Levels of serum inflammatory cytokines and their correlations with disease severity in patients with chronic spontaneous urticaria.

Introduction: Inflammation is crucial in the pathogenesis of chronic spontaneous urticaria (CSU). Investigating the correlation between levels of serum inflammatory cytokines (SICs) and the severity of CSU is of great significance for understanding the disease mechanism and finding effective treatment strategies. Aim: In this context, this work was developed. Material and methods: This work involved a researchy group (Res group) of 114 patients with CSU and a control group (Ctrl group) of 100 healthy individuals. SICs including leukotriene B4 (LTB4), leukotriene C4 (LTC4), interleukin (IL) 4 (IL-4), IL-17, IL-31, and tumor necrosis factor-γ (TNF-γ), of patients in different groups were measured and compared. Furthermore, the correlations between each SIC and pruritus severity, duration of pruritus, urticaria activity, and quality of life (QOL) were compared among the patients in different groups. Results: The Res group exhibited higher levels of LTB4, LTC4, IL-4, IL-17, and IL-31 but lower levels of TNF-γ. Great differences (p < 0.05) were found in IL-4, IL-17, and IL-31 among the patients with different pruritus severity, and positive correlations were observed between IL-17 and IL-31 levels and urticaria activity in the patients (p < 0.05). Additionally, levels of IL-4 and IL-31 exhibited a positive association to QOL scores in the patients, with obvious differences (p < 0.05). Conclusions: IL-4, IL-17, and IL-31 showed the strongest correlation with the severity of CSU, which may be attributed to their involvement in immune, inflammatory, and pruritic reactions, exacerbating the disease condition.

Associated effects of clinical characteristics, risk factors, and comorbidity on disease severity and mortality among patients with COVID-19 in Sulaimani City/ Kurdistan Region of Iraq.

The effects of clinical symptoms, laboratory indicators, and comorbidity status of SARS-CoV-2-infected patients on the severity of disease and the risk of death were investigated. Questionnaires and electronic medical records of 371 hospitalized COVID-19 patients were used for data collection (demographics, clinical manifestation, comorbidities, laboratory data). Association among categorical variables was determined using Kolmogorov-Smirnov test (P-value ≤0.05). Median age of study population (249 males, 122 females) was 65 years. Roc curves analysis found that age ≥64 years and age ≥67 years are significant cut-offs identifying patients with more severe disease and mortality at 30 days. CRP values at cut-off ≥80.7 and ≥95.8 significantly identify patients with more severe disease and mortality. Patients with more severe disease and risk of death were significantly identified with platelet value at the cut-off ≤160,000, hemoglobin value at the cut-off ≤11.7, D-Dimer values ≥1383 and ≥1270, and with values of neutrophil granulocytes (≥8.2 and ≤2) and lymphocytes (≤2 and ≤2.4). Detailed clinical investigation suggests granulocytes together with lymphopenia may be a potential indicator for diagnosis. Older age, several comorbidities (cancer, cardiovascular diseases, hypertension) and more laboratory abnormalities (CRP, D-Dimer, platelets, hemoglobin) were associated with development of more severity and mortality among COVID-19 patients.

Genetic Polymorphism and serum levels of Insulin like Growth Factor-1 (Igf-1) in patients of rheumatoid arthritis.

Objectives: Insulin like growth factor-1(IGF-1), is a modulator of immunity and inflammation, it promotes the anabolic role of growth hormone (GH) on bone and skeletal tissue. Genetic polymorphism in IGF-1 gene is reported to affect the transcriptional efficiency affecting its serum level. In this study we aim: 1) To study the presence of 192bp polymorphism of IGF-1 gene in patients of rheumatoid arthritis (RA), 2) To study the association of 192 bp polymorphism of IGF-1 gene with serum IGF-1 levels and disease severity in patients of RA. Methods: A cross-sectional study was carried out at University of Health Sciences (UHS), Lahore. Diagnosed RA cases who fulfilled the American College of Rheumatology (ACR) criteria were recruited from Fatima Memorial Hospital (FMH) and Behbud Rheumatology Clinics, Lahore during 2018-2019. Serum IGF-1 levels were determined by ELISA in blood samples of 200 RA patients and 200 healthy individuals. DNA was extracted and genetic polymorphism was determined. Results: The serum IGF-1 level in RA group was significantly lower compared to healthy group. Our study shows presence of 192bp allele of IGF-1in 77% of the studied population. Carriers of 192bp allele of IGF-1 had a significantly higher serum level of IGF-1 as compared to non-carriers in the RA patients. Rheumatoid factor (RF) positive patients had a higher number of 192bp carriers in comparison to RF negative patients. Significant difference was also seen in severity of disease between carrier and non-carriers of 192bp allele with the disease being more severe in male carriers. Conclusions: There is an association of IGF-1gene polymorphism with variation in serum IGF-1 levels and severity of RA.

