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Abstract Understanding the immune response to COVID-19 is challenging due to its high variability among individuals. To identify differentially expressed cytokines between the deteriorating and recovering phases, we analyzed the Electronic Health Records (EHR) and cytokine profile data in a COVID-19 cohort of 444 infected patients and 145 non-infected healthy individuals. We categorized each patient’s progression into Deterioration Phase (DP) and Recovery Phase (RP) using longitudinal neutrophil, lymphocyte and lactate dehydrogenase levels. A random forest model was built using healthy and severe patients to compute the contribution of each cytokine toward disease progression using Shapley Additive Explanations (SHAP). SHAP values were used for supervised clustering to identify DP and RP-related samples and their associated cytokines. The identified clusters effectively discriminated DP and RP samples, suggesting that the cytokine profiles differed between deteriorating and recovering health conditions. Especially, CXCL10, GDF15, PTX3, and TNFSF10 were differentially expressed between the DP and RP samples, which are involved in the JAK-STAT, NF- $$\kappa$$ κ B, and MAPK signaling pathways contributing to the inflammatory response. Collectively, we characterized the immune response in terms of disease progression of COVID-19 with deteriorating and recovering health conditions.

Abstract 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 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 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): 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 Common bean (Phaseolus vulgaris L.) is important legume crop world-wide and in Ethiopia for its multipurpose uses. Common bean rust, is the most destructive fungal disease that severely reduces bean yield. For years, rust appeared in a farmer's field in Southern Ethiopia; however, the disease's significance remains unclear. The research aimed to ascertain the distribution and intensity of common bean rust, as well as elucidate the association of biophysical parameters. The field survey was conducted in southern Ethiopia in 2022. Ninety percent of the 78 commonbean fields were affected by common bean rust. Mareko, Meskan, Duguna Fango, Damot Woide, and Demba Gofa had 100% of the fields affected, and Boricha had 90%. Damot Woide and Lanfuro had the highest and lowest mean rust incidence rates, respectively, 59.2% and 22.5%. Duguna Fango had the highest rust severity (35.5%), while Lanfuro had the lowest (13.5%). In the research areas, the biophysical factors, either alone or in combination, have a significant impact on the intensity of common bean rust. The current investigation verified the distributionand the association biophysical factors with common bean rust. In addition, the survey of the disease and the identification of factors should continue over time and space.

Abstract 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 COVID-19's long-lasting and complex impacts have become a global concern, with diverse clinical outcomes. This study evaluated 226 participants to understand the clinical spectrum of COVID-19/Long COVID (LC), exploring how disease severity correlates with sociodemographic factors and biomarkers. Determinants related to COVID-19 severity included age (P

Abstract 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 30 ng/mL) and deficient groups (

Background/Aims Fecal microbiota transplantation (FMT) is a promising therapy for inducing and maintaining remission in patients with ulcerative colitis (UC). However, FMT has not been approved for UC treatment in Korea. Our study aimed to investigate patient perceptions of FMT under the national medical policy. Methods This was a prospective, multicenter study. Patients with UC ≥ 19 years of age were included. Patients were surveyed using 22 questions on FMT. Changes in perceptions of FMT before and after education were also compared. Results A total of 210 patients with UC were enrolled. We found that 51.4% of the patients were unaware that FMT was an alternative treatment option for UC. After reading the educational materials on FMT, more patients were willing to undergo this procedure (27.1% vs. 46.7%; p < 0.001). The preferred fecal donor was the one recommended by a physician (41.0%), and the preferred transplantation method was the oral capsule (30.4%). A large proportion of patients (50.0%) reported that the national medical policy influenced their choice of FMT treatment. When patients felt severe disease activity, their willingness to undergo FMT increased (92.3% vs. 43.1%; p = 0.001). Conclusions Education can increase preference for FMT in patients with UC. When patients have severe disease symptoms or their quality of life decreases their willingness to undergo FMT increases. Moreover, national medical policies may influence patient choices regarding FMT.

Aim: To assess lung function in patients with persistent dyspnea 1 year after mild coronavirus disease 2019 (COVID-19) and compare with those hospitalized with moderate or critical COVID-19. Methods: Adults with confirmed severe acute respiratory syndrome coronavirus-2 infection with mild COVID-19 and persistent dyspnea (n = 18) or with moderate (n = 34) or critical COVID-19 (n = 19) were followed up 11–13 months after initial infection. Inclusion criteria were age < 65 years, no smoking history, and no preexisting respiratory diseases. Sociodemographic and clinical data were collected, and patients underwent spirometry and measurement of diffusing capacity for carbon monoxide (DLCO). Results: The non-hospitalized patients were significantly younger and more often female compared with those in the moderate and critical groups (P = 0.002 and P < 0.001, respectively). No significant differences in comorbidities or body mass index (BMI) were noted between severity groups. An obstructive spirometry pattern (ratio of forced expiratory volume during the first exhalation second to forced vital capacity under the lower limit of normal (LLN)) was found in 5.6, 5.9, and 5.3% of patients in the mild, moderate, and critical groups, respectively (P = 0.995). Abnormal DLCO (< LLN) rates were seen in 5.6, 16.7, and 47.4% in the mild, moderate, and critical groups, respectively (P = 0.018). DLCO, expressed as a z-score, was significantly lower in the critical group compared with the mild group after adjustment for age, sex, and BMI. Conclusion: Only a few subjects with mild COVID-19 and persistent dyspnea had abnormal lung function 1 year after initial infection, assessed based on spirometry and DLCO measurements. An obstructive spirometry pattern at 1-year follow-up was uncommon even in patients with moderate or critical COVID-19. Impaired DLCO was more common in patients with critical COVID-19.

Background Sepsis is a systemic inflammatory response caused by an imbalance of the host immune response to infectious factors, potentially leading to life-threatening organ dysfunction. The application of immature platelet fraction (IPF) to assessing the severity and prognosis of sepsis has been previously analyzed. However, the application of IPF combined with other biomarkers to predict sepsis has been rarely reported. Objective To explore the predictive value of IPF combined with other biomarkers in the severity and prognosis of sepsis. Methods A total of 60 sepsis patients admitted to the Department of Critical Care Medicine, Zhongshan Hospital, Fudan University (Xiamen Branch) from November 2020 to November 2022 were retrospectively recruited for analyzing their clinical data. Patients were classified into the severe sepsis group (n=24) and septic shock group (n=36) based on the severity of sepsis. Divided by the Sequential Organ Failure Assessment (SOFA) score, 60 sepsis patients were assigned into the low SOFA group (SOFA score

