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Background: Numerous studies have investigated the molecular properties that contribute to the symptoms of COVID-19, such as the virus's genetic makeup, its replication mechanisms, and how it interacts with host cells. However, identifying the immunopathological properties, such as the immune system's response, cytokine levels, and the presence of specific biomarkers, that are associated with the severity of the infection remains crucial for developing effective treatments and preventions. Methods: We analyzed blood protein factor profiles from 420 individuals to identify features differentiating between test-negative healthy, asymptomatic, and symptomatic individuals using statistical comparison and the least absolute shrinkage and selection operator (i.e., LASSO) algorithm. Additionally, we examined single-cell RNA sequencing data from 141 individuals to identify specific cell types associated with the COVID-19 symptoms. Results: Healthy individuals who tested negative had distinct blood protein factor levels compared to asymptomatic individuals. We identified two key protein factors, Serpin A10 and Complement C9, that differentiate between asymptomatic and symptomatic patients. Symptomatic patients showed lower levels of CD4+ T naïve, CD4+ T effector & memory, and CD8+ T naïve cells, along with higher levels of CD14+ classical monocytes compared to asymptomatic patients. Additionally, CD16+ non-classical monocytes, major producers of C1QA/B/C, appeared to contribute to the observed Complement C9 levels. Conclusions: These findings advance our understanding of the immunopathological mechanisms underlying COVID-19 and may inform the development of targeted therapies and preventative measures. Future research should focus on further elucidating these mechanisms and exploring their potential clinical applications in managing COVID-19 severity. [ABSTRACT FROM AUTHOR]

Motorcyclist fatalities have risen in Latin and Asian countries, highlighting the necessity for a systematic approach through the Safe System (SS) to achieve zero fatalities. Traditional studies often rely on data-driven methodologies, which may lead to biased results and may fall short of capturing the systematic SS perspective. This paper develops a causal analysis of crash severity involving motorcyclists based on the SS approach and Pearl's causal inference paradigm, using observational data. Initially, the main sources of bias related to traditional categorical modeling applied to crash severity analysis were illustrated through a simulation example. Subsequently, a literature review was conducted to establish a conceptual framework rooted in the SS. Finally, causal hypotheses were formulated and tested using structural equation modeling applied to data collected from motorcyclist crashes on federal highways in the state of Ceará/Brazil. The outcomes of the causal model support the initial hypothesis that alcohol use significantly contributes to the severity outcome of motorcycles-related crashes. The model unveils a noteworthy association between weekends and alcohol consumption and an inclination among younger individuals toward newer motorcycles with more powerful engines. The adoption of a causal approach enhances result reliability by controlling for confounding variables and incorporating a theoretical framework. [ABSTRACT FROM AUTHOR]

We aimed to assess the performance of common pneumonia severity scores, such as pneumonia severity index (PSI), CURB-65, CRB-65, A-DROP, and SMART-COP, in predicting adverse outcomes in elderly community-acquired pneumonia cohort and to determine the optimal scoring system for specific outcomes of interest. A total of 822 elderly inpatients were included in the retrospective cohort study. Clinical and laboratory results on admission were used to calculate the above scores. The primary outcome was 30-day mortality. Secondary outcomes were in-hospital mortality, need for mechanical ventilation (MV) and ICU admission. Model discrimination was evaluated by the area under receiver operating characteristic curves (AUCs). The 30-day and in-hospital mortality rates were 6.8% (56/822) and 8.6% (71/822), respectively. One hundred and ninety-eight (24.0%) received MV and 111 (13.5%) were admitted to the ICU. All five scoring systems showed the same trend of increasing rates of each adverse outcome with increasing risk groups (all p < 0.001). PSI had the highest AUC, sensitivity, and negative predictive value (NPV) in predicting 30-day mortality and in-hospital mortality. SMART-COP had the highest AUC for predicting the need for MV and ICU admission, but PSI had the highest sensitivity and NPV for these two outcomes. PSI performed well in identifying elderly patients at risk for 30-day mortality and its high NPV is helpful in excluding patients who are not at risk. Considering their effectiveness and simplicity, SMART-COP and CURB-65 are easier to perform in clinical practice than PSI. [ABSTRACT FROM AUTHOR]

Background: Little is known about factors associated with the severity of cleft lip with or without cleft palate (CL/P) especially during the COVID-19 pandemic with its dramatic changes. Objectives: The aim of this multi-national study is to measure the association between CL/P severity, COVID-19 infection, and fear of COVID-19 in five Arab countries. Methods: This cross-sectional study took place in major governmental hospitals in five Arab countries from November 2020 to April 2023. Participants were infants born with CL/P and their mothers who were in their 1st trimester during the COVID-19 pandemic. Clinical examination was carried out, and CL/P cases were grouped according to phenotype: cleft lip and palate (CLP) versus cleft lip (CL), cleft extension (incomplete versus complete), and site (unilateral versus bilateral) to assess severity. Information on maternal COVID-19 infection and fear of COVID-19 were gathered. Results: The study recruited 273 CL/P infants. Maternal COVID-19 infection during one-month pre-gestation and 1st trimester was significantly associated with higher odds of CL/P severity (AOR = 2.707; P = 0.002) than mothers without the COVID-19 infection. Using supplements during pregnancy showed a protective effect (AOR = 0.573; P = 0.065). Conclusion: Mothers infected with COVID-19 before and during pregnancy had more than twofold higher odds of having an infant with a more severe CL/P phenotype. [ABSTRACT FROM AUTHOR]

The association between the fibrinogen-to-albumin ratio (FAR) and intracranial arterial stenosis (ICAS) in patients with acute ischemic stroke (AIS) has not yet been reported. In this large-scale investigation, 7894 AIS patients with ICAS-evaluation imaging data from the Third China National Stroke Registry were included. ICAS was defined as >50% stenosis of the intracranial arteries. We dichotomized the degree of ICAS into stenosis and occlusion. The number of ICAS lesions was the total number of intracranial stenotic arteries. Fibrinogen and albumin levels were assessed in the central laboratory of Beijing Tiantan Hospital. Univariate and multivariate analyses with logistic regression were used to determine the association between the FAR quartiles and ICAS. A total of 3900 (49.66%) patients had ICAS. Compared with those of the lowest FAR quartile, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the highest FAR quartile were 1.26 (1.10–1.44), 1.15 (.99–1.33), and 1.19 (1.01–1.39) for ICAS, symptomatic ICAS, and asymptomatic ICAS, respectively. An elevated FAR was also associated with occlusion (adjusted OR: 1.28, 95% CI: 1.10–1.49) and lesion number ≥2 (adjusted OR: 1.25, 95% CI: 1.07–1.45). [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) has significant social and economic consequences in addition to health implications. Alcohol and drug use are linked to violence, particularly intimate partner violence and domestic violence. Identifying the characteristics of individuals with AUD and a history of domestic violence is important. Our study aimed to investigate differences between AUD patients with and without domestic violence. This retrospective study examined the medical records of individuals diagnosed with AUD participating in a central Taiwan alcohol treatment program from 2019 to 2020. Utilizing the Cut down, Annoyed, Guilty, and Eye-opener questionnaire (CAGE), Alcohol Use Disorders Identification Test (AUDIT), Brief Michigan Alcoholism Screening Test (MAST), Beck Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), World Health Organization Quality of Life (WHOQOL), and a question on suicidal ideation, we collected data on diverse variables, including a history of domestic violence. A total of 136 individuals were included in the analysis. Twenty participants had a history of domestic violence, while 116 did not. Those with a history of domestic violence had significantly higher MAST scores, lower quality of life, and higher caregiver burden compared to those without a history of domestic violence. They also had a higher proportion of adverse consequences related to alcohol use and higher suicidal ideation scores. It is important to assess the risk of domestic violence in individuals with AUD, particularly those with higher MAST scores. Questions 4 and 10 of the MAST, which relate to adverse consequences of alcohol use, such as losing friends or being arrested for drunk driving, could serve as warning questions for domestic violence. Further research is needed to assess the efficacy of interventions in reducing domestic violence risk in individuals with AUD. • AUD patients with domestic violence history had higher MAST scores, lower quality of life, and increased caregiver burden. • AUD patients with domestic violence history showed more adverse alcohol use consequences and higher suicidal ideation. • AUD patients with domestic violence history experienced greater mental health challenges, including more severe suicidal thoughts. [ABSTRACT FROM AUTHOR]

To compare match injury incidence, severity and burden in men's and women's elite rugby league. A prospective cohort epidemiological study. Time loss match injury data were collected from all men's (11,301 exposure hours) and women's (5,244 exposure hours) Super League clubs. Injury incidence and burden were not different between men and women (mean [95 % CI]; 54 [45 to 65] vs. 60 [49 to 74] per 1000 match-hours; p = 0.39, and 2332 [1844 to 2951] vs. 1951 [1560 to 2440] days lost per 1000 match-hours; p = 0.26). However, injury severity was greater for men than women (42 [35–50] vs. 35 [29 to 42]; p = 0.01). Lower limbs accounted for 54 % and 52 % of injuries for men and women, with the head/face the most frequently injured location due to concussion (12 [10 to 15] and 10 [8 to 14] per 1000 match-hours for men and women). Injuries to the knee had the greatest burden for men and women (708 [268–1868] and 863 [320–2328] days lost per 1000 match-hours). Being tackled was the most common injury mechanism for men and women (28 % and 38 %) with greater burden (p < 0.01) than other injury mechanisms. Male and female rugby league players have similar injury incidence and burden; however, injury severity was higher in men. Head/face injuries have the highest injury incidence and knee injuries have the highest burden. These injuries should be the focus for prevention initiatives at a league (via laws), player, and coach level, with equal and specific focus for both men's and women's rugby league players. [ABSTRACT FROM AUTHOR]

