Search

Background and purpose Methods Results Conclusions Few data are available on the course of myasthenia gravis (MG) regarding disease severity and stability over time in real‐world settings. This study used the French National Health Insurance Database (SNDS) to assess markers of disease severity in patients with MG longitudinally.All patients with MG‐related claims in the SNDS between 2013 and 2020 were identified. Patients were followed for up to 8 years after the first claim. Intensive care unit (ICU) stays, treatment with intravenous immunoglobulin (IVIg) or plasma exchange (PE), and death were documented throughout the follow‐up period. Standardized mortality rates were estimated, and mortality‐related variables were identified using a Cox model.In all, 14,459 individuals constituted the full study population, including 6354 incident patients. In the incident population, 2199 (34.6%) were admitted to ICUs at least once, principally during the first year after the index date (N = 1477; 23.3%). This proportion decreased progressively to reach 3.0% in the seventh year. A total of 2817 patients received IVIg and 432 PE, again principally in the first year. In the full study population, the standardized mortality rate was 1.08 (95% confidence interval [CI] 1.03–1.13), being lower in men (0.95, 95% CI 0.89–1.02) than in women (1.15, 95% CI 1.07–1.23) and in patients aged >65 years (1.06, 95% CI 1.01–1.11) than in younger patients (1.50, 95% CI 1.24–1.76). Male gender, older age and higher comorbidity were independently associated with mortality.A subgroup of patients with MG require ICU admission and rescue therapy with IVIg or PE, indicative of poor disease control. New therapies are needed to improve disease control and reduce disease burden. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of carer- and disease-related factors on anticipatory grief (AG) in family carers supporting people living with Motor Neurone Disease. Methods: Seventy-five carers from the UK and USA participated in this cross-sectional study, between July 2021 and February 2023. Participants completed assessments on: anticipatory grief (MMCGI-SF, comprising three sub-scales: Personal Sacrifice Burden, Heartfelt Sadness and Longing, Worry and Felt Isolation); person with MND (pwMND) behavioral changes (MiND-B) and disease severity (ALSFRS-R); carer-pwMND emotional bond (Relationship Closeness Scale), familism levels (Familism Scale), and reported hours of care provided. Multiple linear regression analyses were conducted to explore factors impacting carer AG. Results: AG total scores showed that 50.7% of carers were experiencing common grieving reactions, 22.6% presented intense grieving emotions, and 26.7% presented low grieving responses. Disease severity (regression coefficient, β = −0.31, p = 0.01, 95%CI −0.91 to −0.13) and behavioral changes (β = −0.34, p = 0.002, 95%CI −1.45 to −0.33) predicted AG total scores (proportion of explained variation, R2=0.38, p < 0.001). Regarding AG subscales, Personal Sacrifice Burden (R2=0.43, p < 0.001) was predicted by disease severity (β = −0.39, p < 0.001, 95%CI −0.42 to −0.11). Behavioral changes predicted Heartfelt Sadness and Longing (β = −0.27, p = 0.03, 95%CI −0.49 to −0.03; R2 = 0.21, p = 0.01) and Worry and Felt Isolation (β = −0.42, p < 0.001, 95%CI −0.63 to −0.20; R2=0.33, p < 0.001). Conclusion: This study suggests that disease-related factors may be the strongest predictors of carer AG. Interventions addressing carers' understanding and management of MND symptoms seem crucial to support their experiences of loss and their acceptance of MND. Evidence-based support for carers in MND services is required. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross-sectional study is to investigate the levels of NLRP3 in the serum and induced sputum of children with asthma and their potential association with lung function and disease severity. Methods: This cross-sectional study included 83 children with bronchial asthma who sought medical care at our hospital from May 2023 to February 2024. Portable spirometry was used to monitor lung function parameters, including forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow. The expression of C-reactive protein (CRP), interleukin (IL)-6, IL-1β, TNF-α, and Nod-like receptor family pyrin domain-containing 3 (NLRP3) in the serum and induced sputum were measured by enzyme-linked immunosorbent assay. Data analysis was performed using SPSS 25.0 and differences with P < 0.05 were considered statistically significant. Results: Children with asthma exhibited significantly elevated levels of serum NLRP3, CRP, IL-6, IL-1β, and TNF-α compared to healthy controls. In addition, children with moderate–severe asthma had significantly higher levels of serum and induced sputum NLRP3 and IL-1β compared to children with mild asthma. Spearman's correlation analysis revealed a positive correlation between induced sputum NLRP3 and IL-6. Moreover, induced sputum NLRP3 was negatively correlated with lung function parameters. The results of receiver operating characteristic curves showed that induced sputum NLRP3 could be used for diagnosing children with moderate–severe asthma, with an AUC was 0.758, cutoff value of 3.33 ng/mL, sensitivity of 66.1%, and specificity of 70.8%. Furthermore, the logistic regression analysis revealed that serum and induced sputum NLRP3, induced sputum IL-6 and IL-1β were risk factors for children with moderate–severe asthma. Conclusions: In this cross-sectional study, we found a significant increase in NLRP3 levels in induced sputum of children with asthma, which further increased in those with moderate–severe disease. The levels of NLRP3 in induced sputum could serve as potential biomarkers for assessing disease severity. [ABSTRACT FROM AUTHOR]

Introduction: Pemphigus vulgaris (PV) is an autoimmune disease characterized by IgG autoantibodies targeting desmoglein-3 (Dsg3), leading to blistering of mucous membranes and skin. Although commercial ELISA kits effectively diagnose PV, correlation with clinical phenotype remains unclear. This study assesses multiple panels for monitoring disease severity and activity by profiling IgG autoantibodies against Dsg3’s various extracellular ectodomains. Method: We designed and expressed different extracellular domains of Dsg3 in HEK293T cell line and developed 15 different ELISA panels, each using a single or multi ectodomains encompassing the entire extracellular region of Dsg3 to detect specific autoantibodies against the particular part of Dsg3. Results: To validate our approach, we compared our ELISA panel for the full Dsg3 (EC1-5) against a commercial kit using 154 random serum samples from PV patients, demonstrating a strong correlation. For evaluation of IgG autoantibody profiles in our panels, 59 PV patients were included, along with 11 bullous pemphigoid patients, and 49 healthy controls. For all the included subjects, 15 predefined ELISA panels were tested. The IgG autoantibodies against EC1 were detected in 86% of patients with a positive full Dsg3 ectodomain (EC1-5) ELISA, with 26% against EC2, 14% for EC3, 29% for EC4, and 23% for EC5. Among the panels with multiple Dsg3 ectodomains, EC1-3 and EC1-4 were representative of the entire Dsg3 ectodomain in terms of ELISA positivity across all included patients. A significant correlation (P<0.05) was observed between ELISA optical density (OD) and Pemphigus Disease Area Index (PDAI) scores in five panels, EC1, EC2-3, EC2-5, and EC3-4 in addition to the full ectodomain. It suggests an association with disease severity. Interestingly, while the ELISA panel for the entire Dsg3 extracellular ectodomains did not differentiate disease phases, in three of our panels, including EC1, EC3-5, and EC2-5, ANOVA analysis showed a statistically significant difference between the groups of patients in remission, partial remission or persistent lesions, and those with active disease (new cases or relapse). Among these three panels, EC1 was the only one that showed a significant difference in the multiple comparisons analysis; patients in the active phase had higher levels of autoantibodies than those in ‘partial remission or persistent lesions’ and ‘complete remission’ groups. Conclusion: The level of autoantibodies against EC1 was not only correlated with the full ectodomain but also associated with higher disease severity and active disease phase. This study indicates that a detailed autoantibody profile against Dsg3 ectodomains could serve as a marker for PV severity and activity which may potentially enhance early treatment initiation. [ABSTRACT FROM AUTHOR]

Introduction Aim Materials and methods Results Conclusion The severity of Von Willebrand disease (VWD) is currently based on laboratory phenotype. However, little is known about the severity of the patient's experience with the disease. The most recent VWD guidelines highlight the need for patient‐reported outcomes (PROs) in VWD.The study aimed to investigate the patient‐perspective on VWD severity and to identify key factors that determine the severity of disease experienced by patients.Patients participated in a nationwide cross‐sectional study on VWD in the Netherlands (WiN‐study). Patients filled in a questionnaire containing questions on the experienced severity of VWD (4‐point scale), bleeding score (BS) and quality of life (QoL).We included 736 patients, median age of 41.0 years (IQR 23.0–55.0) and 59.5% were women. A total of 443 had type 1, 269 type 2 and 24 type 3 VWD. Self‐reported severity of VWD was categorized as severe (n = 52), moderate (n = 171), mild (n = 393) or negligible (n = 120). Classification by historically lowest FVIII:C levels < 0.20 IU/mL as a proxy for severe VWD aligned with patient‐reported severity classification with a 72% accuracy. Type 3 VWD (OR = 4.02, 95%CI: 1.72–9.45), higher BS (OR = 1.09, 95%CI: 1.06–1.11), female sex (OR = 1.36, 95%CI: 1.01–1.83), haemostatic treatment in the year preceding study inclusion (OR = 1.53, 95%CI: 1.10–2.13) and historically lowest VWF:Act levels (OR = 0.26, 95%CI: 0.07–1.00) were independent determinants of patient‐reported severity.This study shows that patient‐reported data provide novel insights into the determinants of experienced disease severity. Our findings highlight the need for studies on PROs with validated questionnaires to assess the burden of VWD. [ABSTRACT FROM AUTHOR]

