Diabetes-inducing effects of bronchial asthma

BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.

Management of gastrointestinal bleed in the intensive care setting,an updated literature review

Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill patients.GI bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal failure.Managing GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical procedures.Even with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ failure.This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.

Alpha-1 antitrypsin deficiency and Pi^(*)Z allele as important co-factors in the development of liver fibrosis

BACKGROUND Alpha-1 antitrypsin deficiency(AATD)is a codominant autosomal hereditary condition that predisposes patients to the development of lung and/or liver disease,and Pi*Z allele is the most clinically relevant mutation.AIM To evaluate the impact of clinical parameters and AATD phenotypes,particularly the Pi*Z allele,in liver fibrosis.METHODS Cross-sectional cohort study including consecutive patients with AATD followed in Pulmonology or Hepatology consultation.RESULTS Included 69 patients,49.3%had Pi*MZ phenotype and 10.1%Pi*ZZ.An age≥55 years,age at diagnosis≥41 years and AAT at diagnosis<77 mg/dL predicted a nonalcoholic fatty liver disease fibrosis score(NFS)not excluding advanced fibrosis[area under the curve(AUC)=0.840,P<0.001;AUC=0.836,P<0.001;AUC=0.681,P=0.025].An age≥50 years and age at diagnosis≥41 years predicted a fibrosis-4 index of moderate to advanced fibrosis(AUC=0.831,P<0.001;AUC=0.795,P<0.001).Patients with hypertension,type 2 diabetes mellitus(DM),dyslipidaemia,metabolic syndrome,and regular alcohol consumption were more likely to have a NFS not excluding advanced fibrosis(P<0.001,P=0.002,P=0.008,P<0.001,P=0.033).Patients with at least one Pi*Z allele and type 2 DM were 8 times more likely to have liver stiffness measurement≥7.1 kPa(P=0.040).CONCLUSION Risk factors for liver disease in AATD included an age≥50 years,age at diagnosis≥41 years,metabolic risk factors,regular alcohol consumption,at least one Pi*Z allele,and AAT value at diagnosis<77 mg/dL.We created an algorithm for liver disease screening in AATD patients to use in primary care,selecting those to be referred to Hepatology consultation.

Decoding the genetic landscape of autism:A comprehensive review

BACKGROUND Autism spectrum disorder(ASD)is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings.Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD,influencing both diagnosis and therapeutic strategies.AIM To explore the genetic architecture of ASD,elucidate mechanistic insights into genetic mutations,and examine gene-environment interactions.METHODS A comprehensive systematic review was conducted,integrating findings from studies on genetic variations,epigenetic mechanisms(such as DNA methylation and histone modifications),and emerging technologies[including Clustered Regularly Interspaced Short Palindromic Repeats(CRISPR)-Cas9 and single-cell RNA sequencing].Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar.RESULTS Genetic studies have identified numerous risk genes and mutations associated with ASD,yet many cases remain unexplained by known factors,suggesting undiscovered genetic components.Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving.Epigenetic modifications,particularly DNA methylation and non-coding RNAs,also play significant roles in ASD pathogenesis.Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data.CONCLUSION Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments.Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice.Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies,ultimately enhancing outcomes for individuals affected by ASD.

Gastrointestinal tolerability of organic infant formula compared to traditional infant formula: A systematic review

BACKGROUND Infants'nutrition significantly influences their growth,development,and overall well-being.With the increasing demand for organic infant formula driven by the perception of health benefits and growing awareness of natural feeding options,it is crucial to conduct a comparative analysis of the gastrointestinal tolerability between organic and traditional infant formulas.AIM To provide a concise and precise analysis of the gastrointestinal tolerability of organic infant formula compared to traditional infant formula.Due to limited direct comparisons,the review synthesizes available literature on each formula type,presenting insights into their potential effects on infants'digestive health.METHODS An extensive literature search was conducted,compiling studies on organic and traditional infant formulas,their compositions,and reported effects on gastrointestinal tolerability.We searched academic databases such as PubMed and Google Scholar and specialized nutrition,paediatrics,and infant health journals using relevant keywords till October 1,2023.RESULTS Although specific comparative studies are scarce and formula heterogeneity is a significant limitation,this systematic review provides an in-depth understanding of organic infant formulas'composition and potential benefits.While scientific evidence directly comparing gastrointestinal tolerability is limited,organic formulas strive to use carefully selected organic ingredients to imitate breast milk composition.Potential benefits include improved lipid profiles,higher methionine content,and decreased antibiotic-resistant bacteria levels.Understanding the gastrointestinal tolerability of organic and traditional infant formulas is crucial for parents and healthcare providers to make informed decisions.CONCLUSION Despite limitations in direct comparisons,this systematic review provides insights into the composition and potential benefits of organic infant formulas.It emphasizes the need for further research to elucidate their gastrointestinal effects comprehensively.

