delaying engraftment or increasing the risk of toxicity, neutropenic fever, infection, or ICU admission. Additionally, D30 chimerism, rates of engraftment syndrome and AGVHD, and survival were not affected. This makes OP busulfan an attractive option for transplant centers and their pts.

Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients.

Coronavirus disease 2019 (COVID-19) caused a progress in research to find a solution to this pandemic. Also, various advances in pharmacotherapy against COVID-19 have emerged. Regarding antiviral therapy, casirivimab and imdevimab are antibodies combination against COVID-19. Standard antiviral therapy against COVID-19 includes remdesivir and favipiravir. The objectives were to compare progression and multi-organ function of hospitalized COVID-19 patients between these three antiviral groups. 265 COVID-19 hospitalized patients were included in this study and were divided into 3 groups (1:2:2), respectively, Group (A): casirivimab and imdevimab, group (B): remdesivir, and group (C): favipiravir. The design of the study is a single blind non-randomized controlled trial. This study is a phase IV clinical trial (post-marketing study). The duration of the study was about 6 months after receiving the ethical approval. Casirivimab and imdevimab achieved less case progression as presented by lower World Health Organization scale (P < 0.05 in comparing group A with B and C) and better multi-organ functions as presented by lower Sequential Organ Function Assessment score (P < 0.05 in comparing group A with B and C) than remdesivir and favipiravir. From all these results, it is concluded that Group A (casirivimab and imdevimab) produces better outcomes than B (remdesivir) and C (favipiravir) intervention groups.

CDC42-A promising immune-related target in glioma.

Glioma is the worst prognostic neoplasm in the central nervous system. A polarity-regulating GTPase in cells, known as cell division cycle 42 (CdC42), has been proven to have its overactivation tightly connected to high tumor malignancy. The RNA-seq and protein expression of CDC42 in tumor and comparison tissues were analyzed based on the online tools; CDC42 was remarkably boosted in tumor tissues compared to normal controls. A total of 600 patients in the analysis set from The Cancer Genome Atlas (TCGA) database and 657 patients in the validation set from the Chinese Glioma Genome Atlas (CGGA) database were adopted. The expression of CDC42 in clinical features and biological functions of glioma was analyzed, including differential expression analysis, survival analysis, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and immune infiltration analysis. The enrichment of CDC42 was shown to be strongly associated with poor prognosis and terrible clinical indexes of glioma, including higher World Health Organization scale grade, wild-type isocitrate dehydrogenase 1 expression, O6-methylguanine-DNA methyltransferase non-methylated status, and 1p19q non-codeletion status (p < 0.0001). Functional enrichment analysis showed that CDC42 was highly correlated with immune and inflammatory responses in glioma. Additionally, the concentration extent of CDC42 was closely related to immune infiltration, immune checkpoints, and regulatory T (Treg) cell markers (CD4, CD25, and CD127). All evidence suggested that CDC42 may be a potential target for glioma immunotherapy.

Factors Associated with 28-day Critical Illness Development During the First Wave of COVID-19.

This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic. We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020. The most common presenting symptoms were cough, dyspnea, and fatigue. Critical illness developed in 45 (9.4%; 95% CI=7.0%-12.4%) patients. In the multivariable analysis, age (hazard ratio (HR)=1.05, p<0.001), number of comorbidities (HR=1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR=2.12, p=0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, p=0.03) were independently associated with critical illness development. The World Health Organization (WHO) ordinal scale for clinical improvement on admission was the strongest predictor of critical illness (HR=4.15, p<0.001). The patients hospitalized at the end of the study period had a much better prognosis compared to the patients hospitalized at the beginning (HR=0.14; p=0.02). The C-index of the model was 0.92. Age, comorbidity number, the WHO scale, LDH, and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seemed to be decreasing as the first wave of the pandemic advanced. Graphic Abstract.