Background: Pain is common in the genetic skin fragility disorder epidermolysis bullosa (EB), from skin and mucosal injury and inflammation as well as extra-mucocutaneous sites. Individuals living with EB have identified pain as a priority for better treatments. Objectives: The Prospective EB Longitudinal Evaluation Study (PEBLES) is a prospective register study exploring the natural history of RDEB across all ages from birth to death. Here, we investigated the characteristics and treatment of pain in different RDEB subtypes. Methods: Information was collected from individuals with different RDEB subtypes over an 8-year period. Data included visual analogue scale (VAS) ratings of background and procedural pain, its location, intensity and impact on sleep, as well as pain medication. Disease severity scores and quality of life measures were correlated to pain scores. Results: Sixty-one participants (13 children, 48 adults) completed a total of 361 reviews. Pain was common, experienced by 93% of participants at index review, with 80% suffering both background and procedural pain. Across all RDEB patients, the median VAS for background pain was 40 (out of 100) [interquartile range 20,60] and for those having regular dressing changes, median procedural pain was 52 [40,80]. Severe (RDEB-S) and pruriginosa (RDEB-Pru) groups had the greatest increase in procedural compared to background pain of 20 and 22 VAS points, respectively. Correlations between disease severity and quality of life impairment were observed across most groups, particularly RDEB-S. Over half of those studied experienced pain frequently or constantly, and in one third pain disturbed sleep at least 4 nights per week. Skin was the commonest source of pain in all subtypes except inversa RDEB where the mouth was the main site. Despite frequent and severe pain, one third of participants used no medication for pain and, in those that did, pain levels remained high suggesting ineffectiveness of current pain management approaches and a significant unmet need in RDEB. Conclusion: The frequency, severity, and impact of pain in all RDEB patients is significant, particularly in RDEB-S and RDEB-Pru. Our findings highlight that current RDEB pain management is poorly effective and that further research is needed to address this symptom. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Given the multisystem nature of COVID-19 and its potential neuro-psychiatric effects along with the recognized role of systemic inflammation in the prognosis of both COVID-19 and psychiatric disorders, it is imperative to assess psychiatric symptoms in COVID-19 patients. This study sought to investigate the value of systemic immune-inflammation index (SII) scores, levels of anxiety and depressive symptoms assessed within the initial 24 hours following COVID-19 diagnosis as potential predictors of the clinical trajectory of COVID-19. METHODS: This study involved 64 patients admitted to our COVID-19 ward with mild-to-moderate COVID-19 pneumonia, all of whom underwent a psychiatric evaluation within 24 hours of admission. Upon admission, levels of c-reactive protein and inflammatory markers including leukocyte, neutrophil, thrombocyte, and lymphocyte counts were measured to calculate individual SII scores. Psychiatric evaluations were conducted using the State-Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HDRS), and Standardized Mini-Mental Test (SMMT). RESULTS: The patients with clinical deterioration of COVID-19 exhibited higher STAI-Trait and STAI-State subscale scores measured upon admission compared to those without clinical deterioration. HDRS scores showed no significant correlation with clinical deterioration. STAI-State subscale scores correlated with SII scores and the duration of hospital stay. High baseline STAI scores and SII scores predicted COVID-19 clinical deterioration. CONCLUSION: Our study demonstrated that the initial SII and STAI scores assessed within the initial 24 hours of hospitalization for COVID-19 significantly predicted the clinical progression of the disease during the hospital stay [ABSTRACT FROM AUTHOR]

Background: Social comparison, the process of evaluating one's characteristics in relation to others, influences individuals' self‐perception and behavior. However, instruments are scarce for assessing social comparison in the medical setting. Objectives: Our aim was to develop and validate a new scale for assessing social comparison. Materials and methods: Seven statements were developed, encompassing the perceived normality of having rashes, the tendency to compare their situation with others, and the emotional response when seeing someone better or worse off than themselves. The instrument was piloted in 15 patients for readability and face validity, then prospectively validated using modern psychometric methods in 1,053 adult patients with eczema or psoriasis from three tertiary dermatological centers in Singapore. Results: Of 1,053 adult patients, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Exploratory factor analysis (using a 70% sample split) showed a single factor model comprising three questions (Eigenvalue: 1.4). Confirmatory factor analysis with the remaining 30% of the sample confirmed an excellent model fit. Cronbach's alpha was 0.7, and inter‐item correlations ranged from 0.42 to 0.46. In the Rasch analysis, item fit statistics and item characteristic curves showed appropriate discrimination between response options, although reliability was suboptimal with a person separation reliability of 0.63. Conclusions: Comprising 3 questions, the newly derived social comparison scale showed acceptable psychometrics as a measure of social comparison for clinical and research purposes in dermatology. Its brief nature likely results from its brevity and applicability to conditions beyond eczema and psoriasis, which warrants further investigation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected the global health system and economies largely. Therefore, knowledge about the clinical and laboratory profiles of patients with COVID-19 would help in the management and prognosis of the disease. The immunological and hematological indices have emerged as critical determinants for the severity of the disease and the prognosis; however, association with COVID-19 is clouded. The present study is aimed to characterize the immunological and hematological profiles of patients with COVID-19 in correlation with the disease severity. The study included 1,019 polymerase chain reaction (PCR)–confirmed patients with COVID-19 who were classified into serious and nonserious groups, considering severity criteria. Clinical laboratory investigations included hematological, biochemical, and immunological parameters regarding leukocyte counts, hemoglobin levels, and inflammatory markers. Our analysis of immunological and hematological differences between serious and nonserious patients with COVID-19 indicates that serious cases reflected elevated levels of pro-inflammatory markers such as lactate dehydrogenase, C-reactive protein (CRP), D-dimer, and ferritin, representing immune system dysregulation and systemic inflammation. Furthermore, in serious cases, discrepancies had also been noticed for many hematological parameters than nonserious ones, which also contained leukocyte count and hemoglobin level. Additionally, the CRP, D-dimer, blood urea nitrogen, alanine transaminase, and albumin levels could be independent predictors of COVID-19 severity by multivariate logistic regression analysis. Cutoff values for these biomarkers were defined by receiver operating characteristic curve analysis defining optimal parameters for the risk stratification and prognostication. The current investigation provides a comprehensive understanding of immunological and hematological correlation with COVID-19 severity, refining clinical decision-making and therapeutic interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the dynamic changes in monocytic myeloid-derived suppressor cells (M-MDSCs) and their implications in the pathogenesis of acute coronary syndrome (ACS), shedding light on potential therapeutic targets. Experimental Design: Peripheral blood samples were collected from 68 ACS patients, 35 stable angina pectoris (SAP) patients, and 30 healthy controls (HC). Multi-parameter flow cytometry was employed for analysis of M-MDSCs, explored with disease characteristics and progression. Results: ACS patients exhibited an increased frequency of circulating M-MDSCs compared to SAP patients and HC. M-MDSCs levels demonstrated associations with ACS type, coronary artery lesions, multi-vessel disease, and cardiac dysfunction severity. Higher M-MDSCs levels were found in obese patients. Notably, therapy led to a significant decrease in M-MDSCs frequency. Furthermore, ACS patients exhibited elevated levels of interleukin (IL)-6, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor-α (TNF-α) in the cytokine profile associated with M-MDSCs. Increased expression of arginase-1(Arg-1) was observed in ACS patients, with positive correlations between M-MDSCs levels and IL-6, GM-CSF, and Arg-1 expression. The diagnostic performance of triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and M-MDSCs levels varied in predicting the severity of coronary artery stenosis, with TG showing higher specificity, HDL-C displaying higher sensitivity, and M-MDSCs levels demonstrating balanced sensitivity and specificity. Conclusions: Assessment of M-MDSCs frequency holds promise as a predictive marker for disease progression and therapy response of coronary artery stenosis. The elevated presence of M-MDSCs suggests their potential role in modulating ACS-related inflammation. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease (IBD). It is characterized by diffuse inflammatory process of the bowel mucosa with a relapsing course. The precise evaluation of UC severity is pivotal in the therapeutic decision-making. Modified Mayo score is consistently used for the evaluation of the disease activity which depends on the patient's symptoms as well as the colonoscopic findings. The aim of this study is to assess the role of the CT enterography (CTE) scoring system in the evaluation of the disease severity in ulcerative colitis. From October 2022 to July 2023, 66 patients with known ulcerative colitis patients at time of disease activity were referred from the inflammatory bowel disease unit for radiological assessment by CTE. CT images were analyzed to determine the anatomical location of the affected bowel segments, mucosal thickening and hyperenhancement as well as the extra-enteric involvement. Correlation with the modified Mayo score was established. Results: Our results showed a statistical significant correlation between modified Mayo score and CTE with a P value of 0.000. The correlation coefficient is r = 0.964. The cut-off value of the optimal CTE score to predict mild and moderate UC was 7.5 with 0.996 area under the ROC curve, 92%sensitivity and 100% specificity. The cut-off value of the optimal CTE score to predict moderate and severe UC was 10.5 with 0.983 area under the ROC curve, 90.6% sensitivity and 100% specificity. Conclusions: CTE is a reliable diagnostic method in the systematic assessment of the disease severity of active ulcerative colitis. CTE score shows a strong proportionate correlation with modified Mayo score. The aggravation of the course of the disease increased the CTE score. CTE scoring system can help plan the therapeutic strategy and predict prognosis. [ABSTRACT FROM AUTHOR]