Background: The prevalence of molar incisor hypomineralisation (MIH) varies worldwide. In Saudi Arabia, data about this condition is limited to a few cities. Aim: To evaluate the prevalence, severity and associated aetiological factors of MIH in children seeking dental care in Armed Forces Hospital, Jazan, Saudi Arabia. Methodology: Participants were recruited by convenience sampling according to eligibility criteria. Diagnostic criteria used were according to the molar incisor hypomineralisation severity scoring system (MIH-SSS). Demographic data and past medical history were recorded using a carefully organised questionnaire, and MIH causal factors were evaluated. Results: A total of 1405 children participated in the study. Among the permanent first molars, mandibular teeth were more frequently affected by MIH than maxillary teeth. In the permanent central incisors group, maxillary teeth were more frequently involved than mandibular teeth, whereas lateral incisor was the least affected among the tooth types in all four quadrants. MIH had more frequently involved all four molars (66.1%), and two associated central incisors were found (31.3%). MIH in the incisors had mild to moderate severity, whereas molars presented with severe defects. Among prenatal factors, maternal anaemia and vitamin D deficiency, out-of-perinatal factors, caesarean delivery, low birth weight and perinatal jaundice, and early childhood tonsillitis and early childhood anaemia were the significant associated factors for MIH development. Conclusion: The prevalence of MIH was 8%, and maxillary incisors and mandibular first molars were frequently affected. Children with MIH showed prenatal, perinatal and postnatal aetiological factors involved in the development of MIH.

Abstract Malaria has complex interactions with host physiology, including alterations in cortisol levels. Cortisol, a key hormone in the stress response, is known to be dysregulated in various infectious diseases. This systematic review and meta-analysis aimed to elucidate the relationship between Plasmodium infection and cortisol levels, shedding light on the intricate interplay between the parasite and the host’s endocrine system. The methodological protocol for assessing cortisol levels in malaria patients was registered in PROSPERO (CRD42024496578), a widely recognized international prospective register of systematic reviews. This registration ensures transparency and minimizes the risk of bias in our research. A comprehensive search strategy was employed across major databases, including Embase, PubMed, Scopus, and Medline, to include studies that reported cortisol levels in infected patients. The qualitative synthesis was undertaken to synthesize the difference in cortisol levels between malaria-infected and uninfected individuals. The meta-analysis employed the random effects model in the quantitative synthesis to calculate the effect estimate. The review included a total of 20 studies, with a substantial number conducted in Africa, followed by Asia and South America. Most included studies (13/20, 65%) reported higher cortisol levels in infected patients than in uninfected patients. The meta-analysis confirmed significantly higher cortisol levels in infected patients compared to uninfected individuals (P

INTRODUCTION: Raynaud's phenomenon (RP) is associated with mild disease in adults with systemic lupus erythematosus (SLE). Although RP is more frequently reported in juvenile onset SLE (jSLE) clinical associations were not studied. We aimed to investigate whether the presence of RP is associated with clinical and serological features at onset and outcomes in children with SLE. METHODS: Medical charts of children diagnosed with jSLE were reviewed. The presence of RP was evaluated by the presence of patients reporting symptoms, and patients were compared according to the presence of RP. RESULTS: Among the 52 included patients, 13 (25.0%) displayed RP. The clinical and laboratory features did not significantly differ according to the presence of RP. However, positive anti-dsDNA (76.9% vs. 35.8%, p = 0.02), anti-RNP (53.8% vs. 17.9%, p = 0.02), and anti-centromere (23.0% vs. 2.5% p = 0.04) antibodies were more frequently observed in patients with RP than in those without. RP was not found to be associated with initial disease severity, flare rate, remission, or damage accrual. DISCUSSION AND CONCLUSION: RP was associated with certain serological features. However, RP was not strongly associated with clinical features. Moreover, neither disease severity nor disease outcomes differed according to the presence of RP in children with SLE.

Abstract To explore the role of bronchoscopy for the assessment of checkpoint inhibitor pneumonitis (CIP), a retrospective single-center study was conducted to assess patients diagnosed with CIP at grade 2 or above and also underwent bronchoscopy between January 2020 and December 2022. Clinical data and bronchoscopic findings were recorded. The treatment data and prognosis information were collected. Twenty-one patients who underwent bronchoscopy and were diagnosed with CIP were enrolled in this study. All patients underwent bronchoalveolar lavage fluid (BALF) analysis. Of them, T lymphocyte subsets of BALF were tested in 15 cases. Transbronchial cryobiopsy (TBCB) was performed in 8 patients, and transbronchial lung biopsy was performed in 5 patients. 3 patients developed pneumothorax after TBCB and all recovered without serious compilations.14 patients experienced grade 2 CIP, while 7 patients ≥ grade 3 CIP. Symptoms were improved in 19 (90.5%) patients after standard treatment adhering to CIP guidelines. However, 5 patients relapsed during steroid tapering. Factors related to the severity and recurrence of CIP were analyzed. Patients with previous interstitial lung disease (ILD) were more likely to develop high grade CIP than those without [83.3% (5/6) versus 15.4% (3/15), P = 0.011].The odds ratio (OR) was 32.5 (95% CI 2.284–443.145, P = 0.009). Increased BALF lymphocyte percentage was associated with high grade CIP, OR 1.095 (95% CI 1.001–1.197, P = 0.047), and higher possibility of CIP relapse, OR 1.123 (95% CI, 1.005–1.225, P = 0.040). Lymphocyte subsets were tested in 15 patients. CD4/CD8 > 1 was found in 80% (4/5) of relapsed patients and 20% (2/10) of patients without relapse (P = 0.047). The OR was 16.00 (95% CI 1.093–234.24, P = 0.043). In this retrospective study, patients with previous ILD was more likely to develop high grade CIP. Higher lymphocyte percentage in BALF was associated with high grade CIP and susceptibility to relapse during treatment of CIP. A CD4/CD8 ratio greater than 1 in lymphocyte subsets of BALF was associated with higher possibility of CIP relapse. We found that TBCB is a safe procedure in CIP patients.

