Relation Between Interleukin-6, Interleukin-10 And Interleukin-2 Receptor And Mortality In Severely Ill COVID-19 Patients.

Objectives: To investigate the relation involving soluble interleukin-2 receptor, interleukin-6 and interleukin-10 in hospitalised patients with severe coronavirus disease-2019 infection. Method: This single-centre cohort study was conducted at the Kafrelshiekh University Hospital, Egypt, from January to June 2022, and included all patients of either gender who were hospitalised with severe infection with the coronavirus disease-2019 isolation ward. Chemiluminescence immunoassay method was used to measure levels of procalcitonin, ferritin, soluble interleukin-2 receptor, interleukin-6 and interleukin-10. Data was analysed using SPSS version. 25. RESULTS: Of the 250 patients with median age 57.5 years (interquartile range: 45.8-66.0 years), 147(59%) were males and 103(41%) were females. Of them, 102(40.8%) patients died; 68(66.7%) males, 34(33.3%) females, median age 60.0 years (interquartile range: 48.8-70.0). Among the 148(59.2%) survivors, 79(53.4%) were males and 69(46.6%) were females, while the overall median age was 55.0 years (interquartile range: 41.5-65.8 years). The survivors had significantly lower levels of soluble interleukin-2 receptor, interleukin-6 and interleukin-10 (p<0.001). Correlation analysisidentified significant positive correlation between IL-2R, IL-6 and IL-10 levels and almost all the inflammatory and coagulation parameters, including C-reactive protein, lactate dehydrogenase, procalcitonin, ferritin, D-dimer and fibrinogen (p<0.05). CONCLUSIONS: Elevated levels of soluble interleukin-2 receptor, interleukin-6 and interleukin-10 were found to be associated with greater risk of mortality in coronavirus disease-2019 patients.

Up-regulated serum levels of interleukin (IL)-17A and IL-22 in Egyptian pediatric patients with COVID-19 and MIS-C: Relation to the disease outcome.

Both IL-17A and IL-22 share cellular sources and signaling pathways. They have synergistic action on epithelial cells to stimulate their production of antimicrobial peptides which are protective against infections. However, both interleukins may contribute to ARDS pathology if their production is not controlled. This study aimed to investigate serum levels of IL-17A and IL-22 in relation to the disease outcome in patients with SARS-CoV-2. Serum IL-17A and IL-22 were measured by ELISA in 40 patients with SARS-CoV-2, aged between 2 months and 16 years, (18 had COVID-19 and 22 had multisystem inflammatory syndrome in children "MIS-C") in comparison to 48 age- and sex-matched healthy control children. Patients with COVID-19 and MIS-C had significantly higher serum IL-17A and IL-22 levels than healthy control children (P < 0.001). Increased serum IL-17A and IL-22 levels were found in all patients. Elevated CRP and serum ferritin levels were found in 90% of these patients. Lymphopenia, neutrophilia, neutropenia, thrombocytopenia and elevated ALT, LDH and D-dimer were found in 45%, 42.5 %, 2.5%, 30%, 32.5%, 82.5%, and 65%, respectively of these patients. There were non-significant differences between patients who recovered and those who died or had a residual illness in serum levels of IL-17A, IL-22 and the routine inflammatory markers of COVID-19. In conclusions, serum IL-17A and IL-22 levels were up-regulated in all patients with COVID-19 and MIS-C. Levels of serum IL-17A, IL-22 and the routine inflammatory markers of COVID-19 were not correlated with the disease outcome. Our conclusions are limited by the sample size.

Efficiency of Supplementary Contemporary Single-file Systems in Removing Filling Remnants from Oval-shaped Canals: An In Vitro Study.