Optimization of treatment of patients of older age groups with osteoporosis and fractures of the proximal femur

BACKGROUND: Osteoporosis is mainly found in elderly people, often leading to fractures of the proximal part of the femur, and can worsen the patients quality of life. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups (elderly, senile age, and centenarians according to World Health Organization criteria) with fractures of the proximal femur (S72.0, S72.1, S72.2. according to International Classification of Diseases 10th Revision) and with concomitant osteoporosis.&#x0D; AIM: To improve the treatment results of patients of older age groups with fractures of the proximal femur by modernizing and developing new methods for implant fixation.&#x0D; MATERIALS AND METHODS: 322 patients with fractures of the proximal femur with the presence of II and III degree of osteoporosis, who were treated at the Hospital for War Veterans in Saint Petersburg from 2017 to 2020 were included for the analysis. All the patients were divided into two groups depending on the methods of the treatment used. The first group consisted of 145 patients treated with the proposed method. The patients of the 2nd group (177 people) were treated using the traditional method. To assess the immediate results, the anatomical and functional result and possible complications (false joint, delayed consolidation of fragments, shortening of the damaged lower limb, dislocation of the endoprosthesis, migration of metal structures, osteomyelitis) were studied. The results were evaluated according to Lekens functional index, and the quality of life was assessed according to the World Health Organization scale.&#x0D; RESULTS: In 52.5% of the paients from the first group, good outcomes were obtained after 6 months according to the Lekens scale, while in group 2 such results were demonstrated only in 21.6% of the patients, and a year later, in 53.7% and 19.1%, respectively. In the first group, 13 patients (12.0%) had unsatisfactory outcomes after a year, 12 (13.5%) after 3 years, while in the second group 36 patients (31.3%) had unsatisfactory outcomes after a year, and 38 (35.8%) after 3 years.&#x0D; CONCLUSIONS: As a result, the use of the proposed method for providing care to patients with fractures of the proximal femur ensures significant improve (p 0.01) of the treatment outcomes for this category of patients.

Efficacy of curcumin for amelioration of radiotherapy-induced oral mucositis: a preliminary randomized controlled clinical trial

BackgroundOral mucositis (OM) is one of the main problems in almost all patients undergoing head and neck radiotherapy (RT). Owning to the antioxidant and anti-inflammatory properties of curcumin, the effect of both oral and topical formulations of curcumin was assessed on radiation-induced OM (ROM) in this study.MethodsThe safety and efficacy of curcumin mouthwash 0.1% (w/v) and curcumin-nanocapsule were evaluated in ameliorating severity and pain/burning associated with OM during RT. The current randomized, placebo-controlled trial was conducted on 37 patients with head and neck cancers. Patients with grades 1 to 3 of ROM were randomized to receive one of the three interventions: curcumin mouthwash (0.1% w/v); Sinacurcumin soft gel containing 40 mg curcuminoids as nano-micelles (SinaCurcumin®40); or placebo mouthwash with a similar transparent appearance to curcumin mouthwash for 1 min three times daily during RT. Study evaluations were conducted at baseline and weekly thereafter for up to 3 weeks using the Numeric rating scale (NRS) and world health organization (WHO) scale.ResultsAmong the 45 patients randomized, 37 (mean (SD) age of 53.36 (15.99) years; 14 [37.8%] women) completed the treatment according to the protocol. Patients treated with either oral or topical curcumin showed a significantly reduced severity and burning related to OM during the first 3 weeks after administration (P-Value < 0.001) as compared with the placebo. At study termination, more than 33% of subjects utilizing curcumin mouthwash and 15% of patients utilizing curcumin-nanocapsule remained ulcer free while all of the placebo-receiving subjects had OM. The reduction of NRS and WHO scale between curcumin groups was comparable without significant differences.ConclusionBoth curcumin mouthwash and nanocapsule were effective, safe, and well-tolerated in the treatment of radiation-induced OM. Higher doses of curcumin and larger sample sizes can be used for further investigation in future studies.Trial registration:https://irct.ir/ IRCT20190810044500N17 (13/08/2021).