Abstract Multisystemic inflammatory syndrome in children (MIS-C) might manifest in a broad spectrum of clinical scenarios, ranging from mild features to multi-organ dysfunction and mortality. However, this novel entity has a heterogenicity of data regarding prognostic factors associated with severe outcomes. The present study aimed to identify independent predictors for severity by using multivariate regression models. A total of 391 patients (255 boys and 136 girls) were admitted to Vietnam National Children’s Hospital from January 2022 to June 2023. The median age was 85 (range: 2–188) months, and only 12 (3.1%) patients had comorbidities. 161 (41.2%) patients required PICU admission, and the median PICU LOS was 4 (2–7) days. We observed independent factors related to PICU admission, including CRP $$\ge $$ ≥ 50 (mg/L) (OR 2.52, 95% CI 1.39–4.56, p = 0.002), albumin $$\le $$ ≤ 30 (g/L) (OR 3.18, 95% CI 1.63–6.02, p = 0.001), absolute lymphocyte count $$\le $$ ≤ 2 (× 109/L) (OR 2.18, 95% CI 1.29–3.71, p = 0.004), ferritin ≥ 300 (ng/mL) (OR 2.35, 95% CI 1.38–4.01), p = 0.002), and LVEF

Background Acute pancreatitis (AP) is one of the common gastrointestinal emergencies, and the disease progression of moderately severe and severe AP is rapid. Early and accurate identification is crucial for effective intervention and prognosis assessment. there is still a lack of effective and simple predictive indicators. Objective To investigate the early dynamic changes and predictive value of the systemic inflammation response index (SIRI) in patients with AP. Methods A total of 221 AP patients who met the inclusion and exclusion criteria at the Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, were included as study subjects from August 2020 to March 2023. According to the revised 2012 Atlanta criteria, patients were categorized into mild group (MAP group, mild acute pancreatitis) and non-mild group (non-MAP group, including moderate severe and severe acute pancreatitis). The SIRI values (SIRI 0 h, SIRI 48 h) and C-reactive protein (CRP) levels (CRP 0 h, CRP 48 h) during admission and within 48 hours of admission for the patients were collected by reviewing cases. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to analyze the predictive value of SIRI for non-MAP and compare it with CRP as a common clinical indicator of inflammation. Results A total of 221 AP patients were finally included, 102 with MAP and 119 with non-MAP. SIRI 0 h and SIRI 48 h were higher in patients in the non-MAP group than in the MAP group (P

Background Central retinal artery occlusion (CRAO) has been identified as an acute emergency resulting in vision loss, with its pathogenesis potentially involving systemic inflammation and abnormal lipid metabolism. Over recent years, it has been established that peripheral blood inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), the systemic immunoinflammatory index (SII), and the monocyte-to-high-density lipoprotein ratio (MHR), play significant roles in assessing systemic inflammation and lipid metabolism. However, the role of these indices in assessing the severity of CRAO has rarely been explored. This study aimd to investigate the relationship between these inflammatory indices and the severity of CRAO. Methods This was a retrospective clinical study with a total of 49 CRAO patients and 50 age- and sex-matched controls involved. The patients with CRAO were divided into three groups (13 with incomplete CRAO, 16 with subtotal CRAO and 20 with total CRAO). Data were compared across these groups, and additionally, correlation analysis, restricted cubic spline plots, and receiver operating characteristic curve analysis were performed. Results The values of NLR, SII and MHR were significantly higher in the CRAO group compared to controls (NLR: 2.49(1.71,3.44) vs 1.60(1.24,1.97), P

Purpose To investigate the association between the Dietary Inflammatory Index (DII) and disease severity as well as complications in children diagnosed with Henöch-Schönlein purpura (HSP), shedding light on the potential influence of dietary factors on HSP. Methods A retrospective cohort study was conducted, enrolling children aged 2–14 years diagnosed with HSP. Participants were divided into low and Pro-inflammatory dietary groups based on their DII scores. Biomarkers, nutrient intake, blood lipid profiles and disease complications were compared between the two groups. Spearman correlation analysis was performed to assess the relationship between DII and complications. Results A total of 115 patients, including 56 patients with anti-inflammatory dietary and 59 with pro-inflammatory dietary, were included. The pro-inflammatory dietary group demonstrated significantly elevated of C-reactive protein, tumor necrosis factor-α, interleukin-6, erythrocyte sedimentation rate, white blood cell count, eosinophils, IgE, consumption of total calories, protein, carbohydrates, fiber, fat intake, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL cholesterol, complications of renal, skin, gastrointestinal, coagulation and respiratory in comparison to the anti-inflammatory dietary group. DII was positively correlated with renal, skin, gastrointestinal, coagulation and respiratory complications. Conclusion The study highlights the potential influence of dietary inflammatory potential, as quantified by the DII, on disease severity and complications in children with HSP. Understanding the interplay between dietary patterns and inflammatory responses in pediatric vasculitis has implications for the management of HSP, emphasizing the relevance of considering dietary interventions to optimize clinical outcomes and improve the overall well-being of affected children.

Summary: Background: Severe and prolonged mpox courses have been described during the 2022–2023 outbreak. Identifying predictors of severe evolution is crucial for improving management and therapeutic strategies. We explored the predictors of mpox severity and tested the association between mpox severity and viral load in biological fluids. We also analysed the predictors of disease duration and kinetics of inflammatory markers and described the viral presence and duration of shedding in biological fluids. Methods: This multicentre historical cohort study included adults diagnosed with laboratory-confirmed mpox diagnosis between May 2022 and September 2023 at 15 Italian centres. Patients were followed up from the day of diagnosis until clinical recovery. Biological fluids (blood, urine, saliva, and oropharyngeal and rectal swabs) were collected from each subgroup during the course of the disease and after healing. The primary outcomes were disease severity (presence of mucosal involvement, extended rash, or need for hospitalisation) and its association with the cycle threshold value (Ct-value, surrogate of viral load) in biological fluids, using standard linear and linear mixed-effect logistic regression models. Among the secondary outcomes, predictors of disease duration were assessed using a linear regression model. Findings: A total of 541 patients were enrolled, including four (0.74%) women, with a median age of 38 years (IQR 33–44). Among the 235 people living with HIV (PLWH) (43.44%), 22 (4.07%) had a CD4 count lower than 350 cells/μL. Severe mpox was reported in 215 patients (39.74%). No patient died. Multivariable analysis showed that, severe mpox was more likely among Caucasians (OR 1.82; 95% CI 1.14–2.90, p = 0.012) and patients who had an onset of fever (1.95; 1.27–2.99, p = 0.002), lymphadenopathy (2.30; 1.52–3.48, p

Objective To explore the early predictive value of the C-reactive protein to albumin ratio (CRP/ALB) and procalcitonin to albumin ratio (PCT/ALB) for the severity of acute pancreatitis (AP). Methods A retrospective analysis was conducted on the clinical data of 133 patients with AP who were hospitalized at the Second Affiliated Hospital of Zhengzhou University from January 2020 to December 2022.Among them, there were 85 cases in the non-severe acute pancreatitis (NSAP) group and 48 cases in the severe acute pancreatitis (SAP) group. Univariate analysis of variance was performed on the age, total hospital stays, ICU admission rate, amylase, white blood cell (WBC) count, hematocrit (HCT), Ca2+, serum creatinine (Cr), blood urea nitrogen (BUN), D-dimer, serum procalcitonin (PCT), CRP, serum albumin (ALB), PCT/ALB, CRP/ALB in two groups to screen the indicators related to the severity of AP. Subsequently, ROC curve analysis and binary logistic regression analysis were condacted on the selected indicators. Results The ROC curve analysis showed that the area under the curve of CRP, CRP/ALB, PCT, and PCT/ALB were 0.793, 0.804, 0.869, and 0.881, respectively. The logistic regression analysis showed that CRP/ALB［OR=1.685,95%CI(1.293,2.195)］ and PCT/ALB［OR=1.255,95%CI(1.052,1.497)］ were independent risk factors for predicting the severity of early AP. Conclusion The higher the CRP/ALB and PCT/ALB, the greater the likelihood that AP patients will develop into severe illness, and both are positively correlated with the severity of AP in patients.