Examining the Types and Consequences of Female Genital Mutilation in Somalia: A Cross-Sectional Study on the Burden and Impact of Acute and Long-Term Complications

Background: In Africa, female genital mutilation (FGM) is a widespread and harmful practice, with Somalia having the highest incidence at 98%. This practice has severe and long-lasting physical and mental health consequences. The aim of the study was to evaluate the different types of FGM;immediate and long-term complications associated with the practice, and identify factors related to its prevalence. Method: In a one-year cross-sectional hospital-based study, data were collected from females aged 18 - 50 with a history of FGM. Face-to-face semi-structured questionnaires were used for data collection. Data analysis was performed using SPSS version 26, utilizing univariate and bivariate analyses to identify correlations between variables, which were presented in tables. Results: In a study involving 255 female participants, 65.5% were between 18 and 30 years old. The majority (82.7%) were married, while 47.1% were illiterate. FGM cases were more prevalent in rural areas (61.6%). Among the participants, 45.1% were employed. Type 3 FGM was the most common (44.3%), followed by Type 2 (32.2%) and Type 1 (23.9%). In terms of short-term complications experienced by circumcised women, the most common were bleeding, reported by 29.8% of participants, followed by infection (25.1%), and urinary retention (19.2%). Among the long-term complications observed, recurrent vaginal infections were the most prevalent, affecting 29.8% of the surveyed females. This was episiotomy during delivery (22.3%) and genital scarring (10.2%). Conclusion: The study reveals that Type 3 FGM is highly prevalent among the surveyed females, contributing to an increased risk of recurrent vaginal infections, prolonged second stage of labor, higher likelihood of episiotomy during delivery, and genital scarring. These findings emphasize the urgent need for effective preventive strategies and implementation from both international and local organizations to eliminate the harmful practice of FGM.

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock:An Indian perspective

BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb®extracorporeal haemoadsorption device,has been investigated and shown promising outcome.However,there is a lack of some guidance to make clinical decisions on the use of CytoSorb®haemoadsorption as an adjuvant therapy in septic shock in Indian Setting.Therefore,this expert consensus was formulated.AIM To formulate/establish specific consensus statements on the use of CytoSorb®haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.METHODS We performed a comprehensive literature on CytoSorb®haemoadsorption in sepsis,septic shock in PubMed selecting papers published between January 2011 and March 20232021 in English language.The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps.Using a modified Delphi approach combining evidence appraisal and expert opinion,the following topics related to CytoSorb®in septic shock were addressed:need for adjuvant therapy,initiation timeline,need for Interleukin-6 levels,duration of therapy,change of adsorbers,safety,prerequisite condition,efficacy endpoints and management flowchart.Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.RESULTS Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.All 11 experts in the consensus group(100%)participated in the first,second and third round of voting.After three iterative voting rounds and adapting two statements,consensus was achieved on nine statements out of nine statements.The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb®for all indications in the open-ended question(Q10)focusing on“future recommendations for CytoSorb®therapy”.CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb®haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.

The Prevalence and Risk Factors of Bronchiectasis among Adults Based on CT Scan Findings: A Retrospective Single-Center Study

Background: Bronchiectasis, characterized by irreversible bronchial dilation, often affects patients’ long-term health. This study assessed the prevalence and risk factors of bronchiectasis in adults based on CT scan-finding department (OPD) patients in a single center. Methods: We retrospectively reviewed the medical records of 301 adult OPD patients examined between 2021 and 2022. We diagnosed bronchiectasis based on high-resolution chest CT scans. We analyzed demographic characteristics, tuberculosis (TB) history, and the presence of comorbid conditions using electronic medical records. We conducted univariate and multivariate analyses to identify potential risk factors for bronchiectasis. Results: Among 301 patients who had high-resolution chest CT scans, 139 (46.1%) received a diagnosis of bronchiectasis. Multivariable analysis revealed significant associations between bronchiectasis and the following factors: age greater than 50 years and history of tuberculosis. We found no significant correlation between gender and smoking history. Conclusion: This study found a high prevalence of bronchiectasis (46.1%) among OPD patients in our single center, with older age and a history of tuberculosis identified as independent risk factors.