Black sigatoka, or black leaf streak (BLS), is caused by Pseudocercospora fijiensis and is the most important foliar disease in Musa production. Our goal was to develop a new standard area diagram set (SADs) with high-resolution digital images to aid in visual classification using a quantitative ordinal scale representing six disease severity ranges: 0 (0%), 1 (0 – 5%], 2 (5 – 13%], 3 (13 – 23%], 4 (23 – 40%], 5 (40 – 65%] and 6 (65—100%] and compare visual estimates of BLS severity on banana leaves with those using a previously developed ordinal scale. Three evaluations were conducted by thirteen evaluators and each evaluation was performed at seven-day intervals. The first assessment was done without a SADs. Evaluators subsequently performed two assessments with each the old ordinal scale and the novel SADs. Using the new SADs, evaluators precision, accuracy, repeatability, reproducibility, and residual distributions were improved. The proposed SADs is a tool that helps users in more accurately estimating the severity of BLS. [ABSTRACT FROM AUTHOR]

Background and aim: The D-dimer to fibrinogen ratio (DFR) represents an emerging and significant clinical biomarker. However, its correlation with cerebral venous thrombosis (CVT) remains underexplored. This retrospective cohort study aims to elucidate the association between DFR values and the severity and prognosis of CVT. Methods: Severe CVT was defined as the presence of at least 1 of the following risk factors: mental status disorder, coma state, intracranial cerebral hemorrhage, or thrombosis of the deep cerebral venous system. The modified Rankin Scale was utilized to assess functional outcomes. DFR measurements were obtained within 24 h of hospital admission. Logistic regression analysis was employed to determine the prognostic significance of DFR. After Bonferroni correction, a two-tailed P value < 0.017 (0.05/3) was considered statistically significant. Result: A total of 196 patients were included in the study, among whom 85 patients were diagnosed with severe CVT, and 35 and 14 patients experienced short-term and long-term adverse outcomes, respectively. Receiver operating characteristic curve analysis demonstrated that DFR has predictive value for severe CVT, poor short-term and long-term outcomes, with area under the curve values of 0.690 [95% CI: 0.617–0.764, P <.001], 0.773 [95% CI: 0.701–0.845, P <.001], and 0.754 [95% CI: 0.619–0.886, P =.002], respectively. DFR ≥ 0.253 was identified as a significant predictor of severe CVT [adjusted odds ratio (aOR) (95% CI): 2.03 (1.10–3.75), P =.024]. Additionally, DFR ≥ 0.322 and DFR ≥ 0.754 were significantly associated with poor short-term outcomes at discharge [aOR (95% CI): 2.63 (1.43–4.76), P =.002] and poor long-term outcomes at 12 months [aOR (95% CI): 2.86 (1.32–6.25), P =.008], respectively. Conclusion: Elevated DFR is associated with increased severity of CVT. Additionally, higher DFR levels can predict poorer clinical outcomes in CVT. [ABSTRACT FROM AUTHOR]

Background: Pemphigus is a rare autoimmune disease characterized by the formation of blisters on the skin and mucous membranes, caused by autoantibodies against desmoglein, a key protein in cell adhesion. This study aims to compare demographic and clinical criteria between male and female patients with pemphigus referred to a referral hospital, utilizing data from the pemphigus diseases registry. Method: This retrospective cross‐sectional analysis focused on several key aspects age at disease onset, severity (measured by the Pemphigus Disease Area Index [PDAI]), types of pemphigus, duration of disease, and diagnostic criteria including the presence of antidesmoglein antibodies and findings from direct immunofluorescence (DIF). By examining these variables among a cohort selected based on their diagnosis of pemphigus, the study aimed to identify significant gender differences in disease manifestation, diagnosis, and progression. This approach is crucial for tailoring more effective gender‐specific management and treatment strategies for this rare autoimmune condition. Results: In a comprehensive analysis of 1218 pemphigus patients in the year 2021 from the hospital's registry, comprising 543 males (44.6%) and 675 females (55.4%), significant gender differences were identified in 9 out of 44 variables examined. The study revealed that males had a higher age at disease onset, more frequent clinical manifestations in the head, neck, and trunk areas, and greater severity of disease as measured by the PDAI score compared to females. Conversely, females exhibited higher instances of mucosal manifestations and a higher PDAI score for mucosal erosion blister of the lower gingiva. No significant gender differences were found in 21 variables, including the overall age of patients, specific clinical manifestations across various mucous membranes, types of pemphigus, and PDAI scores for mucosal erosions in particular locations, indicating a nuanced gender impact on the presentation and severity of pemphigus that necessitates tailored clinical approaches. Conclusion: The study highlights significant gender differences in the presentation and severity of pemphigus, underscoring the importance of gender‐specific approaches in the diagnosis and management of this condition. The findings contribute valuable insights into the complex nature of pemphigus and underline the necessity for further research to understand the underlying mechanisms driving these differences. [ABSTRACT FROM AUTHOR]

Background: Dexamethasone is currently administered for Coronavirus disease 2019(COVID-19); however, there are concerns about its effect on specific antibodies' production. The aim of this study was to evaluate whether specific antibodies were affected by COVID-19 severity and corticosteroid treatment. Methods: Of 251 confirmed COVID-19 patients admitted to our hospital between January 26 and August 10, 2020, the early period of the pandemic, 75 patients with sera within 1 month of onset and 1 month or longer were included in the research. A total of 253 serum samples from these patients were collected. The levels of specific antibodies for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), immunoglobulin G (IgG) and M (IgM), were measured retrospectively. The results were compared separately of each COVID-19 severity, and with or without corticosteroid treatment. Results: Among the 75 patients, 47, 18, and 10 had mild, moderate, and severe disease, respectively. The median age was 53.0 years and 22 (29%) were women. The most common comorbidities were hypertension and dyslipidemia. Corticosteroids were administered to 20 (27%) and 10 (53%), patients with moderate and severe disease, respectively. The positivity rates IgM increased first, and IgG was almost always positive after day 16, regardless of the severity of COVID-19. On days 6–10, both IgG and IgM positivity rates were higher in patients with moderate disease than in those with mild or severe disease. In patients with moderate disease, IgG positivity was similar over time, regardless of corticosteroid treatment. Conclusions: In COVID-19 patients, specific IgG is positive and maintained for a long period of time, even after corticosteroid treatment. The effect of corticosteroid treatment in a COVID-19 epidemiological study using specific IgG antibodies was considered minor. COVID-19 patients were more likely to receive oxygen if IgM was positive 1 week after onset, but not mechanical ventilation. IgM measurement 1 week after onset may predict COVID-19 severity. [ABSTRACT FROM AUTHOR]