Abstract The recent article by Harit et al. in Human Genomics reported a novel association of the C allele of rs479200 in the human EGLN1 gene with severe COVID-19 in Indian patients. The gene in context is an oxygen-sensor gene whose T allele has been reported to contribute to the inability to cope with hypoxia due to increased expression of the EGLN1 gene and therefore persons with TT genotype of EGLN1 rs479200 are more susceptible to severe manifestations of hypoxia. In contrast to this dogma, Harit et al. showed that the C allele is associated with the worsening of COVID-19 hypoxia without suggesting or even discussing the scientific plausibility of the association. The article also suffers from certain epidemiological, statistical, and mathematical issues that need to be critically elaborated and discussed. In this context, the findings of Harit et al. may be re-evaluated.

Abstract Malaria infection leads to hematological abnormalities, including deranged prothrombin time (PT). Given the inconsistent findings regarding PT in malaria across different severities and between Plasmodium falciparum and P. vivax, this study aimed to synthesize available evidence on PT variations in clinical malaria. A systematic literature search was performed in PubMed, Embase, Scopus, Ovid, and Medline from 27 November 2021 to 2 March 2023 to obtain studies documenting PT in malaria. Study quality was evaluated using the Joanna Briggs Institute checklist, with data synthesized through both qualitative and quantitative methods, including meta-regression and subgroup analyses, to explore heterogeneity and publication bias. From 2767 articles, 21 studies were included. Most studies reported prolonged or increased PT in malaria patients compared to controls, a finding substantiated by the meta-analysis (P

Abstract Albumin, a key protein in human blood plasma, has been linked to various health conditions. However, its association with malaria, particularly in assessing disease severity, remains inadequately understood. This comprehensive systematic review and meta-analysis aimed to elucidate the relationship between albumin levels and malaria severity. A comprehensive literature search was conducted across multiple databases, including Embase, Scopus, PubMed, MEDLINE, Ovid, and Google Scholar, to identify studies examining albumin levels in malaria patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were pooled using a random-effects model, and heterogeneity was assessed using I 2 statistics. Subgroup and meta-regression analyses were performed based on publication year, study location, and Plasmodium species. A total of 37 studies were included in this review. The thematic synthesis indicated that albumin levels in malaria patients varied significantly based on geographical location. A meta-analysis of 28 studies found that albumin levels were significantly lower in malaria patients compared with non-malarial controls (P

Background: Calcium is an essential electrolyte with critical physiological functions. Recently, it has been implicated in the pathogenesis and outcomes of COVID-19. This retrospective study was conducted to estimate serum ionic calcium and its correlation with clinical severity, inflammatory markers, and in-hospital outcomes in moderate to severe COVID-19 patients. Methods: We retrospectively analyzed data from 377 COVID-19 patients, aged between 23 and 79 years, with a mean age of 54.17±11.53 years. Severity of the disease was determined using ICMR criteria. Parameters including age, gender, inflammatory markers, calcium levels, and clinical outcomes were assessed. Results: The study showed a prevalence of moderate and severe COVID-19 in 58.1% and 41.9% patients, respectively. Severity was significantly associated with younger age, higher mean inflammatory markers, notably IL-6, procalcitonin, D-Dimer, and lower ionic and total calcium levels, as well as vitamin D levels. Mortality and referral rate were significantly higher in the severe group. Hypocalcemia was prevalent in 39% of the patients and was significantly associated with disease severity, ARDS, and mortality. On multivariate assessment, only age and ionic calcium were significantly associated with COVID-19 severity. Conclusion: Lower serum ionic calcium levels are associated with increased severity and poor outcomes, including higher mortality in COVID-19 patients, underscoring the potential role of calcium as a diagnostic and prognostic marker in COVID-19 pneumonia and may be an important factor in various other forms of pneumonia.

Background. Musculoskeletal diseases like osteoarthritis (OA) are widespread. OA affects the knees, makes the joints wear out and hurt, and makes it hard to move around. Body mass index (BMI) is a way to measure obesity, which is linked to a higher chance of getting OA and making it worse. The main aim of this cross-sectional study was to find out how body mass index (BMI) is related to how lousy knee osteoarthritis is. Methods. One hundred people at the Shri Guru Ram Rai Institute of Medical and Health Sciences in Dehradun met the study’s requirements and were enrolled. The Kellgren-Lawrence grading method was used to find the severity of knee osteoarthritis (OA), and standard measurements were used to calculate body mass index (BMI). A correlation study was done to examine the link between BMI and the severity of OA. Results. The sample included 100 participants on average of 60 years old. The typical knee OA symptoms lasted five years. A body mass index distribution analysis showed 35% obese, 40% overweight, and 25% underweight or average weight. Twenty percent of knee OA patients were mild, 35 percent intermediate, 30 percent severe, and 15 percent progressed. The association investigation revealed a significant positive correlation between BMI and knee osteoarthritis severity (r = 0.65, p < 0.001). Conclusion. Our results show that being overweight can worsen knee OA, proving that people with this problem need to watch their weight. If we treat obesity as a risk factor that can be changed, we might be able to improve the results of OA.

Abstract Background Compared with other types of acute pancreatitis (AP), hypertriglyceridemic acute pancreatitis (HTG-AP) is younger, recurrent and more prone to exacerbation. Severe HTG-AP has a high fatality rate. Early and accurate prediction of the severity is crucial. However, there is currently a lack of a specific scoring system for the severity of HTG-AP. Aim/Purpose To construct a risk prediction model that can accurately predict severe HTG-AP in the early stage and evaluate its clinical value. Methods The clinical data of 1768 patients with AP admitted to the Second Affiliated Hospital of Anhui Medical University from January 2020 to May 2023 were analyzed retrospectively, and 136 HTG-AP patients were finally selected. Univariate and multivariate analysis were performed for the early onset indicators to identify the independent risk factors for developing SAP in the patients of HTG-AP. Logistic regression was then utilized to establish a risk prediction model for the severity of HTG-AP, which was subsequently evaluated for its performance through discrimination and calibration analysis. Results Of the 136 patients with HTG-AP, 39 patients (28.7%) progressed to severe acute pancreatitis (SAP). Multivariate analysis revealed that CRP, RDW/SC, and D-dimer were independent risk factors for developing SAP in the patients of HTG-AP. The logistic regression analysis to establish prediction model was: Logit P = − 8.101 + 0.008 × CRP + 0.425 × D-dimer + 0.743 × RDW/SC. The receiver-operating characteristics (ROC) curve showed that area under curve (AUC) value of CRP, RDW/SC, D-dimer, and the prediction model were 0.831, 0.843, 0.874, and 0.915, respectively. Moreover, the AUC value of the prediction model and commonly used scoring systems of AP were compared: prediction model (AUC = 0.915) > Ranson (AUC = 0.900) > SOFA (AUC = 0.899) > CTSI (AUC = 0.889) > BISAP (AUC = 0.887). Conclusion CRP, RDW/SC and D-dimer were independent risk factors for SAP in the patients of HTG-AP. Compared with commonly used scoring systems of AP, the prediction model had good clinical prediction ability, providing reference for early identification of the patients developing severe HTG-AP and active intervention.