AIM: This study investigated the performance of supplementary three single-file systems for eliminating root filling residue from oval-shaped canals utilizing cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty single-rooted human mandibular premolars with oval-shaped canals were chosen. After decoronation and working length determination, ProTaper Universal (PTUR) rotary files were used to prepare canals up to F3. Irrigation was fulfilled by 2.5% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and lastly distilled water. By utilizing the lateral compaction technique, canals were filled by gutta-percha and Endosequence BC Sealer. The PTUR retreatment system (D1, D2, and D3) eliminated the primary filling material sequentially. Subsequently, specimens were categorized into three groups at random: group I: WaveOne Gold (WOG) primary file, group II: TruNatomy (TRN) medium file, and group III: XP-endo Finisher R (XPF-R). The volume of residual left from filling material was quantified utilizing CBCT imaging before and after the supplementary retreatment. Statistical analyses were done by one-way analysis of variance (ANOVA) and Tukey's test at a 5% significance level. RESULTS: The volume of removed root filling after using XPF-R was significantly higher than using WOG in all sections and TRN in the coronal third, while nonsignificantly higher than using TRN in the apical and middle. CONCLUSION: XPF-R as a supplementary technique revealed the highest percentage reduction of root filling material (73.13%) in comparison with the other systems (37.39% WOG and 44.16% TRN) in oval-shaped canals. CLINICAL SIGNIFICANCE: Neither one of the methods and tools used to remove filling material from oval-shaped root canals is perfectly efficient. The performance of supplementary techniques using contemporary single-file systems improves the cleaning and reshaping of root canal space that permits a proper disinfection to optimize the outcome of retreatment option.

Psychological Distress and Quality of Life in Pediatric Crohn Disease: Impact of Pain and Disease State.

OBJECTIVES: For patients with Crohn disease (CD), symptom reporting may not coincide with disease state; patients in remission may continue to report symptoms and pain, whereas other patients may be symptom-free despite a flare. This phenomenon has been documented in adults but only recently assessed in pediatric patients. The present study assessed the role of pain reporting and disease state in pediatric patients with CD in understanding psychological distress and quality of life. METHODS: Participants included 116 children and adolescents ages 8 to 18 years with CD who completed self-report questionnaires assessing pain, disease symptoms, depression, anxiety, functional disability, and quality of life. Physicians completed the Pediatric Crohn's Disease Activity Index to assess disease activity (scores ≤10 = remission, scores >10 = flare). RESULTS: Approximately two thirds of participants reported pain concordant with disease state. For patients in remission, those with pain experienced significantly increased disability and decreased quality of life compared to patients in remission without pain. For patients in a flare, those without pain experienced significantly decreased disability and depressive symptoms, and improved quality of life compared to patients in a flare with pain. CONCLUSIONS: For pediatric patients with CD, report of pain, while in remission or a flare, is associated with increased disability and reduced quality of life. Although levels of depression did not differ by disease state, depressive symptoms did differ by pain report (presence or absence) for those in a flare. Pain reporting in CD appears to be associated with both physical and psychological state and should be assessed regardless of disease activity.

Fructose intolerance/malabsorption and recurrent abdominal pain in children.

OBJECTIVES: The purpose of the present study was to ascertain whether pediatric patients with chronic abdominal pain had concurrent fructose intolerance as determined by a standardized dose breath hydrogen test (BHT), and whether symptoms would improve with a low-fructose diet. METHODS: The fructose BHT test was administered to patients evaluated in clinic with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating, and/or diarrhea. The patients were given a standard dose of 1 g/kg fructose to maximum of 25 g. Hydrogen and methane were measured at 8 time points. The test was presumed positive if breath hydrogen exceeded 20 ppm above baseline. If positive, patients were given a dietitian-prescribed low-fructose diet. RESULTS: A total of 222 patients were part of the study. Ages ranged from 2 to 19 years with a mean of 10.5. BHT for fructose was performed in all of the patients and it was positive for fructose intolerance in 121 of 222 patients (54.5%). A total of 101 of 222 (45.5%) patients had negative BHT for fructose intolerance. All BHT-positive patients had a nutrition consult with a registered dietitian and were placed on a low-fructose diet. Using a standard pain scale for children, 93 of 121 patients (76.9%) reported resolution of symptoms on a low-fructose diet (P < 0.0001). Furthermore, 55 of 101 patients (54.4%) with negative BHT for fructose reported resolution of symptoms without a low-fructose diet (P = 0.37). CONCLUSIONS: Fructose intolerance/malabsorption is common in children with recurrent/functional abdominal pain and a low-fructose diet is an effective treatment.