Taste and Smell Disorders in COVID-19 Patients at a Local Healthcare Trust in Northern Italy: a Cross-Sectional Study.

Background: In Italy, since the beginning of the COVID-19 pandemic, patients testing positive for SARS-CoV-2 through nasopharyngeal swab have reported taste and smell alterations. As these symptoms are quite uncommon in other respiratory infections, their specificity and prevalence are useful features for the differential diagnosis of COVID-19. The objective was to describe taste and smell alterations in patients diagnosed with SARS-CoV-2 infection and to define the onset of those disorders during the clinical course of the disease. Study design: Cross-sectional study. Methods: This study was conducted on adult patients testing positive for SARS-CoV-2 infection through nasopharyngeal swab at a Local Healthcare Trust in Northern Italy between April 27th and May 27th, 2020. In order to investigate the clinical course, the onset of the first symptoms, smell and/or taste alterations, a phone-based questionnaire was administered during the programming of the second nasopharyngeal swab. Results: We recruited 168 patients; the mean age was 52 years old, and 94 (56.0%) were female. Among the 135 symptomatic patients, 87 (64.4%) reported taste and smell alterations. Patients with a mild clinical course showed the highest prevalence for taste and smell disorders (76.6%), which were also associated with a more benign clinical course of the disease (P = 0.0166). Furthermore, in 33 (37.9%) of these patients, changes in smell and taste perception appeared before the acute phase of the disease. Among the 14 patients with a severe clinical course of SARS-CoV-2 infection, 8 reported a variation of taste and smell perception before the hospitalization, with a median of 4 days (IQR 2-7). Conclusions: Smell and taste disorders can be listed among the first symptoms of SARS-CoV-2 infection and may anticipate the acute phase of the disease. Noteworthy, they seem to be associated with a more benign clinical course.

Role of ABO Blood Groups in Susceptibility and Severity of COVID-19 in the Georgian Population.

Aim and objective: The establishment of the potential role of the infected people's ABO blood type in the virus infectivity and aggressivity could clarify the aspects of the various susceptibility to virus and play a key role in assessing its spreading potential in the future. We studied the possible association of risk of coronavirus disease-2019 (COVID-19) infection and severe outcomes of disease with ABO blood groups and Rh factor in the Georgian population. Materials and methods: The effect of blood type on the severity of infection in COVID-19 positive patients admitted to the First University Clinic of Tbilisi State University (Tbilisi, Georgia) from December 2020 to September 2021 was analyzed retrospectively. The odds ratio (OR) criterion was used to determine the influence of the blood group on the risk of COVID-19 infection and of severe course of the disease. Results: The incidence of COVID-19 was 1.65-fold higher in the patients with blood group II(A), and average twice lower in patients with blood groups III(B) and IV(AB), compared with the ABO blood group distribution in healthy donors of the region. The percentage of patients transferring in ICU with I(O) and II(A) blood groups was enough high (42-40%), whereas in patients with III(B) and IV(AB) blood groups very low (12-6%). There were not revealed any statistically significant differences in the distribution of the patients with Rh+ and Rh- blood groups in healthy and COVID-19 infected individuals (including those transferred in the ICU). Conclusion: The link between patients' ABO blood groups and receptivity to COVID-19 infection, progression and severity of the disease, has been detected. These results are relevant in terms of elucidating the mechanisms and risk factors of infecting and severity course of COVID-19 disease. How to cite this article: Ratiani L, Sanikidze TV, Ormotsadze G, Pachkoria E, Sordia G. Role of ABO Blood Groups in Susceptibility and Severity of COVID-19 in the Georgian Population. Indian J Crit Care Med 2022;26(4):487-490.

SARS-CoV-2-directed antibodies persist for more than six months in a cohort with mild to moderate COVID-19.