The aim of the study was to conduct of relationship of acute-phase proteins (APPs) with the severity of COVID-19 defined by National Institutes of Health and according to the criteria of MEWS scale, with the presence of a cytokine storm, oxygen therapy and patient survival. We enrolled 96 patients with COVID-19 and 30 healthy people. The samples were taken on the day of admission and after 9 days on average. Not only commonly used APPs such as CRP, procalcitonin and ferritin and also rarely assayed proteins such as transferrin, haptoglobin, α1-acid glycoprotein and α1-antitrypsin, were tested in the study. The levels of APPs depends on the severity of COVID-19 disease, on the presence of cytokine storm and used oxygen therapy. The greatest APPs changes occurred in the most advanced form of the disease, with the presence of a cytokine storm and the most intense oxygen therapy. The results obtained from MEWS scale were not consistent with National Institutes of Health scores. Studies in the second samples showed the quenching of the acute phase reactions and the effectiveness of oxygen therapy. Only two of the examined APPs i.e. procalcitonin and transferrin, differed between surviving and non-surviving patients, and these two predispose to the role of prognostic factors in Covid-19. In conclusion, the concentration of not all acute-phase proteins depends on the severity of COVID-19 disease, presence of cytokine storm, the used of oxygen therapy and only some of them (procalcitonin and transferrin) are related to the survival outcomes. Of the newly tested acute-phase proteins, only transferrin shows significance as a marker of disease severity and mortality in COVID-19 disease. [ABSTRACT FROM AUTHOR]

Ustilago maydis, the fungus that causes corn smut disease, leads to significant economic losses in maize cultivars. A key feature of successful plant pathogens is their ability to utilize the plant–pathogen relationship to influence disease progression. Greenhouse experiments examined how pollination and plant genotype affect disease incidence and severity of U. maydis infection. Four U. maydis susceptible maize inbreds (B73, H95, Mo17, and Golden Bantam), and two U. maydis resistant maize‐teosinte near‐isogenic lines (NIL1 and NIL2) were utilized for this work. Three‐hundred and sixty plants (pollinated and unpollinated) from the six plant genotypes were inoculated with U. maydis and assessed based on five phenotypic traits [(1) disease incidence, (2) gall number, (3) gall weight, (4) disease severity, and (5) area under disease progress curve]. All pollinated plants demonstrated significantly (p <.001) lower disease incidence, gall number, gall weight, area under the disease progress curve, and severity in comparison to the unpollinated plants. Both pollinated resistant NILs demonstrated significantly (p <.001) less disease development than the pollinated susceptible maize plants and two unpollinated NILs. Therefore, disease resistance to U. maydis was dependent upon pollination and plant genotype. This provides novel evidence that pollination can significantly improve resistance to U. maydis in different plant genotypes. Enhanced disease resistance observed in the resistant NILs after pollination indicates pollination‐mediated resistance is one of the resistance mechanisms functioning in the resistant NILs. Integration of pollination‐mediated resistance and resistance introgressed from a maize progenitor will be useful for improving resistance to U. maydis and management of the disease. [ABSTRACT FROM AUTHOR]

The relationship between peripheral inflammatory markers, their dynamic changes, and the disease severity of myasthenia gravis (MG) is still not fully understood. Besides, the possibility of using it to predict the short‐term poor outcome of MG patients have not been demonstrated. This study aims to investigate the relationship between peripheral inflammatory markers and their dynamic changes with Myasthenia Gravis Foundation of America (MGFA) classification (primary outcome) and predict the short‐term poor outcome (secondary outcome) in MG patients. The study retrospectively enrolled 154 MG patients from June 2016 to December 2021. The logistic regression was used to investigate the relationship of inflammatory markers with MGFA classification and determine the factors for model construction presented in a nomogram. Finally, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were utilized to evaluate the incremental capacity. Logistic regression revealed significant associations between neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), aggregate index of systemic inflammation (AISI) and MGFA classification (p = 0.013, p = 0.032, p = 0.017, respectively). Incorporating dynamic changes of inflammatory markers into multivariable models improved their discriminatory capacity of disease severity, with significant improvements observed for NLR, systemic immune‐inflammation index (SII) and AISI in NRI and IDI. Additionally, AISI was statistically associated with short‐term poor outcome and a prediction model incorporating dynamic changes of inflammatory markers was constructed with the area under curve (AUC) of 0.953, presented in a nomograph. The inflammatory markers demonstrate significant associations with disease severity and AISI could be regarded as a possible and easily available predictive biomarker for short‐term poor outcome in MG patients. [ABSTRACT FROM AUTHOR]

Objectives: Kynurenine is the breakdown product of tryptophan. The tryptophan metabolic pathway increases in COVID-19 infection. This study was designed to reveal the relationship between tryptophan and kynurenine levels and disease severity. Our study also aimed to explore the relationship between tryptophan-kynurenine levels and patient survival, need for mechanical ventilation, and length of hospital stay. Methods: All 82 COVID-19 patients were grouped as severe and mild cases. Serum tryptophan and kynurenine levels were measured by the ELISA method. Receiver operating characteristic curves were generated to plot the KYN/TRP ratio and other variables. Multivariate logistic regression analyses were used to assess the strength of associations between risk factors and patient status. Categorical variables were compared. Results: The kynurenine/tryptophan level was significantly higher (p<0.001), and the tryptophan level was signifi- cantly lower (p=0.008) in the severe group. With a cutoff point of 14.2, the kynurenine/tryptophan ratio had 56.1% sensitivity and 80.49% specificity in predicting COVID-19 severity. In the multivariate logistic regression analysis using age, troponin, platelet count, ferritin, and kynurenine/tryptophan levels, with a cut-off value of 0.34, the sensitivity and specificity were 92.6% and 87.8%, respectively. There was no significant difference in tryptophan and kynurenine levels in terms of patient survival, need for mechanical ventilation, and length of hospital stay. Conclusion: The kynurenine/tryptophan ratio is valuable in evaluating clinical outcomes of COVID-19 patients, especially when used in conjunction with age, troponin, platelet count, and ferritin. It is useful in predicting the clinical course at the time of admission to the emergency department. To our knowledge, the kynurenine/tryptophan ratio, together with age, troponin, platelet count, and ferritin parameters, is the best model with the highest AUC that can be used to show early prediction of clinical outcomes in COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Anaemia is the most common Extraintestinal Manifestation (EIM) associated with Ulcerative Colitis (UC) and has been linked to increased mortality in UC patients, with iron deficiency having the most pronounced effect. Moreover, iron deficiency in UC can occur with or without anaemia. Aim: To assess anaemia and iron deficiency, with or without anaemia, in UC patients. Materials and Methods: The present cross-sectional study was conducted in the Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from August 2020 to December 2021. Study included 75 patients with UC and varying levels of disease activity. A complete haemogram, Red Blood Cell (RBC) indices, and serum iron studies {serum iron levels, Total Iron Binding Capacity (TIBC), Transferrin Saturation (TfS), and serum ferritin} were conducted. Patients were classified as having Iron Deficiency Anaemia (IDA), Anaemia of Chronic Disease (ACD), or mixed anaemia based on the results of the iron studies. Disease activity was assessed using the Mayo score. Patients were divided into group I (mild disease activity) and group II (moderate to severe disease activity). Haemoglobin (Hb), RBC indices and iron levels were compared between the two groups. Independent t-tests and Chi-square tests were employed for statistical analysis. Results: The mean±Standard Deviation (SD) age of the patients was 34.8±14 years, with a male-to-female ratio of 1.7:1. The mean±SD duration of the disease was 28.8±33.8 months (median: 12 months). Fifteen patients had mild disease activity, 52 had moderate activity, and eight had severe activity. The mean±SD Hb level among the patients was 11.1±2.0 g/dL. The mean±SD values for Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were 80.4±7.7 fL, 26.4±4.0 pg, and 32.1±2.5 g/dL, respectively. The mean±SD serum iron level and ferritin levels were 59.3±29.1 mcg/dL and 27.2±27.9 ng/mL, respectively. The mean±SD TfS was 14.3±10.8%, while the mean±SD TIBC was 337.1±80.5 mcg/dL. A total of 45 (60%) patients had anaemia, and 16 (21.3%) patients had iron deficiency without anaemia. Among those with anaemia, 32 (42.7%) had IDA and 13 (17.3%) had mixed anaemia; none of the patients had ACD. In total, 61 (81.3%) patients had iron deficiency, with or without anaemia. Hb, RBC indices and iron studies were comparable between both groups. Conclusion: Iron deficiency anaemia is common in UC patients, affecting 60% of the cohort; however, iron deficiency without anaemia was also observed in 21.3% of patients. Changes in Hb, RBC indices and iron studies were independent of disease activity. [ABSTRACT FROM AUTHOR]