How Students' Big Five personality traits manifest in perceived social loafing behavior.

BACKGROUND: Social loafing (SL) has a detrimental impact on cooperative learning. SL dysfunctionalities are causing more faculty to avoid assigning group projects as part of their course work. AIMS: This qualitative case study examines how students' personalities are expressed in social loafers' behavior during university-level group assignments at a Texas university. The case study added further depth and breadth to current literature on SL in cooperative learning by exploring the perpetrator's personality expressions. SAMPLE(S): Ten faculty members were interviewed, 32 students were surveyed, and 10 loafers were identified and self-assessed. METHODS: A qualitative case study was used to provide in-depth investigation of Big Five personality in SL behavior. RESULTS: The faculty interviews and students' surveys revealed that Openness to Experience and Conscientiousness were not expressed in SL behavior for university-level group assignments assessed by four IPIP facets. Openness to Experience (values, ideas, actions, and fantasy) was not expressed. Faculty and students indicated that loafers were not curious, barely prepared, with very short attention spans after which they get lost. Social loafers showed no originality, no active imagination, and no deep thinking. Conscientiousness (achievement striving, dutifulness, competence, and order) was not expressed. For Extraversion, Agreeableness, and Neuroticism, some facets were expressed, and others were withheld. CONCLUSION: The results of this study provide faculty with a multifaceted understanding of students' personality traits to better guide their group interaction and cooperative learning.

Quantitative Assessment of Apically Extruded Debris after Single-Files Supplemental Retreatment considering Apical Patency Influence: In Vitro Study.

Objective: This study aims to assess the impact of re-establishing apical patency on the quantity of debris extruded through the apex after three supplementary retreatment files (TruNatomy (TRN), WaveOne Gold (WOG), and XP endo Finisher R (XPFR)). Materials and Methods: Eighty single-rooted mandibular premolars were prepared with ProTaper Universal rotary systems (PTU) up to F3 and obturated. The samples were divided into two main groups according to the presence or absence of the apical patency (n = 40), GI with apical patency and GII without apical patency. Based on the file system, which was adopted to eliminate the previous filling, each group had four subgroups (n = 10). In GI PTUR and GII PTUR, ProTaper Universal retreatment files (PTUR) were utilized only to remove the most primary filling material (control groups). In the other groups (PTUR) used, it was first followed by supplementary files. The quantity of debris extruded by different retreatment file systems was determined and compared to the corresponding control group with or without apical patency. Data were analyzed using a two-way ANOVA with a post hoc Tukey's multiple comparison test at a 5% significance level. Results: There was a statistically significant difference among the control and experimental groups. XPFR had the least quantity of extruded debris. Apical patency did not affect the debris extrusion. Conclusion: All tested files led to a significant apical debris extrusion regardless of apical patency.

Prognostic significance of complement factors in severely ill patients with COVID-19.