OBJECTIVE: To follow serological immune responses of front-line healthcare workers after PCR-confirmed COVID-19 for a mean of 30 weeks, describe the time-course of SARS-CoV-2 spike protein-specific IgG, IgA and IgM levels and to identify associations of the immune response with symptoms, demographic parameters and severity of disease. METHODS: Anti-SARS-CoV-2 S protein-specific IgG, IgA and IgM antibodies were measured at three time points during the 30-week follow-up. COVID-19-specific symptoms were assessed with standardized questionnaires. RESULTS: 95% of the participants mounted an IgG response with only modest decline after week 12. IgG-type antibodies were still detectable in almost 90% of the subjects at 30 weeks. IgA and IgM responses were less robust and antibody titers decreased more rapidly. At 30 weeks, only 25% still had detectable IgA-type and none had IgM-type antibodies. Higher age and higher disease severity were independently associated with higher IgG antibody levels, albeit with wide variations. CONCLUSION: Serological immune responses after COVID-19 show considerable inter-individual variability, but show an association with increasing age and higher severity of disease. IgG-type anti-SARS-CoV-2 antibodies remain positive in 90% of the individuals 30 weeks after onset of symptoms.

Effects of saffron supplementation on oxidative/antioxidant status and severity of disease in ulcerative colitis patients: A randomized, double-blind, placebo-controlled study.

Supplementation with saffron helps improve antioxidant status. Oxidative stress plays an important role in ulcerative colitis (UC). The present study aimed to investigate the effect of saffron supplementation on disease severity and Oxidative/Antioxidant factors in patients with UC. This randomized double-blinded study was conducted on 80 mild to moderate UC patients. Participants were randomly divided into intervention (100 mg saffron/daily) and placebo (100 mg maltodextrin/daily) groups. Of all the participants, 75 completed the study. After 8 weeks, there were significantly increased in the mean score of simple clinical colitis activity index questionnaire (3.83 ± 1.78 to 3 ± 1.60, p = .004), the serum levels of total antioxidant capacity (2.68 ± 0.90 to 2.79 ± 0.87, p = .016), superoxide dismutase (60.69 ± 9.59 to 66.30 ± 10.79, p = .009) and glutathione peroxidase (22.05 ± 14.27 to 29.67 ± 17.97, p = .011) in patients received saffron compared to the placebo group. Whereas, there was no significant difference in serum levels of malondialdehyde between the two groups. Finally, dietary saffron as an alternative therapy may effective in improving antioxidant factors and reducing the severity of disease in UC patients.

Chronic Rhinosinusitis with Nasal Polyps: Age and Disease Severity Differences in the Levels of Inflammatory Markers.

Background and objectives: The aim of our study was to analyze the concentrations of inflammatory markers in the nasal tissue of patients with chronic rhinosinusitis with nasal polyps (CRSwNPs) and controls of different age groups, as well as to find associations between age, inflammation development, and NPs. Materials and methods: Patients were divided into two groups-patients with CRSwNPs and control subjects who had nasal surgery for another reason beside CRS. Our analysis was performed across three different age groups (18-30 years, 31-50 years, and 51 years and more). Tissue biopsies from the sinus cavity for all study participants were taken and frozen at -80 °C, until use. The concentrations of IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-13, IL-21, and IL-22, were quantified using a magnetic bead-based multiplex assay. Results: In the group aged 18-30 years, the levels of inflammatory markers IL-1, IL-2, IL-5, and IL-22 were significantly higher in patients with CRSwNPs than the control subjects. Among patients aged 31-50 years, significantly higher concentrations of IL-2, IL-4, IL-5, and IL-22 were recorded in patients with CRSwNPs, as compared to the control subjects. In the oldest group (aged 51 years and more), patients with CRSwNPs had significantly higher concentrations of IL-2, IL-4, and IL-22, as compared to the control group. In the CRSwNP group, only the concentration of IL-21 was significantly higher among patients aged 31-50 years, as compared with those aged 51 years and older (p = 0.013). Conclusions: IL-2 and IL-22 levels were significantly higher in patients with CRSwNP than the control, across all age groups. Only the concentration of IL-21 was higher among patients with CRSwNP in the middle age group, as compared to the oldest group. IL-2, IL-4, and IL-22 levels correlated with the severity of CRSwNPs. Elevated concentrations of IL-2, IL-4, and IL-22 were determined in patients' groups with higher sinonasal outcome test (SNOT-22) scores, pointing to more severe clinical symptoms.