In the treatment process of atopic dermatitis, pompholyx may occurs on palms and soles. However, there is limited knowledge about which patients are more likely to develop pompholyx and when it is expected to occur. Therefore, this study investigated the occurrence of pompholyx after the start of induction remission treatment. We collected medical information from48 AD patientswho visited Hiroshima University Hospital for the first time between January 2019 and December 2020, from the time of their first visit to 12 months later. In the initial group of 48 patients, 10 individuals developed pompholyx within 1 year after their first visit. There was no clear connection between the occurrence of pompholyx and treatment received. Most of the patients who developed pompholyx were above the age of 30. Serum thymus and activation-regulated chemokine (TARC) levels tended to be higher at the first visit in the group that later developed pompholyx compared to the group that did not. In conclusion, patients over the age of 30 with higher serum TARC levels may develop pompholyx while their AD is improving. It is crucial to provide these patients with information about the possibility of developing pompholyx during the course of their AD treatment and that it would be cured in the course of treatment. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19, triggered by the SARS-CoV-2 virus, has varied clinical manifestations, ranging from mild cases to severe forms such as fatal pneumonia and acute respiratory distress syndrome (ARDS). Disease severity is influenced by an exacerbated immune response, characterized by high proinflammatory cytokine levels. Inhibition of AKT can potentially suppress pathological inflammation, cytokine storm and platelet activation associated with COVID-19. In this study, we aimed to investigate the rs2494746 and rs1130214 variants in the AKT1 gene associated with severe COVID-19 outcomes. Methods: Peripheral blood samples and sociodemographic data from 508 individuals with COVID-19, measuring plasma cytokine concentrations using ELISA and genotyped the AKT1 variants. Results: The rs2494746-C allele was associated with severity, ICU admission, and death from COVID-19. The C allele at rs1130214 was linked to increased TNF and D-dimer levels. Moreover, both variants exhibited an increased cumulative risk of disease severity, ICU admission, and mortality caused by COVID-19. In the predictive analysis, the rs2494746 obtained an accuracy of 71%, suggesting a high probability of the test determining the severity of the disease. Discussion: Our findings contribute to understanding the influence of the AKT1 gene variants on the immunological damage in individuals infected with SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Background: Significant individual differences exist in the clinical manifestations of thyroid-associated ophthalmopathy (TAO). Age and gender have an impact on the presentation and severity of TAO. Objective: To evaluate the clinical characteristics of TAO patients, with particular consideration of their age and gender. Methods: Demographic and clinical data of 2479 TAO patients were collected. Patients were divided into 7 groups based on age: Group 1: ≤18 years old; Group 2: 19-29 years old; Group 3: 30-39 years old; Group 4: 40-49 years old; Group 5: 50-59 years old; Group 6: 60-69 years old; Group 7: ≥70 years old. Compared clinical manifestations among different groups and between males and females. Result: In age group 1, the ratio of female to male TAO patients was 3.79, and in age group 7, it was 0.86. As age increased, there was a decline in the percentage of females (g=-0.168, p<0.001). During the aging process, the proportion of TAO patients with unilateral involvement also gradually decreased (g=-0.23, p<0.001). In addition, the proportion of TAO patients with upper eyelid retraction ≥2mm and exophthalmometry ≥17mm also decreased (g=-0.158, p<0.001, g=-0.23, p<0.001). In comparison to males, females with TAO showed a higher proportion of unilateral eye involvement and upper eyelid retraction ≥2mm (p=0.038, p<0.001). However, males had a higher proportion of exophthalmometry ≥17mm (p<0.001). The proportions of patients with eye movement disorder (g=0.535, p<0.001), diplopia (g=0.446, p<0.001), intraocular pressure (IOP) ≥30mmHg (g=0.149, p<0.001), sight-threatening TAO (g=0.479, p<0.001), and active TAO (g=0.469, p<0.001) were positively correlated with age in TAO patients. Additionally, the proportion of male patients is higher than that of female patients.Conclusion: TAO Patients exhibit different clinical features depending on age and gender. In elderly and male patients, TAO tends to be more severe, with a higher prevalence of eye muscle involvement, IOP ≥30mmHg, active phases, and a lower proportion of patients with upper eyelid retraction ≥2mm. Elderly female patients also have a lower proportion of exophthalmometry ≥17mm. [ABSTRACT FROM AUTHOR]

Every year, millions die in road accidents globally, imposing significant economic and humanitarian costs. While road traffic accidents are a major health concern, many developing countries, including Ethiopia, struggle to address this issue effectively. Ethiopia ranks second in East Africa for severe road traffic accidents, highlighting the need for improved injury reduction strategies. This study introduces a novel approach by chronologically identifying and prioritizing accident black spots in the studied area, Ethiopia. This method provides a valuable tool for transportation authorities and traffic police to target high-risk areas for immediate intervention. Focusing on the Dembecha-Injibara highway segment, the study employs both descriptive and inferential analyses, using the Zegeer method to calculate accident rates. It also uses factors of weight contributing to road traffic accidents and their severity to rank accident-prone areas. The findings reveal that areas near Finote Selam, Banja, and Burie are highly prone to severe accidents, with specific accident frequencies and priority values identified. Recommendations are offered to address these high-risk areas and mitigate severe traffic accidents in the study region. [ABSTRACT FROM AUTHOR]

Background: Few studies have attempted to use clinical and laboratory parameters to stratify COVID-19 patients with severe versus non-severe initial disease and evaluate age-specific differences in developing multiple different COVID-19-associated disease outcomes. Methods: A retrospective cohort included patients from the electronic health database of Hong Kong Hospital Authority between 1 January 2022 and 15 August 2022 until 15 November 2022. The cohort was divided into three cohorts by age (≤ 40, 41–64, and ≥ 65 years old). Each age cohort was stratified into four groups: (1) COVID-19 critically exposed group (ICU admission, mechanical ventilation support, CRP > 80 mg/L, or D-dimer > 2 g/mL), (2) severely exposed group (CRP 30–80 mg/L, D-dimer 0.5–2 g/mL, or CT value < 20), (3) mildly–moderately exposed group (COVID-19 positive-tested but not fulfilling the criteria for the aforementioned critically and severely exposed groups), and (4) unexposed group (without COVID-19). The characteristics between groups were adjusted with propensity score-based marginal mean weighting through stratification. Cox regression was conducted to determine the association of COVID-19 disease severity with disease outcomes and mortality in the acute and post-acute phase (< 30 and ≥ 30 days from COVID-19 infection) in each age group. Results: A total of 286,114, 320,304 and 194,227 patients with mild–moderate COVID-19 infection; 18,419, 23,678 and 31,505 patients with severe COVID-19 infection; 1,168, 2,261 and 10,178 patients with critical COVID-19 infection, and 1,143,510, 1,369,365 and 1,012,177 uninfected people were identified in aged ≤ 40, 40–64, and ≥ 65 groups, respectively. Compared to the unexposed group, a general trend tending towards an increase in risks of multiple different disease outcomes as COVID-19 disease severity increases, with advancing age, was identified in both the acute and post-acute phases. Notably, the mildly–moderately exposed group were associated with either insignificant risks (aged ≤ 40) or the lowest risks (aged > 40) for the disease outcomes in the acute phase of infection (e.g., mortality risk HR (aged ≤ 40): 1.0 (95%CI: 0.5,2.0), HR (aged 41–64): 2.1 (95%CI: 1.8, 2.6), HR (aged > 65): 4.8 (95%CI: 4.6, 5.1)); while in the post-acute phase, these risks were largely insignificant in those aged < 65, remaining significant only in the elderly (age ≥ 65) (e.g., mortality risk HR (aged ≤ 40): 0.8 (95%CI: (0.5, 1.0)), HR (aged 41–64): 1.1 (95%CI: 1.0,1.2), HR (aged > 65): 1.5 (95%CI: 1.5,1.6)). Fully vaccinated patients were associated with lower risks of disease outcomes than those receiving less than two doses of vaccination. Conclusions: The risk of multiple different disease outcomes in both acute and post-acute phases increased significantly with the increasing severity of acute COVID-19 illness, specifically among the elderly. Moreover, future studies could improve by risk-stratifying patients based on universally accepted thresholds for clinical parameters, particularly biomarkers, using biological evidence from immunological studies. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionC-reactive protein (CRP) is a pentameric protein commonly used as a biomarker of inflammation or stress response which can be obtained during routine blood tests. Therefore, we conducted a systematic review and meta-analysis to explore its ability to predict the severity of acute pancreatitis (AP). This meta-analysis was registered in the PROSPERO system (registration number: CRD42022353769).41 studies with 6156 cases of acute pancreatitis, retrieved from PubMed, Cochrane Library, Springer, and Embase databases, were incorporated. We calculated the pooled estimates for predicting the severity of acute pancreatitis based on CRP levels. We also calculated the combined negative likelihood ratio (NLR), combined positive likelihood ratio (PLR) and combined diagnostic odds ratio (DOR) using a bivariate mixed model. Sensitivity analysis was used to examine the robustness of the results. Factors associated with heterogeneity were identified by meta-regression analysis. A summary operating characteristic (SROC) curve was generated to assess the diagnostic value of CRP in predicting severe acute pancreatitis. Fagan’s test was used to calculate likelihood ratios and post-test probabilities, and publication bias was gauged by asymmetry tests.SROC analysis yielded an AUC of 0.85 (95%CI: 0.81–0.88) with a sensitivity of 0.76 (95%CI: 0.69–0.83) and specificity of 0.79 (95%CI: 0.74–0.83). The combined NLR, PLR and DOR were 0.30 (0.23–0.40), 3.66 (2.94–4.55) and 12.19 (8.05–18.44) respectively. Sensitivity analysis demonstrated the stability of our results after omitting any study. Finally, meta-regression analysis indicated that the description of the reference test, prospective design, blinding method and spectrum of the disease could account for heterogeneity in this meta-analysis.CRP has significant value as a biomarker for assessing AP severity. Besides, other parameters such as patient history, physical signs, and imaging should be considered to determine disease severity. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodsResultsConclusionsCurrent variations in asthma prevalence and clinical characteristics suggest that lifestyle choices including dietary habits, may affect the pathogenesis and/or clinical expression of the disease. The purpose of this study is to evaluate the association between adherence to Mediterranean diet (MD) and asthma control, considering disease severity.Adherence to MD was assessed through a questionnaire, the MD Adherence Screener (MEDAS), previously validated in Mediterranean populations. Each participant received a score ranging from 0 to 14. A score higher than 10 indicates high MD adherence. The level of asthma control was assessed by the Asthma Control Test and two groups were formed (controlled vs. partly controlled/uncontrolled).The study sample included 105 participants (34% males). About 45% of participants were severe asthmatics. Adherence to MD was associated with 14% higher, though not statistically significant, probability of controlled asthma in the overall study sample (OR = 1.14; 95% CI = 0.46–2.81) and 60% higher probability of controlled asthma among severe asthmatics (OR = 1.60, 95% CI = 0.46–5.59).These results indicate a possible association between adherence to MD and asthma control, but findings are restricted by the study’s small sample size which does not allow asserting the inference. [ABSTRACT FROM AUTHOR]