Peach leaf curl disease, caused by Taphrina deformans (Berk.) Tul., is one of the most serious peach diseases, causing quantitative and qualitative damage to crops across Iran each year. In current study, the efficacy of two new fungicides, Badge®WG280 and Barzidox® WP85%, was evaluated in controlling peach leaf curl disease. The experiment was conducted in Golestan, Semnan and North Khorasan using a randomized complete block design with ten treatments and four replications. Treatments included 0.75, 1, and 1.2 ml l-1 of Badge®WG280 (copper hydroxid+copper oxychloride), 2, 4, and 6 g.l-1 of Barzidox®WP85% (copperoxychloride), 2.5 ml l-1 of Nordox®WG75% (copperoxide(, 3 g l-1 of Captan, and controls (with and without water spraying). Treatments were applied at three physiological stages (the first in autumn after the leaves had fallen, the second at the end of March before the bud had swollen, and the third after the petals had dropped). Disease incidence and severity percentage were determined. Duncan's multiple range test was used to compare the mean disease severity and incidence percentages. The results showed that 6g l-1 of Barzidox® had the highest efficacy in reducing disease severity compared to the control in Golestan and Semnan provinces, with 81% and 80% respectively. Furthermore, the best performance of two indicator fungicides, Nordox® and Captan were 73% and 72% in Golestan province and 67% and 68%, in Semnan province, respectively. According to the results, it is concluded that 1.2ml.l-1 of Badge® and 4g.l-1 of Barzidox® have the best efficiency in controlling the peach leaf curl disease. [ABSTRACT FROM AUTHOR]

Recent evidence indicates that the gut microbiota (GM) has a significant impact on the inflammatory bowel disease (IBD) progression. Our aim was to investigate the GM profiles, the Microbial Dysbiosis Index (MDI) and the intestinal microbiota-associated markers in relation to IBD clinical characteristics and disease state. We performed 16S rRNA metataxonomy on both stools and ileal biopsies, metabolic dysbiosis tests on urine and intestinal permeability and mucosal immunity activation tests on the stools of 35 IBD paediatric patients. On the GM profile, we assigned the MDI to each patient. In the statistical analyses, the MDI was correlated with clinical parameters and intestinal microbial-associated markers. In IBD patients with high MDI, Gemellaceae and Enterobacteriaceae were increased in stools, and Fusobacterium, Haemophilus and Veillonella were increased in ileal biopsies. Ruminococcaceae and WAL_1855D were enriched in active disease condition; the last one was also positively correlated to MDI. Furthermore, the MDI results correlated with PUCAI and Matts scores in ulcerative colitis patients (UC). Finally, in our patients, we detected metabolic dysbiosis, intestinal permeability and mucosal immunity activation. In conclusion, the MDI showed a strong association with both severity and activity of IBD and a positive correlation with clinical scores, especially in UC. Thus, this evidence could be a useful tool for the diagnosis and prognosis of IBD. [ABSTRACT FROM AUTHOR]

Malaria is one of the most infectious disease that affects lives of million people throughout the world. Recently, there are several reports which indicate Plasmodium vivax (P. vivax) causing severe disease in infected patients from different parts of the world. For P. vivax disease severity, the data related to immunological and inflammatory status in human host is very limited. In the present study clinical parameters, cytokine profile and integrin gene were analyzed in P. vivax clinical patients. A total of 169 P. vivax samples were collected and categorized into severe vivax malaria (SVM; n = 106) and non-severe vivax malaria (NSVM; n = 63) according to WHO severity criteria. We measured host biomarker levels of interferon (IFN-γ), superoxide dismutase (SOD-1), interleukins viz. (IL-6, IL-10), and tumor necrosis factor (TNF-α) in patient plasma samples by ELISA for pro- and anti-inflammatory cytokines in severe malaria. Host integrin gene was genotyped using PCR assay. In our study, thrombocytopenia and anemia were major symptoms in severe P. vivax patients. In analyzed SVM and NSVM groups a significant increase in cytokine levels (IL-10, IL-6, and TNF-α) and anti-oxidant enzyme SOD-1 was found. Our study results also showed a higher pro-inflammatory (TNF-α, IL-6 and IFN-γ) to anti-inflammatory (IL-10) cytokine ratio in severe vivax patients. Integrin gene showed no mutation with respect to thrombocytopenic patients among clinically defined groups. It was observed that severe vivax cases had increased cytokine levels irrespective of age and sex of the patients along with thrombocytopenia and other clinical manifestations. The results of current findings could serve as baseline data for evaluating severe malaria parameters during P. vivax infections and will help in developing an effective biomarker for diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this paper is to demonstrate the difference in usefulness of the coronary artery calcium score (CACS) and the full assessment of the severity of coronary artery disease in coronary computed tomography angiography (CCTA) studies. The difference between the population risk of coronary artery disease (CAD) assessed by the CACS and the severity of CAD was demonstrated in images from two CCTA studies. The first image is from a patient with a CACS of 0 and significant coronary artery stenosis. In the native phase of CCTA examination, no calcified changes were detected in the topography of the coronary arteries. In the middle section of the left descending artery (LAD), at the level of the second diagonal branch (Dg2), a large non-calcified atherosclerotic plaque was visible. Mid-LAD stenosis was estimated to be approximately 70%. The second image features a patient with a high CACS but no significant coronary artery stenosis. The calcium score of individual coronary arteries calculated using the Agatston method was as follows: left main (LM) 0, LAD 403, left circumflex (LCx) 207.7, right coronary artery (RCA) 12. CACS was 622.7, representing a significant population risk of significant CAD. In the proximal and middle sections of the LAD, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visible, causing stenosis of 25–50%. Similarly, in the proximal and middle sections of the LCx, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visualized, causing stenoses of 25–50%. Calcified atherosclerotic plaques were found in the RCA, causing stenosis <25%. The entire CCTA image met CAD-RADS 2 (coronary artery disease reporting and data system) criteria. In summary, CACS may be applicable in population-based studies to assess the risk of significant CAD. In the evaluation of individual patients, a comprehensive assessment of CAD severity based on the angiographic phase of the CCTA examination should be used. [ABSTRACT FROM AUTHOR]

Background: Several single-center studies proposed utility of vagus nerve (VN) ultrasound for detecting disease severity, autonomic dysfunction, and bulbar phenotype in amyotrophic lateral sclerosis (ALS). However, the resulting body of literature shows opposing results, leaving considerable uncertainty on the clinical benefits of VN ultrasound in ALS. Methods: Relevant studies were identified up to 04/2024 and individual patient data (IPD) obtained from the respective authors were pooled with a so far unpublished cohort (from Munich). An IPD meta-analysis of 109 patients with probable or definite ALS (El Escorial criteria) and available VN cross-sectional area (CSA) was performed, with age, sex, ALS Functional Rating Scale-revised (ALSFRS-R), disease duration, and bulbar phenotype as independent variables. Results: Mean age was 65 years (± 12) and 47% of patients (± 12) had bulbar ALS. Mean ALSFRS-R was 38 (± 7), and mean duration was 18 months (± 18). VN atrophy was highly prevalent [left: 67% (± 5), mean CSA 1.6mm2 (± 0.6); right: 78% (± 21), mean CSA 1.8 mm2 (± 0.7)]. VN CSA correlated with disease duration (mean slope: left − 0.01; right − 0.01), but not with ALSFRS-R (mean slope: left 0.004; mean slope: right − 0.002). Test accuracy for phenotyping bulbar vs. non-bulbar ALS was poor (summary receiver operating characteristic area under the curve: left 0.496; right 0.572). Conclusion: VN atrophy in ALS is highly prevalent and correlates with disease duration, but not with ALSFRS-R. VN CSA is insufficient to differentiate bulbar from non-bulbar ALS phenotypes. Further studies are warranted to analyze the link between VN atrophy, autonomic impairment, and survival in ALS. [ABSTRACT FROM AUTHOR]