Evaluation of the psychological status of mothers of children with cystic fibrosis and the relationship between children's clinical status.

AIM: In this study, we aimed to determine the psychosocial status of primary care givers of children with cystic fibrosis (CF) and its relationship with the clinical scores of children with CF. METHODS: Thirty-six patients with CF and their primary care givers were assessed. A personal information form, as well as the Parent Attitude Research Instrument, Maslach Burnout Inventory, Beck Depression Scale and modified Shwachman-Kulczycki Score, were used for data collection. RESULTS: All the CF children's primary care givers were their mothers. The mothers' occupation and educational level affected their child-rearing attitudes (P < 0.05). Furthermore, the frequency of hospital visits and hospitalizations was associated with increased emotional exhaustion, depression and negative attitudes towards child-rearing (P < 0.05). Higher levels of emotional exhaustion in mothers were associated with increased depersonalization and depression, while personal accomplishment was associated with lower levels of depression (P < 0.05). Depression was present in 69.4% of mothers, and its severity was correlated with their children having a poor clinical status. Moreover, increased depression was associated with increased negative attitudes towards child-rearing (P < 0.05). CONCLUSION: The rate of depression is high in mothers of children with CF. These mothers displayed a negative attitude towards child-rearing, along with the disease, which was more severe in their children. These mothers should undergo routine psychosocial screening, and support should be given to those in need.

[The Correlation Between Serum Hcy Level and Clinical Indicators in Systemic Lupus Erythematosus Patients].

OBJECTIVE: To explore the serum homocysteine (Hcy) level and its influence factors in systemic lupus erythematosus (SLE) patients. METHODS: 90 SLE patients were included in the study. According to the systemic lupus erythematosus disease activity index (SLEDAI) score, 41 patients were in active stage (> 9 scores), 49 patients were in inactive stage (≤9 scores), while 46 healthy individuals were selected as controls. Total cholesterol (TC), triacylglyceride (TG), serum creatinine (Ser), C-reactive protein (CRP), serum cystatin (cystin c, CysC) and Hcy level were measured. Analysis on the relationship between Hcy level and SLEDAI score, as well as serum indicators was conducted. RESULTS: The levels of Hcy, TG, TC, CRP and CysC in SLE patients were higher than healthy controls (P < 0.05), and the serum level in active SLE patients was higher than inactive SLE patients (P < 0.05). There was no significant difference in Ser level among the active SLE patients, inactive SLE patients and healthy controls (P>0.05). There was a positive correlation between Hcy level and SLEDAI score (r=0.698 3, P < 0.01), as well as CysC (r=0.597 5, P < 0.01). There was no significant correlation between Hcy level and CRP, TC, TG and Ser levels (P>0.05). CONCLUSIONS: The Hcy level in SLE patients was higher than healthy controls. The level of Hcy was positively correlated with the degree of disease activity. The Hcy level and SLEDAI score can be used as indicators to evaluate the activity of SLE.

Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting.

OBJECTIVES: Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually. STUDY DESIGN: This is a linked cross-sectional study. METHODS: In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested. RESULTS: The best health expenditure predictors proved to be PCS and SI (R2 = 0.15 and R2 = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R2 = 0.19). CONCLUSIONS: A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.

[Influence of social characteristics on the duration of treatment, severity of the disease and social support of patients in a surgical intensive care unit]. / Einfluss sozialer Charakteristika auf die Behandlungsdauer, Erkrankungsschwere und soziale Unterstützung von Patienten einer operativen Intensivstation.