Background: Neonatal respiratory distress syndrome (NRDS) is a primary cause of morbidity and mortality in premature infants. Platelets have a unique role in lung repair and remodeling. This study aimed to determine the relationship between platelet count and NRDS severity. Methods: The study included 234 newborns diagnosed with NRDS from January 2019 to August 2023. This study employed two methods of grouping: the first based on platelet count, dividing participants into thrombocytopenia (platelet count < 150 × 109/L, n = 50) and non-thrombocytopenia groups (platelet count ≥ 150 × 109/L, n = 184), and the second based on the severity of NRDS, categorizing them into severe (n = 24) and mild-moderate (n = 210) groups. Within the first grouping method, the thrombocytopenia group was further subdivided into moderate-severe group (platelet count < 100 × 109/L, n = 4) and mild group (platelet count was between 100.0 × 109/L and 150.0 × 109/L, n = 46). This study aimed to analyze the clinical characteristics of NRDS with thrombocytopenia, explore the correlation between platelet count and clinical indicators of NRDS. Binary Logistic regression analysis was employed to identify independent risk factors for thrombocytopenia in NRDS. Results: A higher proportion of newborns in the severe group exhibited thrombocytopenia (severe group = 41.7%, mild-moderate group = 19.0%). Hospital stay, ventilation time, oxygen therapy duration were longer in the thrombocytopenia group compared to the non-thrombocytopenia group. Hospital stay, ventilation time, oxygen therapy duration, chest radiography score, and C-reactive protein (CRP) levels were inversely associated with platelet count. Conversely, Apgar scores at 1 and 5 min, gestational age, and birth weight showed positive correlations with platelet count. Point-biserail correlation showed that thrombocytopenia was more likely to occur in newborns whose mothers had gestational hypertension, and the lower platelet count, the more severe NRDS. Oxygen therapy duration, birth weight < 1500 g, gestational hypertension and CRP levels emerged as independent risk factors for thrombocytopenia in NRDS. All differences were statistically significant (p all < 0.05). Conclusion: NRDS accompanied by thrombocytopenia indicates a more severe condition and poorer clinical outcomes. It is hypothesized that NRDS with thrombocytopenia involves a complex multifactorial etiology, including severe lung inflammation. [ABSTRACT FROM AUTHOR]

This study analyzed the fire regime in the highly diverse Paraguayan Chaco, focusing on different aspects of fire patterns, including spatial (area burned) and temporal (frequency) aspects and magnitude (severity). We focused on fire as it is a natural phenomenon that drives ecosystem change and has significant economic, ecological and social impacts of particular concern in vulnerable ecosystems. Using the K-means clustering technique, we identified four distinct fire regimes in the study region: High (H), Moderately High (MH), Moderately Low (ML) and Low (L). On the one hand, the Dry Chaco predominantly featured Low and Moderately High regimes, characterized by a low fire frequency due to arid conditions. On the other hand, the Humid Chaco was particularly affected by agricultural burning, driven by extensive livestock activity and higher biomass productivity. Finally, in the Pantanal, the variations in fire intensity were influenced by flood pulses and rainfall patterns. Our findings highlight the distinct fire regimes across the Paraguayan Chaco and detail the differences in the regimes. The study's findings are valuable for developing efficient management strategies that account for fire behaviour during agricultural burning in this poorly studied region. [ABSTRACT FROM AUTHOR]

Tinnitus affects millions of people around the world and causes significant negative impacts on their quality of life (QoL). Tinnitus is rarely examined in Saudi Arabia. This study aimed to estimate the prevalence of tinnitus among adults, explore their experience with tinnitus, investigate the impact of tinnitus on their QoL, and discover their tinnitus management methods. A descriptive cross-sectional study design was performed utilizing a non-probability purposive sampling technique and a face-to-face in-person administered questionnaire. Descriptive statistics and a chi-square test were used to assess the data and find any correlation between the variables. Out of 4860 adults, 320 (males: n = 172; females: n = 148; age range = 18–90 years) had tinnitus, mainly described as a daily, gradual, continuous, whistling, and ringing tinnitus in both ears. Tinnitus prevalence was estimated at 6.54% with a slight predominance in males (6.9%) compared with females (6.2%). Most of the participants were unaware of the cause of their tinnitus. The modal value of the severity of tinnitus signals was severe for both genders. The modal value of the impact of tinnitus on the QoL was moderate for males and severe for females. Sleep, social activities, quiet settings, and concentration were largely affected by tinnitus. Significant associations (p < 0.05) between the impact of tinnitus on the QoL and risk factors, such as gender, age, hearing loss, and hyperacusis were determined. Also, the impact of tinnitus on the QoL was significantly associated (p < 0.05) with the duration of complaints and the severity of tinnitus signals. Approximately, 61% of the participants did not use any tinnitus treatment, while the remaining participants usually used hearing aids, medications, and counseling to manage their tinnitus. By increasing awareness, establishing standard practice, developing guidelines for managing tinnitus, expanding access to suitable interventions, and carrying out additional research, adults living with tinnitus in Saudi Arabia will have better support and, ultimately, an enhancement of their overall well-being. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested differences in multiple sclerosis (MS) severity according to ethnicity. Methods: Data were obtained from the UK MS Register, a prospective longitudinal cohort study of persons with MS. We examined the association between self-reported ethnic background and age at onset, symptom of onset and a variety of participant-reported severity measures. We used adjusted multivariable linear regression models to explore the association between ethnicity and impact of MS, and Cox proportional hazards models to assess disability progression. Results: We analysed data from 17,314 people with MS, including participants from self-reported Black (n = 157) or South Asian (n = 230) ethnic backgrounds. Age at MS onset and diagnosis was lower in those of South Asian (median 30.0) and Black (median 33.0) ethnicity compared with White ethnicity (median 35.0). In participants with online MS severity measures available, we found no statistically significant evidence for an association between ethnic background and physical disability in MS in both cross-sectional and longitudinal analyses. Conclusion: We found no association between ethnic background and MS severity in a large, diverse UK cohort. These findings suggest that other factors, such as socioeconomic status and structural inequalities, may explain previous findings. [ABSTRACT FROM AUTHOR]

Viral respiratory diseases place a heavy burden on the healthcare system, with children making up a significant portion of related hospitalizations. While comorbidities increase the risk of complications and poor outcomes, many hospitalized children lack clear risk factors. As new vaccines for respiratory viral diseases emerge, this study examined pediatric respiratory hospitalizations, focusing on viral etiology, complication rates, and the impact of comorbidities to guide future policy. Data were analyzed from eight pre-COVID influenza seasons (2011/2012–2018/2019) involving patients under 18 years hospitalized with respiratory complaints across 4–10 hospitals in Valencia, Spain. Respiratory specimens were tested for eight viral targets using multiplex real-time reverse-transcription polymerase chain reaction. Demographics, clinical outcomes, discharge diagnoses, and laboratory results were examined. Among the hospitalized children, 26% had at least one comorbidity. These children had higher rates of pneumonia, asthma exacerbation, and pneumothorax, and were twice as likely to require ICU admission, though mechanical ventilation and length of stay were similar to those without comorbidities. Respiratory syncytial virus (RSV) was the most common virus detected (23.1%), followed by rhinovirus/enterovirus (9.5%) and influenza (7.2%). Viral codetection decreased with age, occurring in 4.6% of cases. Comorbidities increase the risk of complications in pediatric respiratory illnesses, however, healthcare utilization is driven largely by otherwise healthy children. Pediatric viral vaccines could reduce this burden and should be further evaluated. [ABSTRACT FROM AUTHOR]

Summary: Perioperative sleep disturbance may increase delirium risk. However, the role of perioperative sleep disturbance in delirium following total joint arthroplasty remains unclear. This prospective cohort study aimed to observe the delirium risk in patients with sleep disturbances. After excluding pre‐existing sleep disturbances, older patients scheduled for total joint arthroplasty from July 17, 2022, to January 12, 2023, were recruited. Preoperative sleep disturbance or postoperative sleep disturbance was defined as a Chinese version of the Richards–Campbell Sleep Questionnaire (RCSQ) score of <50 during hospitalisation. A cut‐off score of 25 was used to classify the severity of sleep disturbance. The primary outcome was the incidence of postoperative delirium. In all, 11.6% of cohort patients (34/294) developed delirium. After multivariate analysis, a preoperative Day 1 RCSQ score of ≤25 (odds ratio [OR] 3.62, 95% confidence interval [CI] 1.19–10.92; p = 0.02), occurrence of sleep disturbances (OR 2.76, 95% CI 1.19–6.38; p = 0.02) and RCSQ score of ≤25(OR 2.91, 95% CI 1.33–6.37; p = 0.007) postoperatively were strong independent predictors of delirium. After sensitivity analysis for daily delirium, a postoperative Day 1 RCSQ score of ≤25 (OR 9.27, 95% CI 2.72–36.15; p < 0.001) was associated with a greater risk of delirium on postoperative Day 1, with a reasonable discriminative area under the curve of 0.730. We concluded that postoperative but not preoperative sleep disturbances may be an independent factor for delirium risk. Sleep disturbance on the first night after surgery was a good predictor of subsequent delirium, no matter the nature of self‐reported sleep disturbance. [ABSTRACT FROM AUTHOR]