Introduction: There are only a few studies exploring post-thymectomy outcome in patients with acetylcholine receptor antibody (AChR-Ab)-positive generalised myasthenia gravis (MG). Objective: To assess the predictors of outcome in patients with AChR-Ab-positive generalised MG who underwent thymectomy. Methods: A retrospective study of 53 patients from a single neuroscience centre in the UK. Results: The mean disease duration from diagnosis was 6.2 ± 4.3 years. Pre-thymectomy, 37 patients had mild weakness affecting muscles other than ocular muscles, 11 patients had moderate weakness and 5 patients had severe weakness. 27/53 patients had thymoma. Post-thymectomy (mean duration of 5.7 ± 4.2 years), 34 patients (64%) had a good outcome characterised by Myasthenia Gravis Foundation of America Post-Intervention Status of complete stable remission (no symptoms or signs of MG for at least 1 year without any therapy) or pharmacological remission (no symptoms or signs of MG with some form of therapy) or minimal manifestations (no symptoms of functional limitations from MG but weakness on examination of some muscles with or without some form of therapy) on last follow-up visit. Having thymomatous or non-thymomatous MG did not predict the outcome. The only variable that did predict outcome was pre-thymectomy disease severity; patients with mild weakness before thymectomy had a favourable outcome. We found an accuracy of 83% predicting outcome (95% confidence interval (CI) 60%, 100%) with a sensitivity of 84% (95% CI 68%, 94%) and specificity of 81% (95% CI 54%, 96%). Conclusion: Disease severity before thymectomy predicts outcome in patients with AChR-Ab-positive generalised MG. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has affected the whole world and caused the death of more than 6 million people. The disease has been observed to have a more severe course in patients with chronic lung diseases. There are limited data regarding COVID-19 in patients with bronchiectasis. The aim of this article is to investigate the course of COVID-19 and factors affecting the clinical outcome in patients with bronchiectasis. MATERIAL AND METHODS: This study was conducted using the Turkish Adult Bronchiectasis Database (TEBVEB) to which 25 centers in Türkiye contributed between March 2019 and January 2022. The database consisted of 1035 patients, and COVID-19-related data were recorded for 606 patients. RESULTS: One hundred nineteen (19.6%) of the bronchiectasis patients (64 female, mean age 57.3 ± 13.9) had COVID-19. Patients with bronchiectasis who developed COVID-19 more frequently had other comorbidities (P = .034). They also more frequently had cystic bronchiectasis (P = .009) and their Bronchiectasis Severity Index was significantly higher (P = .019). Eighty-two (68.9%) of the patients who had COVID-19 were followed up in the outpatient clinic, 27 (22.7%) in the inpatient ward and 10 (8.4%) patients in the intensive care unit. There tended to be a higher percentage of males among patients admitted to the hospital (P = .073); similarly, the mean age of the patients admitted to the hospital was also higher (60.8 vs 55.8 years for the outpatients), but these differences did not reach statistical significance (P = .071). CONCLUSION: In conclusion, this study showed that severe bronchiectasis, presence of cystic bronchiectasis and worse Bronchiectasis Severity Index are associated with the development of COVID-19, but not with the severity of infection. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to present the demographic, clinical, laboratory, and treatment data of children with non-infectious uveitis and to evaluate the risk factors for the development of complications and the need for biological treatment. Method: Patients diagnosed with non-infectious uveitis in childhood and followed up for at least 1 year were included in the study. Demographic data, including age, gender, age at diagnosis, uveitis in first-degree relatives, and rheumatologic diseases, were obtained retrospectively from medical records. The presence of complications or the need for biologic therapy was considered a composite outcome suggesting severe disease. Results: The study included 123 patients (female: n = 59, 48%). The mean age at diagnosis was 14.89 ± 4.86 years. Uveitis was symptomatic in 104 patients (84.6%). Approximately one-quarter of the patients had at least one rheumatic disease (n = 35, 28.5%), the most common being juvenile idiopathic arthritis. Thirty-three patients (26.8%) had anti-nuclear antibody positivity. Biologic agents were needed in 60 patients (48.8%). Complications developed in 14 patients (11.4%). Early age at disease onset (aOR, 0.875; 95% C.I. 0.795–0.965, p = 0.007) and female gender (aOR, 2.99; 95% C.I. 1.439–6.248, p = 0.003) were significantly associated with the need for biologic treatment, while Behçet's disease (BD) was strongly associated with uveitis-related complications (aOR, 14.133; 95% C.I. 2.765–72.231, p = 0.001). Conclusion: We suggest that among pediatric patients with non-infectious uveitis, females, those with an early age of disease onset, and those with BD need to be closely monitored due to a significantly increased risk of severe disease. Key Points • Limited data exist on the clinical course of non-infectious uveitis in children and the associated risk factors for severe disease. • Our study reveals that nearly a quarter of pediatric patients with non-infectious uveitis also have a rheumatic disease. • Among pediatric patients diagnosed with non-infectious uveitis, we observed an increased risk of severe disease in those with an earlier onset age, in female patients, and in those diagnosed with Behçet's disease. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate the Oral Lichen Planus-Disease Activity Scale (OLP-DAS) for assessing overall disease activity of OLP. Methods: The OLP-DAS was created by refining the Thongprasom criteria, incorporating inputs from the literature and expert review, and integrating pain assessment. Content validity was evaluated in a virtual meeting with 8 Oral Medicine specialists. Reliability and validity of the final version were examined. Seventeen OLP subjects were assessed for disease activity by 10 investigators using the OLP-DAS, Oral Disease Severity Score (ODSS), OLP-Investigator Global Assessment (OLP-IGA), and Reticular-Erythema-Ulcerative (REU) scale. Convergent validity was assessed by rating 160 OLP subjects using the OLP-DAS, ODSS, and OLP-IGA. Inter-rater and intra-rater reliability, along with convergent validity, were analyzed using intraclass correlation coefficients (ICCs) and Spearman’s rank correlation coefficients (rs). Results: The final OLP-DAS achieved excellent content validity indices. Inter-rater and intra-rater ICCs for total OLP-DAS scores were 0.93 and 0.96, respectively. Total OLP-DAS scores exhibited strong positive correlations with the ODSS and OLP-IGA (rs = 0.94 and rs = 0.76; P < 0.001, respectively). The OLP Severity Index (OLP-SI), a component of the OLP-DAS, showed very strong positive correlations with OLP disease activity parameters of the ODSS (rs = 0.90; P < 0.001). Conclusions: The OLP-DAS is a valid and reliable clinician-reported outcome measure (CROM) for evaluating OLP disease activity. Clinical relevance: The OLP-DAS, as a standardized CROM for OLP, is valuable for both routine clinical assessments and research applications. [ABSTRACT FROM AUTHOR]

In Peninsular Malaysia, Colletotrichum fioriniae, Colletotrichumfructicola, Colletotrichumscovillei, Colletotrichumsiamense and Colletotrichumtruncatum are the causative pathogens of chilli anthracnose. In the present study, the pathogenic variability and virulence levels of these five Colletotrichum spp. were evaluated. Isolates of C. fioriniae, C. fructicola, C. scovillei, C. siamense and C. truncatum were tested for pathogenicity using red and green Capsicum annuum and red and green Capsicumfrutescens. Pathogenicity tests were conducted using spore suspensions and mycelial plugs on wounded and nonwounded chilli fruits. All isolates tested on the wounded chilli fruits caused anthracnose symptoms with variable disease severity and virulence. In nonwounded chilli fruits, only isolates of C. scovillei (n = 7) and C. truncatum (n = 5) caused infection. C. fioriniae, C. fructicola, C. scovillei, C. siamense and C. truncatum showed variability in pathogenicity and virulence levels in red and green chilli fruits of Ca. annuum and Ca. frutescens. Pathogenicity tests on wounded and nonwounded chilli fruits can be used to identify pathotypes within anthracnose pathogen populations. This is important for strategizing the effective disease management of chilli anthracnose. [ABSTRACT FROM AUTHOR]

Alcohol and nicotine are the two most important risk factors of chronic pancreatitis, and they often occur together. It is still unclear how much they influence the severity of the disease and which of the two addictions should be treated with priority. We performed a single-center, retrospective, cross-sectional study in a mixed medicosurgical cohort of 870 patients diagnosed with chronic pancreatitis (CP). We analyzed the impact of the drinking pattern and abstinence for alcohol and nicotine on the course of the disease. Patients with alcoholic CP were subdivided into 1) patients with "life-time drinking history" (LTDH), 2) "current drinkers" with current alcohol abuse without signs of LTDH, and 3) "former drinkers" who stopped or reduced alcohol intake dramatically. Compared to patients with LTDH, "former drinkers" had a lower rate of exocrine insufficiency (29% vs. 59%) and pseudocysts (33% vs. 49%), were more often relapse-free (37% vs. 5%), and had less abdominal pain. There was no correlation detected between the quantity of alcohol consumption and the severity or progression of the disease. Regarding nicotine, 29 pack-years are the threshold for developing the early stage of CP. Under nicotine abstinence, only slightly more patients were relapse-free (37% vs. 22%). In contrast, the cumulative amount of nicotine consumed correlated with overall disease severity and the development of pseudocysts. The need for surgery was increased, with odds ratios of 1.8, for both alcohol and nicotine abuse. Alcohol cessation in chronic pancreatitis reduces exocrine insufficiency, abdominal pain, and local complications. The effect of nicotine cessation is less pronounced in our cohort. However, nicotine abuse represents an important factor for the development of the disease. • Alcohol cessation results in a lower rate of exocrine insufficiency, pseudocysts, and acute pancreatitis episodes. • The drinking pattern, but not the absolute amount of alcohol, correlates with the disease severity. • We were able to identify a threshold of 29 pack-years for the development of chronic pancreatitis. • Smoking cessation only reduced the relapse frequency of acute pancreatitis episodes without affecting the disease severity. [ABSTRACT FROM AUTHOR]