Coagulopathy, cytokine release, platelet hyperactivity and endothelial activation are regarded as potential major contributors to COVID-19 morbidity. Complement activation might provide a bridge linking these factors in severe COVID-19 illness. In this study, we investigated the prognostic significance of selected complement factors in hospitalized patients with severe COVID-19 infection. The study included 300 hospitalized adults with severe COVID-19 infection. Complement factors (C3, C3a, C4, sC5b-9) were assessed by commercial ELISA kits. Outcome parameters included mortality, intensive care unit admission and duration of hospital stay. It was found that survivors had significantly higher serum C3 (median (IQR): 128.5 (116.3-141.0) mg/dL vs 98.0 (70.0-112.8) mg/dL, p<0.001) and C4 (median (IQR): 36.0 (30.0-42.0) mg/dL vs 31.0 (26.0-35.0) mg/dL, p<0.001) levels when compared with non-survivors. On the other hand, it was shown that survivors had significantly lower C3a (median (IQR): 203.0 (170.3-244.0) ng/mL vs 385.0 (293.0-424.8) ng/mL, p<0.001) and sC5b-9 (median (IQR): 294.0 (242.0-318.8) ng/mL vs 393.0 (342.0-436.5) ng/mL, p<0.001) levels when compared with non-survivors. Multivariate logistic regression analysis identified C3a (OR: 0.97 (95% CI 0.96 to 0.99), p<0.001) and C4 (OR: 0.92 (95% CI 0.86 to 0.98), p=0.011) levels as significant predictors of mortality. In conclusion, serum levels of complement factors are related to mortality in severely ill patients with COVID-19.

Comparison of in vitro and in vivo acoustic response of a novel 50:50 PLGA contrast agent.

A comparison between in vitro and in vivo experiments conducted to investigate the acoustic properties of a novel, 1.2 microm diameter poly(lactic-co-glycolic acid) (50:50) (PLGA) ultrasound contrast agent, the development of which was described previously by us, is presented. A pulse-echo setup was used to determine enhancement in vitro. Additional in vitro studies further characterized the hollow microcapsules, including resonance frequency from attenuation measurements (from 2.25 to 15 MHz) and temperature effects (25 degrees C vs. 37 degrees C). In vivo, four rabbits received intravenous injections of the agent (dose range: 0.005-0.13 ml/kg). Quantitative in vivo dose-responses were calculated off-line using spectral power analysis of audio Doppler signals acquired from a custom-made 10 MHz cuff transducer placed around the surgically exposed distal aorta. This frequency was chosen since the very shallow scanning depths encountered in rabbits, in particular for the cuff transducer placed directly around the vessel, necessitates the use of high frequency imaging devices with sufficient spatial resolution to enable meaningful measurements. For qualitative assessments, two rabbits were imaged pre- and post-contrast administration (dose: 0.1 ml/kg) in power Doppler mode. Significant acoustic enhancements (up to 24 dB) were reported both in vitro and in vivo. Moreover, the rabbits did not show any adverse side effects from multiple injections (>20) of the agent. Measured in vitro resonance frequency between 3.09 and 3.49 MHz was lower than predicted for a similar sized free bubble, potentially due to capsule wall structure. Minimal loss of signal (approximately 4 dB) was observed at 25 degrees C over 20 min of insonation at 5 MHz but at 37 degrees C the signal dropped close to base line within the first 5 min. This temperature sensitivity could be due to loss of capsule integrity (and hence loss of gas). Potential causes include increased hydrolysis or polymer softening and increased water uptake by the shell at temperatures closer to the glass transition temperature (T(g)).

Development of a novel method for synthesis of a polymeric ultrasound contrast agent.

Medical ultrasound is a highly valuable diagnostic tool, especially when compared with other imaging modalities. It is a noninvasive, real-time, portable, extremely safe method compared with X-ray and inexpensive relative to magnetic resonance imaging. However, ultrasound is limited in its ability to distinguish between diseased and normal tissue. This limitation has led to the development of contrast agents. We have produced novel poly (lactic-co-glycolic) acid air-filled microcapsules that work well as ultrasound contrast agents, giving up to 24 and 25 dB enhancement when insonated in the medical imaging range at 5 and 7.5 MHz, respectively. The capsules were fabricated by modifying a double emulsion method to encapsulate camphor in the oil phase and ammonium carbonate in the aqueous phase, and later sublime the encapsulated material, leaving voids capable of being filled with a gas in their place. The role of the surfactant, poly vinyl alcohol, solution temperature, was studied and found to play an important role in the morphology of the capsules, altering their acoustic response.