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI 5≥5-30, n=27, 'severe' (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

Comparison of Effectiveness of Gefitinib, Erlotinib, and Afatinib in Advanced Non-small Cell Lung Cancer Patients with EGFR Mutation Positive in Indonesian Population

Background and objective EGFR-tyrosine kinase inhibitors(EGFR-TKIs) were used to treat non-small cell lung cancer(NSCLC) patients with EGFR mutation positive. This study aims to compare the effectiveness of first line TKIs;gefitinib, erlotinib, and afatinib in the treatment of advanced stage NSCLC patients with EGFR mutation positive in the Indonesian population.Methods A retrospective cohort study of 88 NSCLC patients with EGFR mutation positive treated with gefitinib(n=59), erlotinib(n=22), and afatinib(n=7) was performed in national cancer hospital in Indonesia.Inclusion criteria were stage IIIb or IV NSCLC with adenocarcinoma subtype. Subjects less than 18 years or with a history of other malignancy were excluded. Outcomes were treatment response, progression-free survival(PFS), and mortality rate. Results Complete response, partial response, and stable disease were shown in 1.1%, 35.2%, and 31.8% of subjects, respectively. There were 31.8% of subjects developed progressive disease during treatment. Regarding EGFR mutation positive profile, a total of 56.8% subjects had deletion in exon 19, 42% subjects had mutation in exon 21, and rare mutation in exon 18 was found in 3.4% of total subjects. Demography and clinical characteristics had no significant association with the risk of progressive disease. The median PFS of subjects was 11 months(95%CI: 6.8-15.2 months). There was no statistical difference of PFS between treatment groups.Conclusion Gefitinib, erlotinib, and afatinib have similar effectiveness in advanced stage NSCLC with EGFR mutation positive. Afatinib tends to be associated with longer PFS but further investigation is required.

Methods of computed tomography screening and management of lung cancer in Tianjin: design of a population-based cohort study

Objective: European lung cancer screening studies using computed tomography(CT) have shown that a management protocol based on measuring lung nodule volume and volume doubling time(VDT) is more specific for early lung cancer detection than a diameter-based protocol. However, whether this also applies to a Chinese population is unclear. The aim of this study is to compare the diagnostic performance of a volume-based protocol with a diameter-based protocol for lung cancer detection and optimize the nodule management criteria for a Chinese population.Methods: This study has a population-based, prospective cohort design and includes 4000 participants from the Hexi district of Tianjin, China. Participants will undergo low-dose chest CT at baseline and after 1 year. Initially, detected lung nodules will be evaluated for diameter and managed according to a routine diameter-based protocol(Clinical Practice Guideline in Oncology for Lung Cancer Screening, Version 2.2018). Subsequently, lung nodules will be evaluated for volume and management will be simulated according to a volume-based protocol and VDT(a European lung nodule management protocol). Participants will be followed up for 4 years to evaluate lung cancer incidence and mortality. The primary outcome is the diagnostic performance of the European volume-based protocol compared to diameter-based management regarding lung nodules detected using low-dose CT.Results: The diagnostic performance of volume-and diameter-based management for lung nodules in a Chinese population will be estimated and compared.Conclusions: Through the study, we expect to improve the management of lung nodules and early detection of lung cancer in Chinese populations.