Key points: PVP‐I is a widely used antiseptic but only recently proposed for intranasal use.The extent of iodine absorption from available PVP‐I nasal products is unknown.Iodine absorption from use of Nasodine (0.5% PVP‐I nasal spray) is not clinically significant. [ABSTRACT FROM AUTHOR]

Background: Although allergic rhinitis (AR) can negatively impact the ability to smell, the degree to which this occurs is not clear and prevalence estimates vary among studies. This study had 4 main objectives: (1) To estimate the prevalence and the degree of olfactory dysfunction in AR patients; (2) To compare olfactory perception between AR patients with different persistence and severity of symptoms and determine if olfactory testing may aid in differentiating among Allergic Rhinitis and its Impact on Asthma (ARIA) groups; (3) To determine whether allergic reactions to different allergens differentially impact olfactory function, and (4) Verify possible changes in the olfactory epithelium (OE) caused by AR. Methods: One hundred thirty-three patients with AR and one hundred controls were tested. The main outcome was the score in University of Pennsylvania Smell Identification Test (UPSIT®). The OE was examined using immunofluorescence markers for neuronal activity, apoptosis, oxidative stress, signal transduction, eosinophils, and epithelial thickness. Results: Prevalence of olfactory dysfunction in the AR patients was higher (AR: 42.9% vs controls: 9%, P <.001). No difference was found either between intermittent and persistent disease cases (P =.58) or between cases with mild and those with moderate/severe symptomatology (P =.33). Lower olfactory capacity was not associated with the reaction to more (P =.48) or diverse types of allergens (P s >.05). Although not significant, patients with AR had a greater amount of eosinophilia and a lower amount of cAMP (cyclic adenosine monophosphate) in the OE. Conclusion: The study highlights a higher prevalence of olfactory dysfunction in AR patients compared to controls, but olfactory testing may not effectively differentiate AR severity or allergen sensitivities. Although trends suggest potential pathophysiological changes in the OE of AR patients, further research is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Rice cultivation in Madurai district, Tamil Nadu, spans distinct cropping seasons: Kar (May -- Jun), Semi-dry (Jul - Aug), Samba/ Late Samba (Aug - Sep), and Navarai (Dec - Jan), each with unique weather conditions and rice varieties. This study explores the correlation between weather parameters temperature, rainfall, humidity, sunshine hours, and wind speed and rice blast disease severity from 2021 to 2023. Using multiple linear regression with ordinary least squares (OLS), the analysis achieves high predictive accuracy (R² = 0.98). Results show that the maximum temperatures correlated negatively with disease severity (r = -0.869 to -0.892), while rainfall (r = 0.768 to 0.804) and wind speed (r = 0.766 to 0.938) correlated positively during the semi-dry season. Relative humidity exhibits varying impacts across seasons. These findings underscore the importance of tailored disease management strategies, such as targeted fungicidal applications during warmer seasons and optimized water management in others. By elucidating these dynamics, the study enhances understanding of weather-disease interactions, providing actionable insights to optimize disease management and enhance crop resilience in Madurai district. [ABSTRACT FROM AUTHOR]

This research aimed to evaluate the sleep quality (QoS) in individuals with Behçet's disease (BD) compared to a control group of healthy individuals. Additionally, it sought to investigate any possible correlation between BD activity and sleep quality. In this case-control study, individuals with BD and healthy controls, matched for age and gender, were enrolled. The study collected demographic information, body mass indexes (BMI), and disease durations. The BD Behcet disease current activity form (BDCAF) was employed to gauge the disease activity of BD, while the Pittsburgh Sleep Quality Index (PSQI) was utilized to evaluate the QoS. PSQI scores were compared between the patients and controls and the possible correlation between PSQI and BDCAF scores were investigated. Besides, demographic features, disease characteristics, total score and sub parameters of disease activity were compared between BD cases with and without poor QoS. Among 56 BD patients and 56 controls, there were no significant differences in age, gender distribution, or BMI. BD cases demonstrated significantly higher QoS scores than controls (PSQI score: 6.5±4.84 in cases, 3.7±1.48 in controls, p=0.022). While no correlation was observed between PSQI, demographic characteristics, and disease duration, a notable positive correlation emerged between PSQI and BDCAF total score (p=0.037, r=0.458). No statistical difference was determined between demographic data, disease duration, and BDCAF sub parameters between patients with poor (24 patients, 42%) and without poor QoS (32 patients, 58%); however, the total score of BDCAF was significantly higher than those of BD with low QoS (p= 0.021). Our study data suggest that impaired sleep quality in BD cases may be linked to overall disease activity, irrespective of the specific form of involvement. Consideration of QoS in the management of BD will contribute to a holistic approach to the disease. [ABSTRACT FROM AUTHOR]

Rhinoviruses (RVs) are a leading cause of acute respiratory infections (ARI) in children. The relationship between RV viral loads (VL), RV/viral‐co‐detections and disease severity, is incompletely understood. We studied children and adolescents ≤21 years with RV‐ARI that were identified as inpatients or outpatients using a PCR panel from 2011‐2013. RV VL were stratified according to cycle threshold (CT) values in high (≤25), intermediate (26‐32) and low (>32). Adjusted analyses were performed to assess the role RV VL and RV/viral codetections on hospital admission, oxygen requirement, PICU care, and length of stay. Of 1,899 children with RV‐ARI, 78% had chronic comorbidities and 24% RV/viral co‐detections. Single RV vs RV/viral co‐detections was associated with higher VL (24.74 vs 26.62 CT; p = 0.001) and older age (14.9 vs 9.5 months; p = 0.0001). Frequency of RV/viral co‐detections were inversely proportional to RV loads: 32% with low; 28% with intermediate, and 19% with high VL, p = 0.0001. Underlying conditions were independently associated with all clinical outcomes, high VL with PICU care, and single RV‐ARI with higher odds of hospitalization. In summary, single RV vs RV/viral co‐detections were associated with higher VL and older age. Underlying diseases, rather than RV loads or RV/viral co‐detections, consistently predicted worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has had a substantial influence on healthcare systems, requiring early prognosis for innovative therapies and optimal results, especially in individuals with comorbidities. AI systems have been used by healthcare practitioners for investigating, anticipating, and predicting diseases, through means including medication development, clinical trial analysis, and pandemic forecasting. This study proposes the use of AI to predict disease severity in terms of hospital mortality among COVID-19 patients. Methods: A cross-sectional study was conducted at King Abdulaziz University, Saudi Arabia. Data were cleaned by encoding categorical variables and replacing missing quantitative values with their mean. The outcome variable, hospital mortality, was labeled as death = 0 or survival = 1, with all baseline investigations, clinical symptoms, and laboratory findings used as predictors. Decision trees, SVM, and random forest algorithms were employed. The training process included splitting the data set into training and testing sets, performing 5-fold cross-validation to tune hyperparameters, and evaluating performance on the test set using accuracy. Results: The study assessed the predictive accuracy of outcomes and mortality for COVID-19 patients based on factors such as CRP, LDH, Ferritin, ALP, Bilirubin, D-Dimers, and hospital stay (p-value ≤ 0.05). The analysis revealed that hospital stay, D-Dimers, ALP, Bilirubin, LDH, CRP, and Ferritin significantly influenced hospital mortality (p ≤ 0.0001). The results demonstrated high predictive accuracy, with decision trees achieving 76%, random forest 80%, and support vector machines (SVMs) 82%. Conclusions: Artificial intelligence is a tool crucial for identifying early coronavirus infections and monitoring patient conditions. It improves treatment consistency and decision-making via the development of algorithms. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this cross-sectional study is to investigate the levels of NLRP3 in the serum and induced sputum of children with asthma and their potential association with lung function and disease severity. Methods This cross-sectional study included 83 children with bronchial asthma who sought medical care at our hospital from May 2023 to February 2024. Portable spirometry was used to monitor lung function parameters, including forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow. The expression of C-reactive protein (CRP), interleukin (IL)-6, IL-1β, TNF-α, and Nod-like receptor family pyrin domain-containing 3 (NLRP3) in the serum and induced sputum were measured by enzyme-linked immunosorbent assay. Data analysis was performed using SPSS 25.0 and differences with P

Abstract Background Pain is common in the genetic skin fragility disorder epidermolysis bullosa (EB), from skin and mucosal injury and inflammation as well as extra-mucocutaneous sites. Individuals living with EB have identified pain as a priority for better treatments. Objectives The Prospective EB Longitudinal Evaluation Study (PEBLES) is a prospective register study exploring the natural history of RDEB across all ages from birth to death. Here, we investigated the characteristics and treatment of pain in different RDEB subtypes. Methods Information was collected from individuals with different RDEB subtypes over an 8-year period. Data included visual analogue scale (VAS) ratings of background and procedural pain, its location, intensity and impact on sleep, as well as pain medication. Disease severity scores and quality of life measures were correlated to pain scores. Results Sixty-one participants (13 children, 48 adults) completed a total of 361 reviews. Pain was common, experienced by 93% of participants at index review, with 80% suffering both background and procedural pain. Across all RDEB patients, the median VAS for background pain was 40 (out of 100) [interquartile range 20,60] and for those having regular dressing changes, median procedural pain was 52 [40,80]. Severe (RDEB-S) and pruriginosa (RDEB-Pru) groups had the greatest increase in procedural compared to background pain of 20 and 22 VAS points, respectively. Correlations between disease severity and quality of life impairment were observed across most groups, particularly RDEB-S. Over half of those studied experienced pain frequently or constantly, and in one third pain disturbed sleep at least 4 nights per week. Skin was the commonest source of pain in all subtypes except inversa RDEB where the mouth was the main site. Despite frequent and severe pain, one third of participants used no medication for pain and, in those that did, pain levels remained high suggesting ineffectiveness of current pain management approaches and a significant unmet need in RDEB. Conclusion The frequency, severity, and impact of pain in all RDEB patients is significant, particularly in RDEB-S and RDEB-Pru. Our findings highlight that current RDEB pain management is poorly effective and that further research is needed to address this symptom.