Objective: To evaluate the relationship between different environmental risk factors and the severity of cleft lip with/without palate (CL ± P) and cleft palate (CP) in Saudi Arabia. Methods: This was a cross-sectional national study, of government hospitals in 10 cities distributed across major regions of Saudi Arabia, from June 2020 to June 2021. All newborns with CL ± P or CP were clinically examined and evaluated for cleft phenotype severity using the LAHSHAL classification system. Various environmental factors were evaluated by interviewing parents using a validated questionnaire. The severity of CL ± P and CP was evaluated in relation to environmental factors. Results: We recruited 174 patients with non-syndromic orofacial cleft (NSOFC); 122 (70.1 %) had CL ± P and 52 (29.9 %) had CP. After adjusting the odds ratios by ordinal regression for CL ± P and logistic regression analysis for CP, environmental factors that significantly increased the severity of CL ± P were family history of NSOFC, maternal illnesses, and maternal medication use (P = 0.02, adjusted odds ratio [AOR]:2.70; P = 0.002, AOR:3.70; and P = 0.03, AOR:2.14, respectively). Folic acid supplementation in the first trimester significantly reduced the severity of CL ± P and CP (P = 0.001, AOR:0.18 and P = 0.001, AOR:0.012, respectively). Conclusion: The severity of CL ± P was affected by some maternal exposures during the 3-month pre-gestation period. Therefore, our results suggest the possibility of controlling the severity of NSOFC.

Background The quick sequential [sepsis-related] organ failure assessment (qSOFA) acts as a prompt to consider possible sepsis. The contributions of individual qSOFA elements to assessment of severity and for prediction of mortality remain unknown.Methods A total of 3974 patients with community-acquired pneumonia were recruited to an observational prospective cohort study. The area under the receiver operating characteristic curve (AUROC), odds ratio, relative risk and Youden’s index were employed to assess discrimination.Results Respiratory rate ≥22/min demonstrated the most superior diagnostic value, indicated by largest odds ratio, relative risk and AUROC, and maximum Youden’s index for mortality. However, the indices for altered mentation and systolic blood pressure (SBP) ≤100 mm Hg decreased notably in turn. The predictive validities of respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg were good, adequate and poor for mortality, indicated by AUROC (0.837, 0.734 and 0.671, respectively). Respiratory rate ≥22/min showed the strongest associations with SOFA scores, pneumonia severity index, hospital length of stay and costs. However, SBP ≤100 mm Hg was most weakly correlated with the indices.Conclusions Respiratory rate ≥22/min made the greatest contribution to parsimonious qSOFA to assess severity and predict mortality. However, the contributions of altered mentation and SBP ≤100 mm Hg decreased strikingly in turn. It is the first known prospective evidence of the contributions of individual qSOFA elements to assessment of severity and for prediction of mortality, which might have implications for more accurate clinical triage decisions.

Krebs von den Lungen-6 (KL-6) is a glycoprotein mainly expressed by type II pneumocytes and recently known as a lung injury biomarker. However, the number of studies is still limited, especially in Indonesian COVID-19 populations. Therefore, we aim to provide correlation, sensitivity, and specificity analyses of KL-6 and other biomarkers in Indonesian COVID-19 severity and mortality. We conducted a cross-sectional study involving adult COVID-19 patients at Universitas Airlangga Hospital, Surabaya, East Java, Indonesia, between March 26, 2021, and August 25, 2021. KL-6 and other biomarker levels were compared according to severity (severe versus non-severe) and mortality (non-survivor versus survivor). We also included the receiver operating characteristic analysis to define the optimal cut-off, sensitivity, and specificity of KL-6 to determine COVID-19 severity and mortality. We enrolled 78 COVID- 19 patients (23 non-survivors), including 39 non-severe and 39 severe patients. There was no significant difference in serum KL-6 levels, neither in severity nor mortality groups. KL-6 had the strongest positive correlations with ferritin in severe patients (r=0.313) and non-survivors (r=0.467). We observed that the best sensitivity was KL-6 combined with platelet-to- lymphocyte ratio (PLR) (0.818) in severe patients and with neutrophil-to-lymphocyte ratio (NLR)/PLR/ferritin/C-reactive protein (0.867) in non-survivors. In contrast, the best specificity was found when KL-6 was combined with NLR/D-dimer (0.750) in severe patients and with D-dimer (0.889) in non-survivors. Serum KL-6 is a useful auxiliary laboratory evaluation index for COVID-19 lung injury to depict its severity and mortality.

Key Clinical Message Patients of Bullous Pemphigoid with predominant lymphocytic inflammatory infiltrate on histopathology have a severe form of the disease requiring high doses of steroids along with an adjuvant immunosuppressant. Thus, the histopathological evaluation would predict the severity of Bullous Pemphigoid, especially in countries where ELISA and immunofluorescence are not readily available.

Abstract Acne vulgaris is one of the most common skin diseases worldwide and causes great distress to patients. In addition, most acne patients suffer from low self-esteem and social withdrawal. This study aimed to assess the prevalence of acne and its impact on quality of life among medical students. It also evaluates the patterns of self-treatment use. The study population consisted of all medical students from An-Najah National University (ANU) and the hospital. The questionnaire consists of three parts, and the first part consists of questions regarding demographic information. The second part consisted of questions to measure the severity of acne using the acne severity scale as well as the Cardiff Disability Index, which assesses the quality of life concerning acne in medical students. Finally, the third part consisted of questions exploring and assessing acne self-treatment. The mean age of our study sample was 21.3 ± 1.9 years, with a female predominance of 72.3%. The prevalence of acne among medical students was 80.9%, and 36.6% practiced self-medication. Acne was strongly associated with female sex (p

Abstract The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn’s Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.