COVID-19 is characterized by pronounced hypercytokinemia. The cytokine switch, marked by an imbalance between pro-inflammatory and anti-inflammatory cytokines, emerged as a focal point of investigation throughout the COVID-19 pandemic. However, the kinetics and temporal dynamics of cytokine release remain contradictory, making the development of new therapeutics difficult, especially in severe cases. This study collected serum samples from SARS-CoV-2 infected patients at 72 h intervals and monitored them for various cytokines at each timepoint until hospital discharge or death. Cytokine levels were analyzed based on time since symptom onset and patient outcomes. All cytokines studied prospectively were strong predictors of mortality, particularly IL-4 (AUC = 0.98) and IL-1β (AUC = 0.96). First-timepoint evaluations showed elevated cytokine levels in the mortality group (p < 0.001). Interestingly, IFN-γ levels decreased over time in the death group but increased in the survival group. Patients who died exhibited sustained levels of IL-1β and IL-4 and increased IL-6 levels over time. These findings suggest cytokine elevation is crucial in predicting COVID-19 mortality. The dynamic interplay between IFN-γ and IL-4 highlights the balance between Th1/Th2 immune responses and underscores IFN-γ as a powerful indicator of immune dysregulation throughout the infection. [ABSTRACT FROM AUTHOR]

This study aims to establish a random forest model for detecting the severity of Graves Orbitopathy (GO) and identify significant classification factors. This is a hospital-based study of 199 patients with GO that were collected between December 2019 and February 2022. Clinical information was collected from medical records. The severity of GO can be categorized as mild, moderate-to-severe, and sight-threatening GO based on guidelines of the European Group on Graves' orbitopathy. A random forest model was constructed according to the risk factors of GO and the main ocular symptoms of patients to differentiate mild GO from severe GO and finally was compared with logistic regression analysis, Support Vector Machine (SVM), and Naive Bayes. A random forest model with 15 variables was constructed. Blurred vision, disease course, thyroid-stimulating hormone receptor antibodies, and age ranked high both in mini-decreased gini and mini decrease accuracy. The accuracy, positive predictive value, negative predictive value, and the F1 Score of the random forest model are 0.83, 0.82, 0.86, and 0.82, respectively. Compared to the three other models, our random forest model showed a more reliable performance based on AUC (0.85 vs. 0.83 vs. 0.80 vs. 0.76) and accuracy (0.83 vs. 0.78 vs. 0.77 vs. 0.70). In conclusion, this study shows the potential for applying a random forest model as a complementary tool to differentiate GO severity. [ABSTRACT FROM AUTHOR]

Background: The causal agent in a lower respiratory tract sample was identified as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Objective: To evaluate the vaccinated and unvaccinated persons for signs and severity of SARS-CoV-2. Patients and methods: This retrospective analysis included 99 cases ranging in age from 25 to 65 with a history of SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR). We compared the incidence and severity of COVID-19 between vaccinated and non-vaccinated groups for a variety of COVID-19 outcomes. We performed the following tests on all cases: blood pressure, pulse rate, oxygen saturation, PCR, CBC, CRP, ferritin, and D-dimer. Results: In terms of severity, 60.6% of cases are in the moderate category, and 13.1% are in the critical level. Among the non-vaccinated group, 47.2% had lung symptoms, compared to 22.2% in the vaccinated group (p = 0.001). The vaccinated group had a mix of pulmonary and extrapulmonary symptoms. A significant difference between groups: 36 (100%) of unvaccinated had CT, 26 (96.3%) of two-dose vaccinated cases, and 30 (83.3%) of three-dose vaccinated cases. Conclusion: We provided proof that vaccine recipients had reduced CT severity ratings and elevated inflammatory markers compared to those individuals who were not given vaccines. Cases that were not immunized had lower oxygen saturation levels. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between hysteroscopic surgery for patients with varying cesarean scar diverticulum (CSD) severity and in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) pregnancy outcomes, focusing also on the correlation between the CSD size with its severity, and pregnancy outcomes. Methods: A retrospective study was conducted on patients with CSD who underwent IVF/ICSI‐ET at a university‐based hospital between January 2017 and July 2023. Patients were categorized into four groups based on CSD severity and whether they received hysteroscopic surgery: a mild surgical group (Group A, n = 86), a mild non‐surgical group (Group B, n = 30), a moderate‐to‐severe surgical group (Group C, n = 173), and a moderate‐to‐severe non‐surgical group (Group D, n = 96). Baseline characteristics and pregnancy outcomes were compared among these groups. Correlation assessments were conducted to explore relationships between CSD size with its severity, and pregnancy outcomes. Results: Compared with Group D, Group C exhibited significantly increased rates of biochemical pregnancy (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.03–3.51, P = 0.041), clinical pregnancy (OR 2.30; 95% CI1.18–4.45; P = 0.014), and live birth (OR 2.77; 95% CI 1.10–7.00, P = 0.031). However, no differences in pregnancy outcomes were observed between Groups A and B. Correlation analyses revealed significant positive associations between CSD severity and its depth, length, width, and volume. Conclusions: Patients with moderate‐to‐severe CSD achieved favorable IVF/ICSI pregnancy outcomes following hysteroscopic surgery. The CSD size was significantly related to its severity. Synopsis: Our study explored the impact of hysteroscopic surgery on IVF/ICSI pregnancy outcomes for patients with different cesarean scar diverticulum severity. [ABSTRACT FROM AUTHOR]

Background and purpose: Management of idiopathic intracranial hypertension (IIH) is complex requiring multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges for healthcare professionals and patients. Thus, an interdisciplinary integrated outpatient clinic for IIH (comprising neurology, neuroophthalmology, neuroradiology, neurosurgery and endocrinology) was established with central coordination and a one‐stop concept. Here, the aim was to evaluate the effects of this one‐stop concept on objective clinical outcome. Methods: In a retrospective cohort study, the one‐stop era with integrated care (IC) (1 July 2021 to 31 December 2022) was compared to a reference group receiving standard care (SC) (1 July 2018 to 31 December 2019) regarding visual impairment/worsening and headache improvement/freedom 6 months after diagnosis. Multivariate binary logistic regression models were used to adjust for confounders. Results: Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female 90.6% vs. 90.1%; mean age 33.6 vs. 32.8 years; median body mass index 31.8 vs. 33.0; median cerebrospinal fluid opening pressure 32 vs. 34 cmH2O; at diagnosis, visual impairment was present in 71.8% vs. 69.1% and chronic headache in 55.3% vs. 56.8% in IC vs. SC). IC was associated with a higher likelihood of achieving both headache improvement (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.52–4.33, p < 0.001) and headache freedom (OR 1.75, 95% CI 1.11–3.09, p = 0.031). Regarding the risk of visual impairment and visual worsening IC was superior numerically but not statistically significantly (OR 0.87, 95% CI 0.69–1.16, p = 0.231, and OR 0.67, 95% CI 0.41–1.25, p = 0.354). Conclusions: Interdisciplinary integrated care of IIH is favourably associated with headache outcomes and potentially also visual outcomes. [ABSTRACT FROM AUTHOR]

The circulating androgens have a role in the pathogenesis of both acne vulgaris and androgenetic alopecia; an association between these two have been found previously. The aim of this study is to investigate the relationship of the severity of acne vulgaris lesions to the subtype of AGA; and to validate the relationship between severities of acne vulgaris and AGA. This study was conducted cross-sectionally at five different dermatology clinics. Male and female androgenetic alopecia patients with comorbid acne vulgaris have been included. The age, gender, severity of acne lesions, subtype of androgenetic alopecia and the severity of androgenetic alopecia were noted. The severity of acne lesions were graded according to the Global Acne Severity Scale and androgenetic alopecia was graded according to the Hamilton and Ludwig Scales. SPSS v 21 was used for the statistical analysis. A total of 101 patients have been included (12 male and 89 female). The mean age of the patients with severe acne was statistically significantly lower (p = 0.020). The difference in terms of gender was statistically insignificant (p = 0.388). The severity of acne vulgaris was found to be independent of the severity and of the subtype of AGA; p = 0.623 and 0.870 respectively. Neither a relationship between the severity of androgenetic alopecia and severity of acne; nor a relationship between acne severity and androgenetic alopecia subtype were found in this study. Thus we report that, acne severity is independent of the subtype and stage of the co-existing androgenetic alopecia. [ABSTRACT FROM AUTHOR]

Various risk factors for developing severe coronavirus disease 2019 (COVID-19) have been reported. However, studies on the nutritional-related risk factors are limited. In this study, we investigated the effects of serum zinc deficiency on the severity of COVID-19. The study included a total of 60 COVID-19 patients who were admitted to Tsuyama Chuo Hospital between March 2020 and April 2021. We divided the patients into two categories based on serum levels of zinc (normal and latent zinc deficiency vs. zinc deficiency [<60 μg/dL]) at the time of diagnosis. Severity of COVID-19 was defined as the most exaggerated disease status during admission. The associations between serum zinc deficiency and the severity of COVID-19 were examined using a logistic regression model adjusted for potential confounders. Patients who required oxygen therapy had a higher prevalence of comorbidities and poorer nutritional status, including zinc deficiency, than those who did not require oxygen therapy. Zinc deficiency was associated with an increased risk of COVID-19 severity, with an adjusted odds ratio of 7.29 (95% confidence interval: 1.70–31.18). This result remained significant in the sensitivity analyses conducted after adjusting for patient background factors. Zinc deficiency at the time of COVID-19 diagnosis is an independent risk factor for severe disease. Our findings need to be validated in external studies. [ABSTRACT FROM AUTHOR]