BACKGROUND: In critical illnesses low socioeconomic status (SES) is associated with higher morbidity and mortality. In addition to the SES, further factors at an individual level (e.g., sex, health insurance status and place of residence) may influence the severity of illness and medical treatment. We investigated these additional parameters in a secondary analysis of the ECSSTASI data. METHODS: Within the framework of the ECSSTASI study, 996 patients were recruited from a surgical intensive care unit. We examined the influence of sex, insurance status and place of residence on health-related behavior, disease severity, duration of intensive care and ventilation (28 ventilator-free days score, 28-VFDS) and social support by the next of kin. Multivariate-adjusted logistic regression analyses were carried out and odds ratios (OR) are presented with corresponding 95% confidence intervals. RESULTS: Among patients admitted to the intensive care unit, the disease severity (SOFA score >5) was significantly lower in women than in men (OR 0.62 [0.45-0.87]). Increasing size of the patient's town of residence was associated with a significantly shorter duration of treatment on the intensive care unit (OR 0.54 [0.32-0.91]). An increasing number of persons in the household was associated with a significantly increased risk of being ventilated longer compared to 1­person households (p = 0.028). Patients with private insurance (OR 1.87 [1.28-2.70]), patients from households with ≥4 persons (OR 1.92 [1.1-3.33]) and patients without German citizenship (OR 2.56 [1.39-4.55]) were visited significantly more often by next of kin. CONCLUSION: In addition to the SES, sociodemographic characteristics of the individual patient are associated with the course of treatment in intensive care medicine. The extent of social support by the next of kin depends on intercultural and individual patient characteristics. An increasing size of the town of residence and private health insurance status positively influence intensive care outcomes. In order to evaluate these data, further epidemiological studies in intensive care medicine are necessary.

Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis.

BACKGROUND: Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. METHODS: We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. RESULTS: The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more cost-effective. CONCLUSIONS: On average, ICU admission versus general ward care was cost-effective at a threshold of €22,000/QALY (p = 95%). According to the individualized cost-effectiveness information, one in six ICU admissions was not cost-effective at a threshold of €64,000/QALY. Almost half of these admissions that were not cost-effective can be regarded as acceptable when weighted by severity of disease in terms of expected lifetime health. Overall, existing ICU services represent reasonable resource use, but considerable uncertainty becomes evident when disaggregating into individualized results.

The effect of severity of illness on total joint arthroplasty costs across New York state hospitals: an analysis of 172,738 cases.

We explored the average cost of 94,197 total knee and 78,541 total hip arthroplasties (TKA and THA) using the New York State Hospital Inpatient Cost Transparency database to evaluate the effect of beneficiary health status on hospital reported cost for the two operations. Using the 3M APR-DRG severity of illness index as a measure of patient's health status, we found a significant increase in cost for both TKA and THA for patients with higher severity of illness index. This study confirms the greater cost and variability of TKA and THA for patients with increased severity of illness and illustrates the inherent unpredictability in cost forecasting and budgeting for these same patients.

The effect of severity of disease on cost burden of 30-day readmissions following total joint arthroplasty (TJA).

In order to control the unsustainable rise in healthcare costs the Federal Government is experimenting with the bundled payment model for total joint arthroplasty (TJA). In this risk sharing model, providers are given one payment, which covers the costs of the TJA, as well as any additional medical costs related to the procedure for up to 90 days. The amount and severity of comorbid conditions strongly influence readmission rates and costs of readmissions in TJA patients. We identified 2026 TJA patients from our database with APR-DRG SOI data for use in this study. Both the costs of readmission and the readmission rate tended to increase as severity of illness increased. The readmission burden also increased as SOI increased, but increased most markedly in the extreme SOI patients.

Relationship between serum Midkine and Omentin-1 levels and the severity of sepsis in patients and their prognostic value.

To explore the relationship between serum levels of midkine and omentin-1 and the severity of sepsis in patients, and their prognostic value. A retrospective analysis was conducted on the clinical data of 180 sepsis patients. According to the severity of the patient's condition, they were separated into sepsis group (n = 76), severe sepsis group (n = 59), and sepsis shock group (n = 45). Based on the survival within 28 days of admission, they were grouped into survivors group (n = 128) and nonsurvivors group (n = 52). The serum Midkine level and APACHE II score in the sepsis shock group were higher than those in the severe sepsis group and sepsis group, while the Omentin-1 level was lower than that in the severe sepsis group and sepsis group (p < 0.05). The serum Midkine level and APACHE II score in the severe sepsis group were higher than those in the sepsis group, while the Omentin-1 level was lower than that in the sepsis group (p < 0.05). The Midkine and APACHE II score in the nonsurvivors group was higher than those in the survivors group, while the Omentin-1 score was lower than that in the survivors group (p < 0.05). Midkine and APACHE II score were independent risk factors for the prognosis of sepsis patients, while Omentin-1 was a protective factor for the prognosis of sepsis patients (p < 0.05). The AUC of the combined prediction of serum Midkine and Ommentin-1 for the prognosis of sepsis patients was 0.880, with a sensitivity of 90.38% and a specificity of 72.66%. The combined prediction of serum Midkine and Ommentin-1 was better than that of individual prediction of Midkine and Ommentin-1. Serum Midkine is highly expressed and Omentin-1 is lowly expressed in sepsis patients, and the combination of the two has a high predictive power for the prognosis of sepsis patients.