Background: The early prediction of the clinical course of COVID-19 helps health professionals to discriminate the severe cases that need ICU admission from those with no risk of worsening outcomes. Materials & methods: This cohort retrospective study included 389 COVID-19 patients admitted to Al-Hussein Teaching Hospital during the period from March to August 2021. Demographic characteristics, clinical symptoms, and laboratory findings upon hospital admission were analyzed by univariate analysis to determine their association with the severity of COVID-19; only those variables with (P>0.05 ) were included in the multivariable logistic regression to find the strong predictors of severity in term of Odd ratios. Results: The mean age of the 389 patients was 33.6 +- 14.8; there were 231(59.4%) severe cases (admitted to ICU), and 158(40.6%) were non-severe cases (admitted to regular wards). Univariate analysis revealed that gender (male) presence of co-morbidities and all clinical symptoms and laboratory findings were associated with severe outcomes of COVID-19. However, multivariate logistic regression revealed that dyspnea [O.R 42.58 (12.22; 148.36)] and high grad fever [O.R 29.25 (5.34; 160.24)] were very strong predictors for severity, while male gender [O.R4.26 (1.95; 9.33)] and hypertension [O.R6.83 (2.4; 19.54)] were strong predictors of the severity. On the other hand, Ferritin gave an indiscernible predictive value [O.R1.003 (1.001; 1.006)]. Conclusion: Some risk factors are very helpful for clinicians to discriminate against patients who may develop severe outcomes and need ICU admission, which might help the efficient use of health resources in sensitive times.

Background: Serum ferritin was found to be a positive acute phase protein and it was linked to a hyperinflammatory process, cytokine storm, and multiple organ damage in coronavirus disease (COVID-19). Objective: The objective of this study was to establish whether ferritin could be utilized as a biomarker to evaluate disease severity in COVID-19 waves one and two in hospitalized patients. Materials and Methods: It was an observational, retrospective study. A total of 2093 patients' data with confirmed reverse transcriptase-polymerase chain reaction positive for COVID-19 disease were reviewed. Serum ferritin values on the day of hospital admission were compared in both waves among different grades of clinical severity correlated in terms of survival and death. Results: Survivors in wave one were 92.5% and 85.4% in wave two. In waves one and two, the nonsurvivor rate was 7.5% and 14.6%, respectively, with statistically significant P values of 0.001. Analysis of the receiver operating curve (ROC) showed the ideal ferritin cutoff point for death is 687.6 ng/mL (sensitivity: 70%; specificity: 57.3%), with an Area under curve (AUC) of 0.67, suggesting that ferritin was a better marker of mortality and severity in the first wave. In the second wave, the cutoff for severity is 583.9 ng/mL (sensitivity of 85.1%, specificity of 54.8%). AUC 0.74 suggested a marker of severity in the second wave. Conclusion: Elevated serum ferritin levels in the first wave indicated severity and mortality with exaggerated cytokine storm and early organ damage and severity in the second wave, indicating reduced inflammation and better treatment plan.

Background: Respiratory distress (RD) is one of the common indications of hospitalisation in the neonatal intensive care unit. Due to recent advances in clinical diagnosis and treatment, there is a need for data on the current profile and outcome of neonatal RD (NRD). Aims: To determine the clinical presentation, causes, risk factors, severity, and outcome of NRD. Patients and Methods: All neonates who presented with signs of RD were enrolled. Neonatal data such as birth weight, mode of delivery, gestational age, saturation on room air, mode of oxygen therapy, and onset and severity of RD were noted in predesigned pro forma. The severity of RD in term and pre-term neonates was assessed by Downe's score and Silverman–Anderson's score, respectively. Relevant investigations and treatment were started as per standard protocol. Results: The most common cause of NRD was RD syndrome (29%). Chest indrawing was the most prevalent sign of RD (90.0%). There was no significant association of gestational age with the severity of RD (P = 0.140), but the birth weight was significantly associated with the severity of RD (P = 0.002). Severe RD was associated with extreme prematurity, meconium-stained amniotic fluid and birth weight of

Context: Acute cholecystitis (AC) is one of the most common afflictions of the gastrointestinal system presenting to hospitals whose delayed diagnosis can lead to severe complications. Neutrophil-to-lymphocyte ratio (NLR) is a new and inexpensive predictor of severe AC that can be used as prognostic biomarker for the stratification of patients for appropriate management. Aims: The aims of the study are to determine the usefulness of the NLR as a prognostic marker and to find range that distinguishes between grades of AC and to compare NLR use with white blood cell, high sensitivity C-reactive protein, and radiological modalities in the diagnosis of severe AC. Settings and Design: This is a 1-year prospective observational study in tertiary care center. Subjects and Methods: Demographic data, investigations, and management of 110 patients diagnosed with AC were collected. Categorization in mild, moderate, or severe AC group was based on Tokyo guidelines and NLR was calculated as absolute neutrophil count/absolute lymphocyte count. Statistical Analysis Used: One-way analysis of variance. Results: Sixty-four were male and 46 were female. 23.64% had severe AC, 30.91% had moderate, and 45.45% had mild AC. Mean hospital stay and intensive care unit stay were more in severe cholecystitis group. Diabetes mellitus was commonly associated comorbidity in severe cholecystitis (35.48%). As per the study, NLR ranges 10 in severe AC (sensitivity of 97% and specificity of 88%). The cardiovascular system was most commonly affected in severe AC, followed by renal derangement. Conclusions: NLR has proved to be a prognostic marker to determine disease severity in patients with AC which will help in appropriate management and better patient outcome.

Background: Vaccines, including COVID-19 vaccines, are known to be cost-effective interventions for disease prevention and control. However, adverse events following immunisation (AEFI) may challenge the acceptance of these vaccines. This study assessed the prevalence and severity of COVID-19-related AEFI amongst healthcare workers at tertiary health facilities in Nigeria. Materials and Methods: This descriptive, cross-sectional study was conducted among healthcare workers who had received the COVID-19 vaccine. A multi-stage sampling technique was used to select participants from six Tertiary Health Facilities in Nigeria. Ethical approval (NHREC/01/01/2007-19/07/2021) was obtained from NHREC. Data were analysed using IBM® SPSS version 25 and categorical variables were presented in tables/charts using frequencies and proportions. Results: A total of 2130 respondents participated in the study, with a mean age of 37.4 ± 9.1 years. Most of the respondents, 1674 (78.6%), had two doses of the vaccine, and the overall prevalence of AEFI was 813 (38.2%). Common among the AEFI reported following the administration of the first dose of the vaccine were fever 649 (30.5%) and pain at the injection site 644 (30.2%), while it was pain at the injection site 216 (10.1%) and fever 173 (8.1%) for second dose. The higher proportions of AEFI were mostly mild to moderate. Conclusion: The study observed a relatively low prevalence of AEFI, with the commonly reported ones being fever and injection site pain. It is crucial that countries continuously collect the data on AEFI and establish causality as a way to improve quality and guarantee vaccine safety.