Objectives: Parkinson's disease (PD) involves the progressive loss of dopaminergic neurons and the accumulation of α-synuclein. Elevated cholesterol levels may exacerbate α-synuclein aggregation, potentially contributing to PD. This study investigates the link between lipid profiles and PD severity, as well as cognitive functions in patients, aiming to inform pathogenesis and management strategies. Methods: Data from 250 PD patients and 100 healthy controls were analyzed. Serum cholesterol levels were compared with disease severity using Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn & Yahr Rating Scale (mH&Y). Mini-Mental State Examination (MMSE) assessed cognitive functions. Results: Of the participants, 45.4% were female, 54.6% male, with a mean age of 69.09 ± 11.13 years. Mean UPDRS score was 52.34 ± 26.32, mH&Y was 2.28 ± 0.91. Patients had significantly higher HDL levels (47.92 ± 11.63) than controls (45.40 ± 13.89) (p = 0.024). HDL levels were significantly higher in patients with cognitive impairment than in patients with cognitive normal (p = 0.004). On the contrary, triglyceride levels were significantly lower in those with cognitive impairment compared to those with cognitively normal (p = 0.005). Multivariate logistic regression showed being male associated with 3.796 times higher risk of illness, and HDL is associated with 1.030 times increased illness risk. Conclusion: High HDL levels and male gender particularly increase the risk of Parkinson's disease. Additionally, HDL and triglyceride levels affect the cognition of PD patients. Further studies on the impact of cholesterol metabolism on the pathogenesis of PD could contribute to identifying effective treatment targets. [ABSTRACT FROM AUTHOR]

Quality of life has emerged as a powerful indicator of therapeutic success. However, little research has been conducted to study potential factors that influence quality of life in persons with schizophrenia, particularly in low-income developing nations. This study aimed to investigate how insight and empathy impacted the quality of life and severity of symptoms in patients. A descriptive cross-sectional research design was conducted on 168 patients with schizophrenia using the PANSS Scale, Schizophrenia Quality of Life Scale R4, the Interpersonal Reactivity Index, and the Birchwood Insight Scale. Our findings show that the mean score for quality of life was (70.9 ± 9.2), whereas the mean scores for empathy and insight were (60.8 ± 15.8) and (5.8 ± 1.9), respectively. Insight and empathy have predicted effects on QoL (adjusted r square = 0.035, sig = 0.009) and (adjusted r square = 0.012, sig = 0.027), respectively. On the other hand, the regression model also showed a substantial inverse relationship between the severity of the illness and both empathy and insight. Conclusion: The majority of the clients had poor quality of life, low insight, and low empathy. Insight and empathy play a role in anticipating the patient's perceptions of quality of life. They might affect how severe their illness is. Our findings highlight the importance of developing empathy and insight, and therapies that do so may aid patients with low quality of life. [ABSTRACT FROM AUTHOR]

Obesity, the current pandemic, is associated with alarming rises among children and adolescents, and the forecasts for the near future are worrying. The present paper aims to draw attention to the short-term effects of the excess adipose tissue in the presence of a viral infection, which can be life-threatening for pediatric patients, given that the course of viral infections is often severe, if not critical. The COVID-19 pandemic has been the basis of these statements, which opened the door to the study of the repercussions of obesity in the presence of a viral infection. Since 2003, with the discovery of SARS-CoV-1, interest in the study of coronaviruses has steadily increased, with a peak during the pandemic. Thus, obesity has been identified as an independent risk factor for COVID-19 infection and is correlated with a heightened risk of severe outcomes in pediatric patients. We sought to determine the main mechanisms through which obesity is responsible for the unfavorable evolution in the presence of a viral infection, with emphasis on the disease caused by SARS-CoV-2, in the hope that future studies will further elucidate this aspect, enabling prompt and effective intervention in obese patients with viral infections, whose clinical progression is likely to be favorable. [ABSTRACT FROM AUTHOR]

Objectives: To compare the course of generic and specific health-related quality of life (HRQOL) of individuals with stroke, and its physical, mental, and social domains, at three, six, and 12 months after hospital discharge, considering the levels of stroke severity. Methods: This is a longitudinal study, in stroke individuals, assessed during hospital admission by the National Institutes of Health Stroke Scale (NIHSS), and divided into mild (NIHSS ≤3) or moderate/severe (NIHSS ≥4) disease. At three, six, and 12 months after hospital discharge, the individuals were assessed for generic (Short Form Health Survey–36: total score and physical and mental domains) and specific (Stroke Specific Quality of Life Scale: total score and social domain) HRQOL. A 2 × 2 repeated measures analysis of variance (ANOVA) with post-hoc was applied. Results: 146, 122, and 103 individuals were assessed at three, six and 12 months, respectively HRQOL courses showed different behaviors according to stroke severity (3.37≤F ≤ 4.62; 0.010≤p ≤.036). Individuals with mild stroke showed significant changes in the physical domain, with a reduction between three and six months, and an increase between six and 12. Moderate/severe individuals showed a significant increase in all HRQOL variables between three and six months, and a maintenance of values for almost all variables, except for physical domain, which improved significantly between three and six months, and got significantly worse between six and 12. Conclusions: HRQOL during the first year after stroke showed distinct trajectories, being stroke severity an important factor in identifying stroke subjects at risk of HRQOL decline. Clinical Implications: These results demonstrate the importance of considering not only the phase of the stroke, the severity, and the general and specific HRQOL, but also the physical, social, and mainly the mental domain, which has long been neglected, when assessing this population. [ABSTRACT FROM AUTHOR]

Background: IL-6 polymorphisms were associated to viral infection outcomes through affection of IL-6 production and it is an early indicator of tissue injury and systemic inflammatory response. The study aimed to determine whether genetic IL-6 polymorphisms, serum interleukin-6 level and inflammatory markers (Presepsin, CXCL-10, C3, and C4) are associated with the prediction of disease severity in pediatric COVID-19 patients and its possible use as a prognostic tool in pediatric patients admitted to hospital. Methods: This prospective cohort study was conducted on 150 children with COVID-19. Patients were divided according to the severity of infection into four groups: group I (mild) 67 cases; group II (moderate) 53 cases, group III (severe) 17 cases and group IV (critical) 14 cases. Serum Interleukin 6, CXCL-10, Presepsin, renal and liver functions, electrolytes, C3, C4, ferritin, and D dimer serum levels were assessed in all patients. The Kruskal Wallis test used to compare parametric quantitative data between studied groups and Mann Whitney test for each pair of groups. Non-parametric quantitative data was compared between studied groups using a one-way ANOVA test and post-hoc Bonferroni analysis for each pair of groups. Results: Group I: 35 males and 32 females with a median age of 16 months. Group II: 17 males and 35 females with a median age of 13 months. Group III: 6 males and 11 females with a median age of 12 months and group IV: 3 males and 11 females with a median age of 12 months. There was no statistical difference between the studied groups regarding gender and age. Serum levels of IL- 6, serum ferritin; D-dimer, Presepsin and CXCL 10 were significantly higher in both severe and critical groups than the other 2 groups (mild and moderate). ROC curve analysis showed that interleukin-6 and Presepsin were good markers for prediction of severity of COVID-19 among the diseased children. For severe cases, the sensitivity of interleukin-6 was 76.47% and specificity was 92.31%. For critical cases, the sensitivity of interleukin-6 was 71.43% and specificity was 82.35%. The sensitivity of Presepsin was 76.47% and specificity was 88.46% in severe cases. For critical cases, the sensitivity of Presepsin was 78.57% and specificity of 91.2%. There was significant difference in IL-6 572 allelic among moderate cases with the most frequent 42.3% for genotype (GC) and allelic among severe cases with the most frequent 47.1% for genotype (GC). Significant difference in IL-6 174 allelic among critical cases with the most frequent 78.6% for genotype (CC). Conclusions: Children whom expressed GC genotypes of IL6 (-572G > C) polymorphism are at a considerably higher risk of developing a severe disease. This risk is significantly larger in the severe group of children than in children in critical condition who have GC genotypes of IL6 (-174 G > C) polymorphism. While IL6 (-597G > A) polymorphism has no role in COVID 19 severity in children. [ABSTRACT FROM AUTHOR]

The International Roughness Index (IRI) is closely related to pavement distress. However, previous studies employing statistics and machine learning approaches would present challenges in comprehensively analyzing the influence of pavement distress on IRI considering their severities. This study introduces interpretable machine learning to investigate the influence of pavement distress on IRI, with a particular focus on the severity of pavement distress. The pavement distress and IRI data for flexible pavements obtained from the long-term pavement performance (LTPP) program were meticulously preprocessed. The developed random forest (RF) model demonstrated satisfactory predictive performance, with an RMSE of 0.2191 and an R2 of 0.7874. The relationship between pavement distress and IRI, as captured by the developed model, was further analyzed using the SHapley Additive exPlanations (SHAP) method. The model interpretation identified the transverse crack, rutting, and alligator crack as the key factors influencing IRI. Notably, both transverse and alligator cracks exhibited significant contributions to IRI increment at medium and high severity levels, highlighting the importance of proactive maintenance for these distress types at lower severity levels. Additionally, a threshold in rutting depth was observed, which could increase IRI. A comparative analysis with the AASHTO MEPDG smoothness model demonstrated that the predictive performance of the RF model was notably superior. [ABSTRACT FROM AUTHOR]