Differential expression of mucin 1 and mucin 2 in colorectal cancer

AIM To determine tissue expression(mRNA, protein) of two types of mucins [mucin 1(MUC1) and mucin 2(MUC2)] in patients with colorectal cancer(CRC).METHODS Expression of membrane-bound mucin(MUC1) and secretory mucin(MUC2) in CRC(mRNA, protein) were analyzed in tissue material including fragments of tumorsobtained from CRC patients(n = 34), and fragments of normal colorectal tissue from the same patients(control). The analysis was conducted using real-time quantitative polymerase chain reaction(RT-qPCR)(transcripts), immunohistochemistry(IHC)(apomucins), and the modern approach for morphometric analysis of IHC reaction(HSV filter software). Results on tissue expression of both mucins(mRNA, protein) were compared to histological alterations in colorectal cancer samples and correlated with selected clinical data in the patients. The statistical analysis was conducted using Statistica PL v. 12.0 software.RESULTS Significantly higher expression of the MUC1 mRNA in the CRC, compared with the control and the borderline correlation of mRNA expression with MUC1 protein levels in colorectal samples was observed. The expression of apomucins concerned cell membranes(MUC1) and cytoplasm(MUC2) and occurred both in control tissues and in most cancerous samples. There were no significant relationships between MUC1(mRNA, protein) and the clinicopathological data of patients. MUC2 protein expression was significantly lower as compared to the control, while MUC2 mRNA expression was comparable in both groups. The MUC1/MUC2 ratio was significantly higher in CRC tissues than in the control. The higher expression of MUC2 was a feature of mucinous CRC subtypes, and characterized higher histological stage of tumors. Negative correlations have been obtained between MUC2 and the Ki-67 antigen, as well as between MUC2 and p53 protein expressions in CRC.CONCLUSION A combination of tissue overexpression of MUC1, reduced MUC2 expression, and high ratio of MUC1/MUC2 is a factor of poor prognosis in CRC patients. MUC2 tissue expression allows to differentiate mucinous and nonmucinous CRC subtypes.

Second to fourth digit ratio： a predictor of adult lung function

Sex and sex hormones play a major role in lung physiology. It has been proposed that the ratio of the second to fourth digits （digit ratio） is correlated with fetal sex hormones. We therefore hypothesized that digit ratio might help predict lung function. We investigated the relationship between digit ratio and pulmonary function test （PFT） findings. A total of 245 South Korean patients （162 male, 83 female） aged from 34 to 90 years who were hospitalized for urological surgery were prospectively enrolled. Before administering the PFTs, the lengths of the second and fourth digits of the right hand were measured by a single investigator using a digital Vernier caliper. In males （n = 162）, univariate and multivariate analysis using linear regression models showed that digit ratio was a significant predictive factor of forced vital capacity （FVC） and forced expiratory volume in I second （FEV1） （FVC： r = 0.156, P = 0.047; FEVI： r = 0.160, P = 0.042）. In male ever-smokers （n = 69）, lung functions （FVC and FEV1） were correlated with smoking exposure rather than digit ratio. In female never-smokers （n = 83）, lung functions （FEV1 and FEVI/FVC ratio） were positively correlated with digit ratio on univariate analysis （FEVI： r = 0.242, P = 0.027; FEVI/FVC ratio： r = 0.245, P = 0.026）. Patients with lower digit ratios tend to have decreased lung function. These results suggest that digit ratio is a predictor of airway function.

High frequency of the c.3207C>A (p.H1069Q) mutation in ATP7B gene of Lithuanian patients with hepatic presentation of Wilson's disease

AIM： To investigate the prevalence of the ATP7B gene mutation in patients with hepatic presentation of Wilson＇s disease （WD） in Lithuania. METHODS： Eleven unrelated Lithuanian families, including 13 WD patients were tested. Clinically WD diagnosis was established in accordance to the Leipzig scoring system. Genomic DNA was extracted from whole venous blood using a salt precipitation method. Firstly, the semi-nested polymerase chain reaction （PCR） technique was used to detect the c.3207C〉A （p.H1069Q） mutation. Patients not homozygous for the c.3207C〉A （p.H1069Q） mutation were further analyzed. The 21 exons of the WD gene were amplified in a thermal cycler （Biometra T3 Thermocycler, G0ttingen, Germany）. Direct sequencing of the amplified PCR products was performed by cycle sequencing using fluorescent dye terminators in an automatic sequencer （Applied Biosystems, Darmstadt, Germany）. RESULTS： Total of 13 WD patients （mean age 26.4 years; range 17-40; male/female 3/10） presented with hepatic disorders and 16 their first degree relatives （including 12 siblings） were studied. Some of WD patients, in addition to hepatic symptoms, have had extrahepatic disorders （hemolytic anemia 3; Fanconi syndrome 1; neurophsychiatric and behavioural disorder 2）. Liver biopsy specimens were available in all of 13 WD patients （8 had cirrhosis; 1-chronic hepatitis; 3-acute liver failure, 1-1iver steatosis）. Twelve of 13 （92.3%） WD patients had the c.3207C〉A （p.HI069Q） mutation, 6 of them in both chromosomes, 6 were presented as compound heterozygotes with additional c.3472-82delGGTTTAACCAT, c.3402delC, c.3121C〉T （p.RI041W） or unknown mutations. For one patient with liver cirrhosis and psychiatric disorder （Leipzig score 6）, no mutations were found. Out of 16 first degree WD relatives, 11 （68.7%） were heterozygous for the c.3207C〉A （p.H1069Q） mutation. Two patients with fulminant WD died from acute liver failure and ii are in full remission under peniciilamine or zinc acetate treatment. Three women with WD successfully delivered healthy babies. CONCLUSION： The c.3207C〉A （p.HI069Q） missense mutation is the most characteristic mutation for Lithuanian patients with WD. Even 92.3% of WD patients with hepatic presentation of the disease are homozygous or compound heterozygotes for the p.H1069Q mutation.