COVID-19 is an infectious disease that can progress from carrier and mild symptoms of acute respiratory infections to bilateral pneumonia, severe respiratory failure, acute respiratory distress syndrome (ARDS), multiorgan failure, sepsis and shock. One of the predictors of severe course of infection is advanced age and comorbidities. In this work we considered a clinical case of COVID-19 patient S., 86 years old, who was admitted to the hospital, to the intensive care unit on the 10th day of the disease, in an extremely severe condition. A diagnosis of bilateral polisegmental pneumonia with 70% lung involvement caused by SARS-CoV-2 virus was made. In addition to antiviral therapy with remdesivir and symptomatic therapy, pathogenetic therapy with tocilizumab was applied. On admission, the patient had leukopenia, thrombocytopenia, elevated values of COE, urea, significant elevation of inflammatory markers CRP and D-dimer, as well as pCo2. During inpatient treatment, positive dynamics of the condition and laboratory parameters were observed. The patient was discharged in satisfactory condition, all laboratory parameters were normalised, except for a slight increase in CRP and pCO2 levels. Despite the age of the patient and the severity of COVID-19 course, the combined use of drugs with multidirectional action, including tocilizumab, may improve the outcome of the disease.

Abstract Background Plant foods are naturally rich in anti-inflammatory nutrients. In this cross-sectional study, we assessed the association between the plant-based dietary index (PDI) and Mayo score in patients with ulcerative colitis (UC). Methods This analytical cross-sectional study included 158 patients with UC. The Mayo score was used to determine disease severity. An expert nutritionist performed the anthropometric assessments. A 168-item quantitative food frequency questionnaire (FFQ) was used to calculate the PDI, healthy PDI (hPDI), and unhealthy PDI (uPDI). To assess the association between the total Mayo score (as a dependent factor) and different indices of PDI (as an independent variable), the linear regression model was used. Results The mean age of participants was 42.52 ± 12.61 years. There were significant differences in the total Mayo score between tertiles of PDI score (p = 0.02). The result of linear regression showed that in the unadjusted model, compared with the patients in the first tertile of PDI, the patients in the second (-0.21 (-1.89, -0.17)), and third tertile (-0.21 (-1.95, -0.16)) had significantly lower total mayo scores. The inverse association remained significant after adjusting for covariates. However, uPDI and hPDI tertiles were not significantly associated with total Mayo scores in the adjusted and unadjusted models. Conclusion higher PDI was significantly associated with higher UC severity. However, considering the limitations of the study, more cohort studies are needed to confirm these results.

Bacterial leaf blight (BLB), caused by Xanthomonas oryzae pv. oryzae (Xoo) is a significant disease attacking rice crops worldwide. This disease attacks at various stages of plant growth and causes significant yield loss. Breeding new varieties resistant to BLB is important to support sustainable agriculture in the future. This study aimed to identify new superior green super rice (GSR) lines resistant to BLB disease. The experiment evaluated the resistance of lowland rice lines obtained from anther culture using a factorial randomized complete block design. The 1st factor was genotype, consisting of 20 lines, 2 checks of commercial varieties (Inpari 42 Agritan GSR and Inpari 18), a resistant check (Conde), and a susceptible check (Taichung Native 1). The 2nd factor was BLB pathotypes (i.e., III, IV, and VIII). Quantitative data on disease severity and severity index were analyzed using analysis of variance and t-Dunnett test at 5% level. The results showed that the interaction between genotype and pathotype affected the disease severity and severity index in both growth phases. The tested lines exhibited varying resistance, from susceptible to resistant, to BLB. Four lines (SN 11, 13, 57, and 58) showed moderate to resistant criteria for BLB disease of 3 pathotypes in both growth phases. The selected lines can be used as a source of parents for breeders and candidates for new superior varieties with BLB resistance properties to support the reduction of synthetic chemical bactericide inputs and control BLB disease. However, further field evaluations are necessary to assess their performance.

Abstract Background Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease (IBD). It is characterized by diffuse inflammatory process of the bowel mucosa with a relapsing course. The precise evaluation of UC severity is pivotal in the therapeutic decision-making. Modified Mayo score is consistently used for the evaluation of the disease activity which depends on the patient’s symptoms as well as the colonoscopic findings. The aim of this study is to assess the role of the CT enterography (CTE) scoring system in the evaluation of the disease severity in ulcerative colitis. From October 2022 to July 2023, 66 patients with known ulcerative colitis patients at time of disease activity were referred from the inflammatory bowel disease unit for radiological assessment by CTE. CT images were analyzed to determine the anatomical location of the affected bowel segments, mucosal thickening and hyperenhancement as well as the extra-enteric involvement. Correlation with the modified Mayo score was established. Results Our results showed a statistical significant correlation between modified Mayo score and CTE with a P value of 0.000. The correlation coefficient is r = 0.964. The cut-off value of the optimal CTE score to predict mild and moderate UC was 7.5 with 0.996 area under the ROC curve, 92%sensitivity and 100% specificity. The cut-off value of the optimal CTE score to predict moderate and severe UC was 10.5 with 0.983 area under the ROC curve, 90.6% sensitivity and 100% specificity. Conclusions CTE is a reliable diagnostic method in the systematic assessment of the disease severity of active ulcerative colitis. CTE score shows a strong proportionate correlation with modified Mayo score. The aggravation of the course of the disease increased the CTE score. CTE scoring system can help plan the therapeutic strategy and predict prognosis.

Introduction: Anaemia is the most common Extraintestinal Manifestation (EIM) associated with Ulcerative Colitis (UC) and has been linked to increased mortality in UC patients, with iron deficiency having the most pronounced effect. Moreover, iron deficiency in UC can occur with or without anaemia. Aim: To assess anaemia and iron deficiency, with or without anaemia, in UC patients. Materials and Methods: The present cross-sectional study was conducted in the Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from August 2020 to December 2021. Study included 75 patients with UC and varying levels of disease activity. A complete haemogram, Red Blood Cell (RBC) indices, and serum iron studies {serum iron levels, Total Iron Binding Capacity (TIBC), Transferrin Saturation (TfS), and serum ferritin} were conducted. Patients were classified as having Iron Deficiency Anaemia (IDA), Anaemia of Chronic Disease (ACD), or mixed anaemia based on the results of the iron studies. Disease activity was assessed using the Mayo score. Patients were divided into group I (mild disease activity) and group II (moderate to severe disease activity). Haemoglobin (Hb), RBC indices and iron levels were compared between the two groups. Independent t-tests and Chi-square tests were employed for statistical analysis. Results: The mean±Standard Deviation (SD) age of the patients was 34.8±14 years, with a male-to-female ratio of 1.7:1. The mean±SD duration of the disease was 28.8±33.8 months (median: 12 months). Fifteen patients had mild disease activity, 52 had moderate activity, and eight had severe activity. The mean±SD Hb level among the patients was 11.1±2.0 g/dL. The mean±SD values for Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were 80.4±7.7 fL, 26.4±4.0 pg, and 32.1±2.5 g/dL, respectively. The mean±SD serum iron level and ferritin levels were 59.3±29.1 mcg/dL and 27.2±27.9 ng/mL, respectively. The mean±SD TfS was 14.3±10.8%, while the mean±SD TIBC was 337.1±80.5 mcg/dL. A total of 45 (60%) patients had anaemia, and 16 (21.3%) patients had iron deficiency without anaemia. Among those with anaemia, 32 (42.7%) had IDA and 13 (17.3%) had mixed anaemia; none of the patients had ACD. In total, 61 (81.3%) patients had iron deficiency, with or without anaemia. Hb, RBC indices and iron studies were comparable between both groups. Conclusion: Iron deficiency anaemia is common in UC patients, affecting 60% of the cohort; however, iron deficiency without anaemia was also observed in 21.3% of patients. Changes in Hb, RBC indices and iron studies were independent of disease activity.