Neurosurgical Patient's Quality of Life: A Questionnaire-Based Study.

INTRODUCTION: The burden of disease, as well as social and epidemiological factors, have a clear impact on a patient's quality of life. Especially in neurosurgery, patients commonly experience a decline in their quality of life. This study aims to assess the quality of life of neurosurgical patients and evaluate the impact of epidemiologic and disease-related factors. METHODS AND MATERIAL: Adult, non-trauma neurosurgical patients were included in the study, which took place in the Neurosurgical Department at AHEPA University Hospital. Self-administered questionnaires including the 36-Item Short Form Survey Instrument (SF-36) and the EQ-5D-5L were used to assess the overall patient's quality of life. Additionally, all patients were asked to provide data on the perceived severity of the disease and the extent of information regarding their health condition. Epidemiologic factors including gender, age, education level, and rural or urban living environment were also taken into account. Statistical analysis was performed to assess the impact of the aforementioned parameters on the patient's quality of life. RESULTS: In total, 74 patients were included in the study (56.9% male, mean age: 51 years). In general, better mean scores were observed in general health perception, vitality, social role functioning, and mental health, whereas the lowest values were detected in the reported physical and emotional role functioning. No statistically significant differences were observed among genders. Age was found to impact the general health perception and EQ-VAS (visual analog scale) score, while physical functioning presented significant differences depending on the patient's living environment and education level, with better scores for rural residents and secondary education graduates. The perceived severity of the health condition presented a significant negative effect on the EQ-VAS score, while it affected significantly physical functioning, with better outcomes reported by patients dealing with more serious diseases. Finally, in most of the evaluated categories, the level of information seemed to increase the reported quality of life, even though statistical significance was not confirmed. CONCLUSION: Quality of life should be taken into account when treating neurosurgical patients, and utilizing measuring tools assists in objectively evaluating their well-being. Most parameters that influence the patient's quality of life are fixed. Therefore, based on our study results, healthcare professionals should prioritize providing comprehensive information regarding the patient's disease and treatment, as the level of information seems to improve the overall patient's quality of life.

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis.

Objective: Movement disorders (MDs) are common in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis but are poorly studied. This study aimed to investigate the clinical characteristics of MDs and the clinical differences between patients with and without MDs in anti-NMDAR encephalitis. Methods: A retrospective study was conducted on patients with anti-NMDAR encephalitis who were first diagnosed and treated in the First People's Hospital of Yunnan Province from January 2017 to September 2022. According to the presence or absence of MDs, all patients were divided into two groups, and the clinical manifestations, auxiliary examinations, and prognosis of the two groups were compared. Patients in the MDs group were further subgrouped by different ages (<12 years, 12-17 years, and ≥ 18 years) and genders, and the prevalence of each MD was compared in different age and gender groups. Results: (1) In our study there were 64 patients, of whom 76.6% (49/64) presented with MDs; the median age of onset in patients with MDs was 21 (15,35) years and 65.3% (32/49) were female. The three most common MDs were orofacial dyskinesia (OFLD) (67.3%), dystonia (55.1%), and stereotypies (34.7%). Patients <12 years were more likely to experience chorea than patients in other age groups (p = 0.003). (2) Compared with the non-MDs group, patients in the MDs group showed higher rates of prodromal manifestations, autonomic dysfunction, consciousness disorders, as well as pulmonary infection and gastrointestinal dysfunction (all p < 0.05). Peripheral blood neutrophil to lymphocyte ratio (NLR) (p = 0.014), the proportion of cerebrospinal fluid (CSF) NMDAR antibody titers ≥1:32 (p = 0.047), ICU admission rate (p = 0.04), length of stay (p = 0.007), maximum mRS score in the course of disease (p = 0.001) and mRS score at discharge (p = 0.006) in the MDs group were significantly higher than the non-MDs group. Conclusion: MDs associated with anti-NMDAR encephalitis were predominantly hyperkinetic. Chorea occurred more commonly in patients aged <12 years. Patients with MDs were prone to autonomic dysfunction, consciousness disorders, pulmonary infection, and gastrointestinal dysfunction; they had more intense inflammation, more severe disease, and a poorer short-term prognosis.

EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia.

Background: Data about eosinophil-to-lymphocyte ratio (ELR) and eosinophil-to-monocyte ratio (EMR) in patients with community-acquired pneumonia (CAP) are rare. We aimed to evaluate the role of EMR and ELR in predicting disease severity and mortality in patients with CAP. Methods: A total of 454 patients (76 with severe CAP (SCAP), 378 with non-SCAP) were enrolled from November 18, 2020, and November 21, 2021. Laboratory examination on day 1 after admission was measured. The ELR and EMR values were calculated for patients. Propensity score matching (PSM) was performed to balance potential confounding factors. Binary logistic regression model was fitted to identify the potential risk factors for disease severity and Cox proportional hazards regression model analysis for mortality in CAP. Receiver operating characteristic (ROC) analysis was performed to distinguish disease severity and mortality. Results: EMR and ELR at admission were significantly lower in SCAP patients than in non-SCAP patients (P<0.001). EMR < 0.018 ([OR] = 12.104, 95% CI: 4.970-29.479), neutrophil (NEU) ([OR]=1.098, 95% CI:1.005-1.199), and age ([OR]=1.091, 95% CI:1.054-1.130) were independent risk factors for disease severity of CAP. EMR < 0.032 ([HR] = 5.816, 95% CI: 1.704-9.848) was an independent predictor of in-hospital mortality. Combining EMR or ELR with CRB-65 improved the overall accuracy of disease severity prediction (AUC from 0.894 to 0.937), the same as CURB-65. The area under the curve of EMR (AUC=0.704; 95% CI: 0.582-0.827) to predict in-hospital mortality was higher than that of CURB-65 (AUC=0.619; 95% CI: 0.484-0.754). Otherwise, EMR combined with CRB-65 (AUC=0.721; 95% CI: 0.592-0.851) had significantly higher diagnostic accuracy for in-hospital mortality than that of CURB-65 alone. Conclusion: EMR combined with CRB-65 was superior to CURB-65 in predicting mortality in patients with CAP. This new combination was simpler and easier to obtain for physicians in clinics or admission, and it was more convenient for early recognition of patients with poor prognoses.

Comorbid allergy and rhinitis and patient-related outcomes in asthma and COPD: a cross-sectional study.

Introduction: The study aimed to compare prevalence of comorbid allergic manifestations and rhinitis, allergy testing and associations with patient-related outcomes in patients with asthma and COPD. Methods: Cross-sectional study of randomly selected Swedish patients with a doctor's diagnosis of asthma (n = 1291) or COPD (n = 1329). Self-completion questionnaires from 2014 provided data on demographics, rhinitis, allergic symptoms at exposure to pollen or furry pets, exacerbations, self-assessed severity of disease and scores from the Asthma Control Test (ACT) and the COPD Assessment Test (CAT), and records were reviewed for allergy tests. Results: Allergic manifestations were more common in asthma (75%) compared with COPD (38%). Rhinitis was reported in 70% of asthma and 58% of COPD patients. Allergy tests had been performed during the previous decade in 28% of patients with asthma and in 8% of patients with COPD.In patients with asthma; comorbid allergy and rhinitis were both independently associated with increased risk for poor asthma symptom control (ACT < 20) (OR [95% CI] 1.41 [1.05 to 1.87] and 2.13 [1.60 to 2.83]), exacerbations (1.58 [1.15 to 2.17] and 1.38 [1.02 to 1.86]), and self-assessed moderate/severe disease (1.64 [1.22 to 2.18] and 1.75 [1.33 to 2.30]). In patients with COPD, comorbid allergy and rhinitis were both independently associated with increased risk for low health status (CAT ≥ 10) (OR [95% CI] 1.46 [1.20 to 1.95] and 2.59 [1.97 to 3.41]) respectively, with exacerbations during the previous six months (1.91 [1.49 to 2.45] and 1.57 [1.23 to 2.01]), and with self-assessed moderate/severe disease (1.70 [1.31 to 2.22] and 2.13 [1.66 to 2.74]). Conclusion: Allergic manifestations and rhinitis are more common in asthma than COPD but associated with worse outcomes in both diseases. This highlights the importance of examining and treating comorbid allergy and rhinitis, not only in asthma but also in COPD.