Background. Community-acquired pneumonia (CAP) remains one of the most common diseases requiring urgent hospitalization, with a significant part of patients already receiving antibiotics before admission to the hospital. Aim. To assess the relationship between outpatient antibacterial therapy and in-hospital mortality and the severity of the CAP. Materials and methods. The retrospective study included the data of adult patients with CAP who were hospitalized in Tomsk from January 1 to December 31, 2017. Results. Among 1412 patients, 22.2% received antibiotics before admission to the hospital, the proportion of deaths in this group was significantly lower – 3.8% compared with 10.6% among patients without antibiotic therapy (p0.001). Subjects who received antibiotics on outpatient basis were less likely to require being in the intensive care unit and administering vasopressors, in contrast to patients without prior antibiotic therapy: 5.1 and 10.6% (p=0.003); 7.1 and 4.7% (p=0.018) respectively. In patients with severe CAP on a scale IDSA/ATS, only 11.8% of cases were detected with antibiotics before hospitalization, while in mild CAP the frequency of administration was 16.6% (p0.001). Conclusion. Ambulatory antibacterial therapy had a positive effect on the subsequent course and outcomes of CAP in a hospital setting. Patients had a predominantly mild course of the disease, needing for vasopressors, and being in the intensive care unit, but was not consistent with the need for invasive mechanical ventilation.

COVID-19 has proven to be a disease that affects not only the respiratory tract but also leads to a state of generalized systemic hyperinflammation and overall immune dysregulation. An important role in its pathogenesis is the disturbance of many cytokines – a condition which, in its most pronounced form, is also called a „cytokine storm“.

Aim: This nationwide study assessed the prevalence and severity of dental caries in 6-, 12-, and 15-year-old school children across Saudi Arabia. This study examined differences between genders and among regions regarding the mean values of decayed, missing, and filled teeth (dmft/DMFT), the care index (CI), and the significant caries index (SiC index). Materials and methods: Data from 19,870 participants, 10,435 males and 9435 females, were collected using stratified multistage cluster random sampling. The survey team divided Saudi Arabia into five regions (northern, eastern, western, southern, and middle). To represent each respective region, a large city, two random towns (peri-urban), and four random rural areas were selected for surveying. Lastly, the sampling technique was applied by choosing random schools and random classes within the selected schools. Dental caries were assessed using the dmft/DMFT score, CI, and the top 30% and 10% of the sample dmft/DMFT scores (SiC30 and SiC10, respectively). Results: The overall prevalence of caries was 65.6%, with 72.1 occurring in primary teeth and 61.7% in permanent teeth. The percentages of individuals with missing teeth and filled teeth were 9.0% and 20.5%, respectively. The mean dmft was 3.93 ± 3.60, while the mean DMFT was 2.42 ± 2.52; most of the DMFT components were significantly higher in females than males, while the dmft components were higher in males. The northern region had the highest and worst DMFT/dmft ratios of the five regions. The mean SiC30 and SiC10 values were significantly higher than the overall average DMFT/dmft values (P

Background The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating. Methods The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors. Results A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041–0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL. Conclusion The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

Objective: To determine the aetiology, severity and outcome of patients admitted with acute pancreatitis at Hamdard University Hospital Karachi, Pakistan. Methods: This retrospective cross-sectional study was conducted at Hamdard University Hospital Karachi from January 2021 to June 2023. Patients aged 18 years and above who were admitted to the hospital with confirmed acute pancreatitis, admitted through the emergency department or by direct admission were included. Patient’s demographic data, aetiology, along with the severity of disease and outcome, such as alive or dead, were noted. Bedside Index of Severity in Acute Pancreatitis was used to assess the severity of the disease. Results: Of the 188 patients, the mean age was 59.14 ±9.52 years. Mild acute pancreatitis was observed in 58 (30.9%), moderate in 95 (50.5%), and severe in 35 (18.6%) patients. Biliary pancreatitis was the most common etiology in 129 (68.6%) participants, whereas symptoms of abdominal pain and abdominal distension were observed in all 188 (100%) patients. A significant association of acute pancreatitis was observed with age (p-value

Abstract Background Psoriasis is a chronic inflammatory skin disease with metabolic abnormalities serving as important contributors for pathogenesis and progression. Polyunsaturated fatty acids (PUFAs) have been found to be associated with human diseases, including psoriasis. However, differences and controversies exist regarding their content and roles. Methods Plasma PUFAs concentrations were measured in 296 patients with moderate-to-severe plaque psoriasis from the Shanghai Psoriasis Effectiveness Evaluation CoHort. Disease severity was assessed using Clinician-Reported Outcomes (ClinROs), including Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and Physician Global Assessment (PGA), as well as Patient-Reported Outcomes (PROs), including Patient Global Assessment (PtGA) and Dermatology Life Quality Index (DLQI). Multivariate generalized linear regression models (GLMs), subgroup and interaction analysis, and restricted cubic spline were used to estimate the cross-sectional associations between PUFAs concentrations and disease severity. Longitudinal assessments of PASI scores and PASI response were conducted at a 12-week follow-up. Associations between baseline plasma PUFAs levels and prospective PASI scores or PASI response were assessed using multivariate GLMs or logistic regression models. Results Males suffered severer psoriasis and presented lower plasma docosahexaenoic acid (DHA) and arachidonic acid (ARA) levels compared to females. Among males, plasma eicosadienoic acid (EDA) level was positively associated with PASI, BSA and PGA scores, while total Omega-3 PUFAs and/or eicosapentaenoic acid (EPA) levels exhibited non-linear associations with PASI and/or BSA scores. α-Linolenic acid (ALA) was negatively, whereas ARA was positively, associated with DLQI scores. In females, Omega-3 PUFAs, including EPA, DHA, and total Omega-3 PUFAs, showed inverse associations with PASI and BSA scores. Longitudinally, plasma total Omega-6 PUFAs were positively associated with the likelihood of achieving PASI 100 at 12 weeks in males. In females, concentrations of dohomo-γ-linolenic acid were prospectively associated with an increase in PASI scores, and DHA was associated with the likelihood of achieving PASI 75 and PASI 90 decline. Conclusions Sex differences cross-sectionally exist in disease severity and plasma PUFAs levels. The association between PUFAs and psoriasis severity also varies cross-sectionally and longitudinally between males and females. Sex differences should be considered when studying the function and clinical application of PUFAs in psoriasis.