Clinical characteristics and work-up of small to intermediate-sized pulmonary nodules in a Chinese dedicated cancer hospital

Objectives:To evaluate the characteristics and work-up of small to intermediate-sized pulmonary nodules in a Chinese dedicated cancer hospital.Methods:Patients with pulmonary nodules 4–25 mm in diameter detected via computed tomography(CT)in 2013 were consecutively included.The analysis was restricted to patients with a histological nodule diagnosis or a 2-year follow-up period without nodule growth confirming benign disease.Patient information was collected from hospital records.Results:Among the 314 nodules examined in 299 patients,212(67.5%)nodules in 206(68.9%)patients were malignant.Compared to benign nodules,malignant nodules were larger(18.0 mm vs.12.5 mm,P<0.001),more often partly solid(16.0%vs.4.7%,P<0.001)and more often spiculated(72.2%vs.41.2%,P<0.001),with higher density in contrast-enhanced CT(67.0 HU vs.57.5 HU,P=0.015).Final diagnosis was based on surgery in 232 out of 314(73.9%)nodules,166 of which were identified as malignant[30(18.1%)stage III or IV]and 66 as benign.In 36 nodules(11.5%),diagnosis was confirmed by biopsy and the remainder verified based on stability of nodule size at follow-up imaging(n=46,14.6%).Among 65 nodules subjected to gene(EGFR)mutation analyses,28(43.1%)cases(EGFR19 n=13;EGFR21 n=15)were identified as EGFR mutant and 37(56.9%)as EGFR wild-type.Prior to surgery,the majority of patients[n=194(83.6%)]received a contrast-enhanced CT scan for staging of both malignant[n=140(84.3%)]and benign[n=54(81.8%)]nodules.Usage of positron emission tomography(PET)-CT was relatively uncommon[n=38(16.4%)].Conclusions:CT-derived nodule assessment assists in diagnosis of small to intermediate-sized malignant pulmonary nodules.Currently,contrast-enhanced CT is commonly used as the sole diagnostic confirmation technique for pre-surgical staging,often resulting in surgery for late-stage disease and unnecessary surgery in cases of benign nodules.

Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

Clinical features and radiological manifestations of COVID-19 disease

Coronavirus disease 2019(COVID-19)was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province(China).Coronavirus is a family of single-stranded RNA viruses.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is transmitted from person to person.Although asymptomatic individuals can transmit the virus,symptomatic patients are more contagious.The incubation period ranges from 3-7 d and symptoms are mainly respiratory,including pneumonia or pulmonary embolism in severe cases.Elevated serum levels of interleukins(IL)-2,IL-6,IL-7 indicate the presence of cytokine release syndrome,which is associated with disease severity.The disease has three main phases:Viral infection,pulmonary involvement,and hyperinflammation.To date,no treatment has proved to be safe or effective.Chest X-ray and computed tomography(CT)are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia,follow-up,and detection of complications.The main radiological findings are ground-glass opacification and areas of consolidation.The long-term clinical course is unknown,although some patients may develop pulmonary fibrosis.Positron emission tomography-computed tomography(PETCT)is useful to assess pulmonary involvement,to define the affected areas,and to assess treatment response.The pathophysiology and clinical course of COVID-19 infection remain poorly understood.However,patterns detected on CT and PETCT may help to diagnose and guide treatment.In this mini review,we analyze the clinical manifestations and radiological findings of COVID-19 infection.