Assessment of Cytological Changes in the Oral Mucosa in Young Hematological Patients Treated with Systemic Chemotherapy

The primary objective of the undertaken study was to determine the morphological changes that occur within the oral epithelium in children undergoing chemotherapy following a diagnosis of hematological malignancies. The study group consisted of 18 patients diagnosed with leukemia or lymphoma undergoing treatment with chemotherapy. Swabs (liquid-based cytology) were collected from the oral cavity for microscopic evaluation at baseline, during the chemotherapy cycle with oral mucositis symptoms present, and upon completion of the cycle. Both the neutrophil count and oral mucositis (OM) were registered using the WHO (World Health Organization) scale. The control group included 41 children who were generally healthy. All samples underwent microscopical analyses at the Department of Pathology, Medical University of Gdansk, Poland. A total of 190 cytological preparations were evaluated. The baseline preparations revealed similar cytological images, and the superficial cells of the epithelial layers were seen. A significant (p < 0.01) increase in the number of cells in the intermediate layer of the oral epithelium, as well as a decrease (p < 0.01) in the volume of cells in the superficial layers, was observed in further stages of cytostatic treatment. A decrease in the percentage of superficial epithelial cells with a corresponding increase in the number of intermediate epithelial cells is considered to be a result of toxic damage to the oral mucosa during chemotherapy.

Isoniazid-induced acute psychotic episode in a child with lymph nodes tuberculosis: case report and literature review

Introduction Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis and is a major public health problem in Morocco. The World Health Organization (WHO) recommends a four-drug combination therapy for two months (isoniazid (INH), rifampicin, pyrazinamide and ethambutol), followed by two drugs (INH and rifampicin) for 4 months, as first-line treatment for newly diagnosed pulmonary TB in children and adults. This regimen is generally considered effective, safe, and cost-effective. However, adverse effects and drug interactions often complicate the treatment of TB. Isoniazid is associated with 32% of adverse events, of which 1.9% are psychiatric. Objectives focus on drug-induced etiologies of acute psychotic symptoms make the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition. focus on drug-induced etiologies of acute psychotic symptomsmake the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition. Methods The patient and guardians were interviewed to obtain information after their consent. Data from the patient profile forms and laboratory test reports were evaluated. Causality assessment was done by the WHO scale and the Naranjo scale. Oral informed consent was obtained from the patient and parents. Results We report a case of acute psychosis in a child with a temporal sequence strongly in favor of INH-induced psychosis. Treatment with risperidone at an appropriate dose improved the symptomatology while waiting for the end of the antituberculosis protocol. As soon as the isoniazid was stopped, there was a clear return to the child’s premorbid state. Conclusions The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic. As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background. The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background. Disclosure of Interest None Declared

The efficacy of honey or olive oil on the severity of oral mucositis and pain compared to placebo (standard care) in children with leukemia receiving intensive chemotherapy: A randomized controlled trial (RCT)

BackgroundOral mucositis (OM) is a significant complication occurring in approximately 40 to 80% of patients receiving chemotherapy regimens. Although a wide variety of agents have been tested to prevent OM or reduce its severity, none have provided conclusive evidence. ObjectivesTo determine the efficacy of honey or olive oil on the severity and OM pain in children with leukemia and suffering from OM compared to placebo (standard care) and, to assess which of the two interventions is more beneficial. MethodsA single blind randomized controlled study (RCT) was used to evaluate the effect of Manuka honey or olive oil, in the treatment of chemotherapy-related OM in 42 children with leukemia. The primary outcome was the severity of mucositis, using the World Health Organization (WHO) scale and the secondary outcome was the pain assessed using the Visual analogue scale (VAS). ResultsChildren who received the honey had less severe OM (assessed on the (WHO) scale), p = 0.00 and less pain (assessed on the VAS scale), p = 0.00, compared to the control group. Children who received the olive oil had less pain than the control group, p = 0.00), although not lower than the honey group. ConclusionManuka honey or olive oil can be used as alternative therapies by nurses to children with leukemia and suffering from OM, especially in low and middle-income countries where more expensive therapies may not be available or economical. Practice implicationsPediatric nurses may recommend Manuka honey to treat OM in children with leukemia as it is safe and inexpensive compared to other treatment modalities.