Background: Forward head posture (FHP) leads to the anterior excursion of the center of gravity, which can affect a person's standing balance. Evaluating the balance in different degrees of severity of FHP can help design and plan appropriate balance exercises for people with FHP. Objectives: This study aimed to evaluate the changes in the limits of stability (LOS) in people with mild and moderate-to-severe grades of FHP. Methods: The participants in this study were 70 individuals suffering from FHP, aged between 17 - 45. They were divided into two groups based on their craniovertebral angle: Mild (> 45.5 degrees) and moderate-to-severe (< 45.5 degrees). The LOS test was performed using a posturography device (NeuroCom, Equitest, USA). Five indices—movement reaction time (RCT), movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL)—were evaluated. Results: Based on the results of the LOS test, RCT, MVL, EPE, MXE, and DCL were significantly different between the mild and moderate-to-severe FHP groups in both anterior and posterior directions (P < 0.05). However, in other directions, no significant difference was observed in these variables based on the LOS test (P > 0.05). Conclusions: It can be concluded that individuals with moderate-to-severe FHP are more likely to have postural control deficits. Therefore, it is necessary to design appropriate targeted interventions to prevent falls in these individuals. Specifically, they should receive balance exercises in dynamic situations. [ABSTRACT FROM AUTHOR]

This study aimed to assess the severity and outcomes of COVID-19 in pregnant women, focusing on laboratory and radiological discrepancies between pregnant women and matched nonpregnant women. In this retrospective cross-sectional analysis, we matched 107 nonpregnant women with 66 pregnant women in terms of age, comorbidities, and the interval between symptom onset and hospital admission. Demographic, clinical, laboratory, and radiological data were collected, and chest CT scans were evaluated using a severity scale ranging from 0 to 5. Logistic regression and adjusted Cox regression models were used to assess the impact of various factors on pregnancy status and mortality rates. Differences in several laboratory parameters, including the neutrophil-to-lymphocyte ratio, liver aminotransferases, alkaline phosphatase, urea, triglycerides, cholesterol, HbA1c, ferritin, coagulation profiles, and blood gases, were detected. Radiologic exams revealed that nonpregnant women had sharper opacities, whereas pregnant women presented with hazy opacities and signs of crypt-organizing pneumonia. A notable difference was also observed in the pulmonary artery diameter. The mortality rate among pregnant women was 4.62%, which was comparable to the 5.61% reported in nonpregnant patients. Compared with nonpregnant patients, pregnancy did not significantly affect the severity or mortality of COVID-19. Our study revealed discernible differences in specific laboratory and imaging markers between pregnant and nonpregnant COVID-19 patients. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exposed a number of key challenges that need to be urgently addressed. Mass spectrometric studies of blood plasma proteomics provide a deep understanding of the relationship between the severe course of infection and activation of specific pathophysiological pathways. Analysis of plasma proteins in whole blood may also be relevant for the pandemic as it requires minimal sample preparation.The frozen whole blood samples were used to analyze 203 plasma proteins using multiple reaction monitoring (MRM) mass spectrometry and stable isotope-labeled peptide standards (SIS). A total of 131 samples (FRCC, Russia) from patients with mild (n=41), moderate (n=39) and severe (n=19) COVID-19 infection and healthy controls (n=32) were analyzed.Levels of 94 proteins were quantified and compared. Significant differences between all of the groups were revealed for 44 proteins. Changes in the levels of 61 reproducible COVID-19 markers (SERPINA3, SERPING1, ORM1, HRG, LBP, APOA1, AHSG, AFM, ITIH2, etc.) were consistent with studies performed with serum/plasma samples. The best-performing classifier built with 10 proteins achieved the best combination of ROC-AUC (0.97–0.98) and accuracy (0.90–0.93) metrics and distinguished patients from controls, as well as patients by severity.Here, for the first time, frozen whole blood samples were used for proteomic analysis and assessment of the status of patients with COVID-19. The results obtained with frozen whole blood samples are consistent with those from plasma and serum. [ABSTRACT FROM AUTHOR]

Background: Interleukin-1 receptor-associated kinase 3 (IRAK3) modulates neuroinflammation. This study aimed to determine the prognostic role of serum IRAK3 in acute intracerebral hemorrhage (ICH). Methods: In this prospective observational cohort study, 152 patients with supratentorial ICH, along with 63 healthy controls, were recruited. Serum IRAK3 levels were measured at the time of enrollment for controls, at admission for all patients, and on poststroke days 1, 3, 5, 7, 10, and 15 in a subset of 63 patients. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Poststroke 6-month modified Rankin Scale (mRS) scores were registered, with scores of 3--6 representing a poor prognosis. Multivariate models were established to investigate severity correlation and prognosis association. Results: Serum IRAK3 levels were significantly elevated at the admission of patients, peaked at day 1, plateaued at day 3, gradually declined until day 15, and were substantially higher over the first 15 days poststroke than in controls. Admission serumIRAK3 levels were independently associated with NIHSS scores, hematoma volume, and 6-month mRS scores in a multivariate linear regression model. They were linearly correlated with the risk of poor prognosis in a restricted cubic spline analysis and were independently predictive of poor prognosis in a binary logistic regression model. Additionally, they demonstrated strong prognostic ability in the receiver operating characteristic curve analysis. Using subgroup analysis, no interactions were found between admission serum IRAK3 levels and some routine variables, such as age, gender, hypertension, and diabetes mellitus. Moreover, the model combining admission serum IRAK3, NIHSS scores, and hematoma volume demonstrated stability and clinical value in calibration and decision curve analyses. Conclusion: A significant increase in serum IRAK3 levels during the early phase after ICH, strongly correlated with disease severity, is independently associated with a poor 6-month prognosis, establishing serum IRAK3 as a valuable prognostic biomarker for ICH. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is a global pandemic that negatively affected the world economy and the health care resources. It is associated with great health impact, mortality, and long-term sequelae. Methods: History taking computed tomography of the chest and laboratory investigations including complete blood count, liver and kidney function tests, serum ferritin, C-reactive protein, and D-dimer were done. Results: A total of 246 hospitalized COVID-19 patients were enrolled. Male predominance (67.1% of the total study population) was observed. The mean age was 57.26 ± 14.08 years. Moderate cases comprised 63.8% of the total study population, 22.4% were severe cases, and 13.8% were critical cases. The mortality rate was 8.13% and 6.1% developed venous thromboembolism. Conclusion: Age, smoking, and the presence of previous pulmonary disease were among the most important factors affecting COVID-19 severity. The severity of the disease greatly influences the incidence of venous thromboembolism and the outcome of the disease. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the "dialysis symptom index" in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden's prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Biomarkers can be used to assess the severity of spinal muscular atrophy (5q SMA; SMA). Despite their potential, the relationship between biomarkers and clinical outcomes in SMA remains underexplored. This study aimed to assess the association among biomarkers, phenotypes, and motor milestones in Chinese patients diagnosed with SMA. Methods: We collected retrospective clinical and follow-up data of diseasemodifying therapy (DMT)-naïve patients with SMA at our center from 2019 to 2021. Four biomarkers were included: survival motor neuron 2 (SMN2) copies, neuronal apoptosis inhibitory protein (NAIP) copies, full-length SMN2 (fl-SMN2), and F-actin bundling protein plastin 3 (PLS3) transcript levels. Data were analyzed and stratified according to SMA subtype. Results: Of the 123 patients, 30 were diagnosed with Type 1 (24.3%), 56 with Type 2 (45.5%), and 37 with Type 3 (30.1%). The mortality rate for Type 1 was 50%, with median survival times of 2 and 8 months for types 1a and 1b, respectively. All four biomarkers were correlated with disease severity. Notably, fl-SMN2 transcript levels increased with SMN2 copies and were higher in Type 2b than those in Type 2a (p = 0.028). Motor milestone deterioration was correlated with SMN2 copies, NAIP copies, and fl-SMN2 levels, while PLS3 levels were correlated with standing and walking function. Discussion: Our findings suggest that SMN2 copies contribute to survival and that fl-SMN2 may serve as a valuable biomarker for phenotypic variability in SMA Type 2 subtypes. These insights can guide future research and clinical management of SMA. [ABSTRACT FROM AUTHOR]

The objective of this article is to evaluate the salivary levels of tumor necrosis factor‐alpha (TNF‐α), interferon‐gamma (IFN‐γ), interleukin‐2 (IL‐2), and IL‐10 in patients with active psoriasis and compare them with those in healthy control subjects. This study included 60 subjects who were clinically diagnosed cases with active psoriasis (categorized further into 33 mild to moderate and 27 severe cases based on the Psoriasis Area Severity Index score) and 60 age‐ and gender‐matched healthy control subjects. Levels of TNF‐α, IFN‐γ, IL‐2, and IL‐10 in the unstimulated saliva of subjects were determined via enzyme‐linked immunosorbent assay (BT Lab). The salivary levels of TNF‐α, IFN‐γ, and IL‐2 were significantly higher, whereas IL‐10 concentration was significantly reduced in psoriatic patients in comparison to controls, and the difference increased with the progressing severity of the disease. Assessment of cytokine profiles in psoriasis patients is significant for diagnostic validation and monitoring the disease severity. Saliva offers an alternate, noninvasive, and readily available biological sample for evaluating cytokine levels. Extensive research in this field has been recommended for better scientifically proven conclusions. [ABSTRACT FROM AUTHOR]