Introduction: Dengue is an important viral infectious disease, mostly seen in tropical countries during the rainy season, and is emerging as a public health hazard for healthcare facilities. The most common parameters used to assess the severity of dengue are platelet count and haematocrit. However, new haematological parameters have emerged to predict the severity of dengue fever and assist clinicians, especially in resource-limited settings. Aim: To highlight the significance of Neutrophil-Lymphocyte Ratio (NLR), Neutrophil-Platelet Ratio (NPR), and Neutrophil-toLymphocyte and Platelet Ratio (NLPR) in predicting outcomes in patients with dengue infection. Materials and Methods: A retrospective observational study was conducted in rural central India in the Department of Medicine at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. A total of 540 patients infected with the dengue virus between June 2021 and December 2021. Data analysis was conducted from January to April 2022. Neutrophil, platelet, and lymphocyte counts were used to calculate NLR, NPR, and NLPR, and their roles in predicting the final outcome were studied. The final analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 21.0. The p-value

Background and Objective: The association of leptin with psoriasis is currently controversial. The purpose of this study was to evaluate serum leptin levels in patients with psoriasis and its relationship with the severity of the disease. Materials and Methods: In this case-control study, serum leptin levels were measured in 40 patients with psoriasis and 40 age- and gender-matched healthy controls by sandwich enzyme-linked immunosorbent assay method. The severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Data were analyzed using SPSS software version 16. Results: Of 40 patients, 35 (87.5%) had plaque psoriasis, 3 (7.5%) had palmo-plantar, and one of the remaining two patients had erythrodermic psoriasis while the other one had a pustular type. The mean disease severity based on PASI was 10.2 with a range of 0.8 to 39.9. The most common sites of involvement were generalized (27.5%), upper and lower extremities together (20.0%), lower extremities alone (15%), and trunk and lower extremities (15%) in descending order. Leptin was higher in the patient group than the control group (19.2±16.3 ng/ml versus 15.5±16.1 ng/ml) (P=0.227). The correlation between leptin and body mass index was positive and significant in both groups. No significant relationship was found between the severity and duration of disease and leptin. Conclusion: The findings of this study showed that similar to most studies, serum leptin levels were higher in patients with psoriasis than in healthy subjects, and in obese people, this difference was greater than in normal-weight individuals

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

Early childhood caries (ECC) is not merely a problem of the tooth; rather, it has negative impacts on the child’s growth and development and oral health-related quality of life. The prevalence of ECC varies widely, and more variance is observed between countries than continents, and it changes over time. The current cross-sectional study aimed to determine ECC’s prevalence, associated factors, and severity. This study was conducted in the Dental Clinic Complex, North Riyadh, KSA. The study sample included 306 participants between 36 and 71 months of age. A questionnaire was developed to collect information from participants. The decaying and filled teeth (DMFT) index was used to estimate the prevalence of caries. The study results revealed the prevalence of ECC to be 76% among 36- to 71-month-old children in North Riyadh. ECC is influenced by socioeconomic factors like maternal occupation, education, oral hygiene habits, and dietary patterns. Also, it was found that exclusively breastfed children have lower ECC odds (68.1% vs. 83.6%, p = 0.001), while the intake of more than three between-meal sugar-containing snacks/beverages per day increases the likelihood of ECC (63.5% vs. 79.8%, p = 0.006). The researchers recommend encouraging breastfeeding as it correlates with lower ECC prevalence, in addition to establishing effective oral hygiene practices for preschool children.

This paper aims to investigate the presence of Aggregatibacter actinomycetemcomitans and to assess potential indicators of the risk of severe form(s) of periodontitis. A descriptive cross-sectional study of 156 consecutive patients with periodontitis was conducted. Subgingival plaque samples were collected from the participants. The identification of A. actinomycetemcomitans was performed using quantitative polymerase chain reaction. A descriptive analysis, a chi-square test, and a binary logistic regression statistical evaluation were performed. The prevalence of A. actinomycetemcomitans in this population of 156 participants was 17.30% (27 patients). The prevalence of stage-III periodontitis was 75.6% and greater in older men, while the prevalence of stage-IV periodontitis was 22.4% and greater in younger women. We observed a significant relation between the risk of severe periodontitis (stage-IV) and poor oral hygiene (p = 0.006), attendance at dental appointments (p ≤ 0.001), and familial history of periodontitis (p = 0.032). In conclusion, twenty-seven individuals were positive for A. actinomycetemcomitans. Poor oral hygiene, family history of periodontitis, and irregular attendance at dental appointments were identified as potential risk factors for severe periodontitis in this cohort.

Background and objective: Corona infections disease nowadays is one of the major burden on national health institutes. The aim of the study is to identify the parameters that can predict the mortality in moderate to severely ill COVID-19 infected patients. Methods: A prospective cross sectional study was carried out in Erbil Hospitals, Kurdistan region/Iraq from December 2020 to December 2021 on a sample of 100patients with positive real-time polymerase chain reaction. The data of enrolled patients were collected by direct interview with patients or with their relatives and filled in a prepared questionnaire. The patients were followed up from their admission to hospital until their discharge alive or dead. Results: The mortality rate of hospitalized patients was 44% for 100 patients. Budesonide nebulizer were given to all of the patients. The mortality rate was significantly higher in old COVID-19 patients. The COVID-19 patients presented with dyspnea, hypertension and renal failure were significantly associated with higher mortality rates. High respiratory rate, low oxygen saturation and high C-reactive protein level were accompanied with higher mortality rates of COVID-19 patients. Conclusion: The early predictors of mortality in patients with moderate to severe COVID-19 infection were elderly age, clinical presentation of dyspnea, clinical co-morbidity with hypertension and renal failure, high respiratory rate, low oxygen saturation and elevated levels of C-reactive protein.

Objectives: Hypovitaminosis D is suggested to be related to the high risk of metabolic disorders and symptoms of schizophrenia. Therefore, this study aimed to evaluate the effect of vitamin D supplementation on cardio-metabolic indices and the severity of symptoms in schizophrenic patients. Materials and Methods: Patients with schizophrenia (N=42) were randomly assigned to 2 groups, i.e., intervention (2000 IU of vitamin D daily; n=21) and placebo groups (n=21). The intervention was administered for 8 weeks. Anthropometric, clinical, and laboratory measures were assessed at both baseline and end of the trial. The Positive and Negative Syndrome Scale (PANSS) was performed to assess the schizophrenia symptoms. Results: Vitamin D supplementation leads to a significant decrease in low-density lipoprotein cholesterol (LDL-C) levels (P=0.006). In addition, a significant improvement was found in the PANSS negative subscale score (PANSS-NSS) and PANSS total score (PANSS-TS; P=0.005 and P=0.015, respectively). At the baseline, there was a significant negative correlation between PANSS-NSS, PANSS positive subscale score (PANSS-PSS), and PANSS-TS with serum levels of vitamin D (r=-0.42, P=0.010; r=-0.34, P=0.041; and r=-0.47, P=0.004, respectively). Conclusions: Vitamin D supplementation may have helpful efficacy on some cardio-metabolic indices and schizophrenia severity.