Abstract The aim of the study was to conduct of relationship of acute-phase proteins (APPs) with the severity of COVID-19 defined by National Institutes of Health and according to the criteria of MEWS scale, with the presence of a cytokine storm, oxygen therapy and patient survival. We enrolled 96 patients with COVID-19 and 30 healthy people. The samples were taken on the day of admission and after 9 days on average. Not only commonly used APPs such as CRP, procalcitonin and ferritin and also rarely assayed proteins such as transferrin, haptoglobin, α1-acid glycoprotein and α1-antitrypsin, were tested in the study. The levels of APPs depends on the severity of COVID-19 disease, on the presence of cytokine storm and used oxygen therapy. The greatest APPs changes occurred in the most advanced form of the disease, with the presence of a cytokine storm and the most intense oxygen therapy. The results obtained from MEWS scale were not consistent with National Institutes of Health scores. Studies in the second samples showed the quenching of the acute phase reactions and the effectiveness of oxygen therapy. Only two of the examined APPs i.e. procalcitonin and transferrin, differed between surviving and non-surviving patients, and these two predispose to the role of prognostic factors in Covid-19. In conclusion, the concentration of not all acute-phase proteins depends on the severity of COVID-19 disease, presence of cytokine storm, the used of oxygen therapy and only some of them (procalcitonin and transferrin) are related to the survival outcomes. Of the newly tested acute-phase proteins, only transferrin shows significance as a marker of disease severity and mortality in COVID-19 disease.

We conducted a prospective study of 159 cases of Streptococcus dysgalactiae subspecies equisimilis (SDSE) bacteremia in 157 patients at 2 hospitals in Finland during November 2015–November 2019. Cellulitis was associated with nonsevere disease (p = 0.008); necrotizing fasciitis was associated with severe disease (p = 0.004). Fifty percent of patients had >1 clinical characteristic associated with risk for death. The case-fatality rate was 6%, and 7% of patients were treated in an intensive care unit. Blood leukocyte counts on days 2 (p = 0.032) and 3 (p = 0.020) and C-reactive protein levels on days 3 (p = 0.030) and 4 (p = 0.009) after admission were predictors of severe disease. The Pitt bacteremia score was an accurate predictor of death. Using the Pitt bacteremia score, leukocyte counts, and CRP responses during initial treatment can improve treatment strategies and survival for patients with SDSE.

PrcisRacial/ethnic minorities are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. In addition, we highlight a gap in the use of diagnosis codes.PurposeThe purpose of this study was to analyze patterns of diagnosis coding usage and validate epidemiologic patterns of glaucoma onset and severity among primary glaucoma patients within the National Institutes of Health All of Us database.Patients and methodsWe used International Classification of Disease diagnosis codes to build 4 cohorts of patients with mild, moderate, severe, and unspecified stage glaucoma (N=2982). Descriptive analyses were stratified by disease stage, and mean age at diagnosis was compared across racial and ethnic groups. Multivariable ordinal regression was used to examine risk factors for increasing glaucoma severity.ResultsOf 2982 participants, 1714 (57%) had unspecified severity staging. Black/African Americans and other races were diagnosed with glaucoma at significantly younger ages compared with Whites (means 60 and 60 vs. 66 y; P

Arbovirus-borne dengue fever remains a global public health threat. The actual burden of dengue infection may be underestimated due to undiagnosed or misdiagnosed fever cases. The distribution of dengue is influenced by both climatic and nonclimatic factors, including global warming, which affects the vector population and transmission period. Other factors, such as serotype evolution and host immunity, also contribute to the spread of the virus. Different serotypes of the dengue virus show different clinical manifestations. The prevalence of serotypes varies geographically and over time. Early diagnosis and characterization of circulating viruses at the genomic level are important for disease prevention and control.

Procalcitonin (PCT) is a peptide precursor of calcitonin, considered as an infection marker in many settings. Recently, a few studies reported its rise in some inflammatory processes such as still’s disease, anaphylactic shock and Kawasaki disease. To investigate the serum level of PCT in patients with pemphigus vulgaris (PV) and examine the relationship between serum level of PCT and the severity of disease. A cross-sectional study was conducted on 50 patients with PV, visited at a tertiary care hospital from August 2021 to May 2023. After recording the demographic and clinical characteristics of patients, PCT level as well as CRP and ESR levels were measured and analyzed. The median ESR, CRP and procalcitonin serum level for the patients was 6.40 mm/hr, 11.00 mg/dL and 0.025 ng/ml, respectively. Considering the mean serum PCT level of normal population which is reported as < 0.1 ng/ml, its level among our patients was in a normal range. A significant and positive correlation was observed between procalcitonin and ESR, as well as CRP. In opposite to PCT, CRP and ESR levels showed a significant and positive correlation with disease severity (P values: 0.002 and < 0.001, respectively). Our findings suggest that PCT might not be useful as a biomarker of inflammatory milieu or prognostic factor in patients with PV without any infection. [ABSTRACT FROM AUTHOR]

Background: The impact of psoriasis in special areas (i.e., scalp, nails, palms, soles, genitals) on patient physical functioning, health-related quality of life (HRQoL), and work abilities has not been fully characterized. We assessed associations between disease severity and special area involvement in psoriasis symptoms, HRQoL, and work/activity impairment. Methods: Patients with psoriasis from the CorEvitas Psoriasis Registry who initiated systemic treatment between 04/2015–06/2020 were included. Outcomes were change from baseline in psoriasis symptoms, Dermatology Life Quality Index (DLQI), and work/activity impairment at 6months stratified by baseline disease severity and special area involvement. Results: Among 2620 patients, increasing disease severity was associated with worsening patient-reported outcomes. Patients with (46.0%; N=1205) versus without (54.0%; N=1415) psoriasis in special areas reported greater HRQoL and work/activity impairment. Over 6months, patients with unchanged or worsening disease severity had reduced HRQoL and increased symptom severity; incremental increases in patient HRQoL and decreases in symptom severity were associated with improved disease severity. Conclusions: Higher disease severity and special area involvement was associated with worse outcomes and impaired work abilities. These data highlight the significant impact that adequate treatment of severe psoriasis and/or special area involvement may have on patient HRQoL and function. [ABSTRACT FROM AUTHOR]

Background: The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is independently associated with the severity of various diseases. However, its association with acute biliary pancreatitis (ABP) remains unknown. Methods: This study included 1335 eligible patients diagnosed with ABP from April 2016 to December 2022. Patients were divided into low- and high-NHR level groups using an optimal cut-off value determined utilizing Youden's index. Multivariate logistic regression analysis was used to investigate the correlation between NHR and ABP severity. Multivariate analysis-based limited restricted cubic spline (RCS) method was used to evaluate the nonlinear relationship between NHR and the risk of developing moderate or severe ABP. Results: In this study, multivariate logistic regression analysis indicated an independent association between NHR and ABP severity (p < .001). The RCS analysis showed a linear correlation between NHR and the risk of developing moderate or severe ABP (P for non-linearity > 0.05), and increased NHR was found to be independently associated with a more severe form of the disease. Conclusions: Our study suggests that NHR is a simple and practical independent indicator of disease severity, serving as a potential novel predictor for patients with ABP. [ABSTRACT FROM AUTHOR]

The SARS-CoV‑2 coronavirus has become a major global health concern. Infection with SARS-CoV‑2 has caused millions of deaths worldwide, and the case fatality rate has been found to be largely related to pre-existing clinical conditions. The main clinical manifestation of COVID‑19 is the presence of respiratory symptoms. Severe complications of COVID‑19 are most often observed in people with significant medical histories. The SARS-CoV‑2 virus primarily attacks the respiratory system, causing pneumonia and acute respiratory distress syndrome, which can lead to severe systemic inflammation, multiple organ dysfunction, and death, especially in patients with pre-existing comorbidities. A number of meta-analyses strongly suggest that comorbid respiratory diseases, including chronic obstructive pulmonary disease and interstitial lung diseases, are factors in the development of severe forms of COVID‑19, worsening patient outcomes and survival rates. Studies have shown an association between adverse outcomes of COVID‑19 and the expression level of the angiotensin-­converting enzyme 2 (ACE2) in these patients. Regarding other respiratory system pathologies, such as bronchial asthma and cystic fibrosis, it is known that the main unfavorable factor is long-term immunosuppressive pharmacotherapy preceding infection. In this article, we highlight the main respiratory comorbidities to better understand the pathogenesis of COVID‑19.

Abstract Background Japanese guidelines recommend triple inhaled corticosteroid (ICS)/long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) therapy in patients with chronic obstructive pulmonary disease (COPD) and no concurrent asthma diagnosis who experience frequent exacerbations and have blood eosinophil (EOS) count ≥ 300 cells/mm3, and in patients with COPD and asthma with continuing/worsening symptoms despite receiving dual ICS/LABA therapy. These post-hoc analyses of the KRONOS study in patients with COPD and without an asthma diagnosis, examine the effects of fixed-dose triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) versus dual therapies on lung function and exacerbations based on blood EOS count – focusing on blood EOS count 100 to 100 cells/mm3, even if disease severity is moderate and there is no recent history of exacerbations. Trial registration ClinicalTrials.gov registry number NCT02497001 (registration date, 13 July 2015).