Background: The association between nonalcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) has been inconsistent, and the impact of hepatic fibrosis on this relationship remains uncertain. We investigated the association between NAFLD and the risk of new-onset AF across different age groups. Methods: A total of 3,179,582 participants from the 2009 Korean National Health Screening Program were divided into five groups based on NAFLD status: no NAFLD (fatty liver index [FLI] < 30); grade 1 NAFLD without advanced fibrosis (FLI 30–59 & BARD < 2); grade 1 NAFLD with advanced fibrosis (FLI 30–59 & BARD ≥ 2); grade 2 NAFLD without advanced fibrosis (FLI ≥ 60 & BARD < 2); and grade 2 NAFLD with advanced fibrosis (FLI ≥ 60 & BARD ≥ 2). The primary outcome was incident AF. Results: During the median follow-up of 9.3 years, 62,542 patients were diagnosed with new-onset AF. In the age- and sex-adjusted model, the risk of new-onset AF increased across NAFLD grades and fibrosis categories: grade 1 NAFLD without advanced fibrosis (hazard ratio [HR] 1.120, 95% confidence interval [CI]: 1.081–1.161); grade 1 NAFLD with advanced fibrosis (HR 1.275, 95% CI 1.251–1.300); grade 2 NAFLD without advanced fibrosis (HR 1.305, 95% CI: 1.252–1.360); and grade 2 NAFLD with advanced fibrosis (HR 1.627, 95% CI: 1.586–1.670). In the multivariate model, the excess risk of AF in patients with NAFLD and advanced fibrosis remained significant, even in participants aged 20–39 years. Conclusion: Patients with NAFLD had a higher risk of new-onset AF, which increased progressively with NAFLD severity, particularly in those aged 20–29 years. [ABSTRACT FROM AUTHOR]

Background: Studying the characteristics of hospitalized Coronavirus Disease 2019 (COVID-19) patients is vital for understanding the disease and preparing for future outbreaks. The aim of this study was to analyze and describe the clinical profiles and factors associated with mortality among COVID-19 patients admitted to Jimma Medical Center COVID-19 Treatment Center (JMC CTC) in Ethiopia. Methods: All confirmed COVID-19 patients admitted to JMC CTC between 17 April 2020 and 05 March 2022 were included in this study. Socio-demographic data, clinical information, and outcome variables were collected retrospectively from medical records and COVID-19 database at the hospital. Bivariable and multivariable analyses were performed to determine factors associated with COVID-19 severity and mortality. A P-value < 0.05 was considered statistically significant. Results: A total of 542 confirmed COVID-19 patients were admitted to JMC CTC, of which 322 (59.4%) were male. Their median age was 48 years (IQR 32–64). About 51% (n = 277) of them had severe COVID-19 upon admission. Patients with hypertension [AOR: 2.8 (95% CI: 1.02–7.7, p = 0.046)], diabetes [AOR: 8.8 (95% CI: 1.2–17.3, p = 0.039)], and underlying respiratory diseases [AOR: 18.8 (95% CI: 2.06–71.51, p = 0.009)] were more likely to present with severe COVID-19 cases. Overall, 129 (23.8%) died in the hospital. Death rate was higher among patients admitted with severe disease [AHR = 5.5 (3.07–9.9) p < 0.001)] and those with comorbidities such as hypertension [AHR = 3.5 (2.28–5.41), p < 0.001], underlying respiratory disease [AHR = 3.4 (1.97–5.94), p < 0.001], cardiovascular disease (CVDs) [AHR = 2.8 (1.73–4.55), p < 0.001], and kidney diseases [AHR = 3.7 (2.3–5.96), p < 0.001]. Conclusion: About half of COVID-19 cases admitted to the hospital had severe disease upon admission. Comorbidities such as hypertension, diabetes, and respiratory diseases were linked to severe illness. COVID-19 admissions were associated with high inpatient mortality, particularly among those with severe disease and comorbidities. [ABSTRACT FROM AUTHOR]

We aimed to investigate the preventive effect of vitamin D2 on COVID-19 and the improvement of symptoms after COVID-19 infection. The study recruited 228 health care workers who tested negative PCR or antigen for COVID-19. Subjects were randomly allocated to vitamin D2 or non-intervention at a ratio 1:1. Subjects recorded PCR or antigen tests and the symptoms of COVID-19 twice a week during the follow-up visit. The concentration of serum 25-hydroxyvitamin D (25(OH)D), C-reaction protein (CRP), complement component C1q and inflammatory cytokines were measured. The rates of COVID-19 infection were 50.5% in the vitamin D2 group and 52.4% in the non-intervention group (P = 0.785). There was no difference in the COVID-19 symptoms between the two groups. The mean 25(OH)D level significantly increased from 14.1 to 31.1 ng/mL after administration (P < 0.001). The difference between the two groups was not significant for the concentrations of CRP, C1q and inflammatory cytokines on the thirtieth day of the trial. According to the second level of vitamin D, there was a 14.3% difference in positive infection rates between the vitamin D adequate (> 30 ng/mL) and deficient groups (< 20 ng/mL). Adequate vitamin D had a tendency to prevent COVID-19. Trial registration: ClinicalTrials.gov NCT05673980, dated: 12/2022. [ABSTRACT FROM AUTHOR]

Dickkopf-1 (DKK-1) may be involved in inflammatory response and secondary brain injury after acute brain injury. We gauged serum DKK-1 levels and further assessed its correlation with disease severity and investigated its predictive value for 90-day prognosis in patients with spontaneous intracerebral hemorrhage (sICH). Serum DKK-1 levels were measured in 128 sICH patients and 128 healthy controls. The severity of sICH was assessed using the Glasgow Coma Scale (GCS) scores and hematoma volumes. Poor prognosis was referred to as a Glasgow Outcome Scale (GOS) score of 1–3 at 90 days after stroke. Multivariate analysis was performed to identify associations of serum DKK-1 levels with disease severity, early neurological deterioration (END) and poor prognosis. Receiver operating characteristic curve (ROC) was built to investigate the prognostic predictive capability. The serum DKK-1 levels of patients were significantly higher than those of controls (median, 4.74 ng/mL versus 1.98 ng/mL; P < 0.001), and were independently correlated with hematoma volumes (ρ = 0.567, P < 0.001; t = 3.444, P = 0.001) and GCS score (ρ = -0.612, P < 0.001; t = -2.048, P = 0.043). Serum DKK-1 significantly differentiated patients at risk of END (area under ROC curve (AUC), 0.850; 95% confidence interval (CI), 0.777–0.907; P < 0.001) and poor prognosis (AUC, 0.830; 95% CI, 0.753–0.890; P < 0.001), which had similar prognostic ability, as compared to GCS scores and hematoma volumes. Subsequent Logistic regression model affirmed that GCS score, hematoma volume, and serum DKK-1 levels were independently associated with END and poor prognosis at 90 days after sICH. The models, which contained them, performed well using ROC curve analysis and calibration curve analysis. Serum DKK-1 levels are markedly associated with disease severity, END and 90-day poor prognosis in sICH. Hence, serum DKK-1 is presumed to be used as a potential prognostic biomarker of sICH. [ABSTRACT FROM AUTHOR]

Background and Purpose Methods Results Conclusions Fremanezumab, a monoclonal antibody targeting the calcitonin gene‐related peptide for migraine prevention, is available in monthly (225 mg) and quarterly (675 mg) doses. Previous studies showed efficacy and safety for both regimens, but a real‐life comparison is lacking. This study aimed to compare the effectiveness and safety of monthly and quarterly fremanezumab in a real‐life setting.This Italian, prospective, multicenter study enrolled 95 migraine patients. During a 3‐month treatment period, patients received either monthly or quarterly fremanezumab (49 monthly, 46 quarterly). A 6‐month treatment period involved 79 patients (43 monthly, 36 quarterly). Monthly headache (MHD) and migraine days (MMD), number of days (AMD) and pills (AMP) of acute medication intake, and Headache Impact Test (HIT‐6), Migraine Disability Assessment (MIDAS) test, and Numeric Rating Scale (NRS) scores were recorded at baseline and after 3 and 6 months of treatment. Adverse events (AEs), responder rates, and medication overuse were also investigated.Both monthly and quarterly treatments led to significant reductions in MMD, MHD, AMP, AMD, HIT‐6, MIDAS, and NRS scores after 3 and 6 months. The monthly regimen exhibited a slightly greater reduction in MMD and MHD after the first quarter, with no significant difference observed after 6 months. The most common AE was transient injection‐site reaction, without between‐group differences. Responder rates and resolution of medication overuse did not significantly differ between the groups.Both monthly and quarterly regimens were effective and safe, with a tendency for an advantage of the monthly regimen only in the first quarter of treatment. [ABSTRACT FROM AUTHOR]