Ultrasound degradation of novel polymer contrast agents.

This report describes an investigation into factors affecting the degradation of novel poly(lactic-co-glycolic acid) (PLGA) contrast agents. Contrast agents fabricated by two different methods and varying in acoustic properties were compared. The effect of ultrasound frequency (5 and 10 MHz) on degradation of the microcapsules was also studied. High-performance liquid chromatography was used to quantify the production of lactic and glycolic acid to monitor agent degradation. The degradation pattern from the microcapsules was found to be closely related to capsule morphology; the more acoustically efficient capsules (maximum enhancement of 25 dB at 5 MHz with 0.004 mg/mL) degraded at a faster rate than those with lower acoustical efficiency (maximum enhancement of 25 dB at 5 MHz only achieved with 0.6 mg/mL). The capsules also degraded fastest when insonated at the frequency at which they gave highest backscatter. In addition, despite the use of a 50:50 PLGA copolymer, more glycolic than lactic acid was released at early time points, which reflects the greater hydrophilicity of the glycolic acid residues, and greater degradation rate of glycolic acid repeat units. The results from this study provided unique insight into the degradation behavior of hollow PLGA microcapsules, and their potential in ultrasound diagnosis and therapy.

Interfacial effects in the spreading kinetics of liquid droplets on solid substrates.

Several theories deal with the spreading kinetics of liquids on solid substrate, most of which relate the rate of spreading to the surface tension and the viscosity of the liquid. Measurements of the spreading of a number of liquids exhibiting a wide range of surface tension and viscosity on dry soda-lime glass have been carried out to validate the proposed models. The measurements used a small droplet of constant volume to minimize gravitational effects. The contact radius was acquired as a function of time by an image analysis system. It was noted that power law theories describe the spreading rate for silicone oil on glass. However, significant departures were noted in the case of other liquids. Mechanistic considerations of our data suggest that equal volume droplets of similar surface tension and of diverse viscosity spread to the same area but at different rates. On the other hand, the spreading rate of glycerine, which exhibits incomplete spreading on glass, and that of silicone oil, with comparable viscosity behave similarly. These observations seemingly support the view that surface tension acts to retain the spherical shape of the droplet, whereas the difference between the solid-liquid and solid-vapor interfacial energies acts to enlarge the contact area. In the meantime, viscous dissipation acts to retard the spreading rate, past a constant rate regime.

Systemic auto-antibodies in children with autism.

Autoimmunity to central nervous system may have a role in the pathogenesis of autism. A subset of anti-ds-DNA antibodies has been recently proved to be pathogenic to the brain as well as to the kidney. Due to the paucity of studies investigating the frequency of systemic auto-antibodies in autism, we are the first to investigate the frequency of anti-ds-DNA antibodies in a group of autistic children. The seropositivity of anti-nuclear antibodies (ANA) was also investigated. Serum anti-ds-DNA antibodies and ANA were measured in 100 autistic children, aged between 4 and 11 years, in comparison to 100 healthy-matched children. The seropositivity of anti-ds-DNA antibodies and ANA in autistic children was 34% and 25%, respectively. In addition, 42% of autistic children were seropositive for anti-ds-DNA antibodies and/or ANA. The frequencies of anti-ds-DNA antibodies and ANA in autistic children were significantly higher than that in healthy children (4% and 2%, respectively), (P<0.001 and P<0.001, respectively). Autistic children with a family history of autoimmunity (45%) had significantly higher frequency of serum anti-ds-DNA antibodies (48.9%) than patients without such a history (21.8%), P=0.008. There was a significant positive association between the seropositivity of anti-ds-DNA antibodies and ANA (P<0.001). In conclusion, anti-ds-DNA antibodies and ANA were found in the sera of a subgroup of autistic children. However, replication studies of larger samples are warranted to validate whether these antibodies are a mere association or have a pathogenic role in some autistic children.