Clinical Analysis of Primary Tracheobronchial Tumors in Children and Evaluation of the Predicting Models for Mucoepidermoid Carcinoma

Objective:To determine the clinical characteristics and prognosis of primary tracheobronchial tumors(PTTs)in children,and to explore the most common tumor identification methods.Methods:The medical records of children with PTTs who were hospitalized at the Children's Hospital of Chongqing Medical University from January 1995 to January 2020 were reviewed retrospectively.The clinical features,imaging,treatments,and outcomes of these patients were statistically analyzed.Machine learning techniques such as Gaussian na?ve Bayes,support vector machine(SVM)and decision tree models were used to identify mucoepidermoid carcinoma(ME).Results:A total of 16 children were hospitalized with PTTs during the study period.This included 5(31.3%)children with ME,3(18.8%)children with inflammatory myofibroblastic tumors(IMT),2 children(12.5%)with sarcomas,2(12.5%)children with papillomatosis and 1 child(6.3%)each with carcinoid carcinoma,adenoid cystic carcinoma(ACC),hemangioma,and schwannoma,respectively.ME was the most common tumor type and amongst the 3 ME recognition methods,the SVM model showed the best performance.The main clinical symptoms of PPTs were cough(81.3%),breathlessness(50%),wheezing(43.8%),progressive dyspnea(37.5%),hemoptysis(37.5%),and fever(25%).Of the 16 patients,7 were treated with surgery,8 underwent bronchoscopic tumor resection,and 1 child died.Of the 11 other children,3 experienced recurrence,and the last 8 remained disease-free.No deaths were observed during the follow-up period.Conclusion:PTT are very rare in children and the highest percentage of cases is due to ME.The SVM model was highly accurate in identifying ME.Chest CT and bronchoscopy can effectively diagnose PTTs.Surgery and bronchoscopic intervention can both achieve good clinical results and the prognosis of the 11 children that were followed up was good.

Early efficacy of individual regimens containing bedaquiline in patients with drug resistant tuberculosis

Objective:To evaluate early efficacy of sputum conversion within 6 months of individual regimens containing bedaquiline in patients with drug resistant tuberculosis.Methods:We conducted a retrospective study among patients with drug resistant tuberculosis who were receiving individual regimens containing bedaquiline.The primary outcome was sputum conversion of both smear and culture within 6 months of treatment.We used medical records of drug resistant tuberculosis patients from January 2020 to December 2021.The study was conducted at Dr.Soetomo Hospital,Indonesia from August to October 2022.Results:In this study,44 eligible drug resistant tuberculosis patients were initiated on regimens containing bedaquiline.There were 52.3%males and the median age was 45.5 years.The rates of previous treatment(70.5%)and lung cavity(36.4%)were high.The most common companion drugs included clofazimine,cycloserine,levofloxacin,and linezolid.Sputum smear and culture conversion was seen in 79.4%and 82.1%at the 2nd month,respectively.More than 97%patients had smear and culture conversion at the end of 6 months.Conclusions:Among drug resistant tuberculosis patients,individual regimens containing bedaquiline were associated with high rates of smear and culture conversion at the end of 6 months.Early efficacy of regimens containing bedaquiline can be used to predict cure rate at the end of treatment.

Predictive value of serum cystatin C for risk of mortality in severe and critically ill patients with COVID-19

BACKGROUND The outbreak of coronavirus disease 2019(COVID-19)has rapidly evolved into a global pandemic.COVID-19 is clinically categorized into mild,moderate,severe,and critical illness.Acute kidney injury is an independent risk factor for poor prognosis in patients with.Serum cystatin C(s Cys C)is considered a more sensitive biomarker for early renal insufficiency than conventional indicators of renal function.Early detection of risk factors that affect the prognosis of severe and critically ill patients while using active and effective treatment measures is very important and can effectively reduce the potential mortality rate.AIM To determine the predictive value of s Cys C for the prognosis of patients with COVID-19.METHODS The clinical data of 101 severe and critically ill patients with COVID-19 at a designated hospital in Wuhan,Hubei Province,China were analyzed retrospectively.According to the clinical outcome,the patients were divided into a discharge group(64 cases)and a death group(37 cases).The general information,underlying diseases,and laboratory examination indexes of the two groups were compared.Multivariate Cox regression was used to explore the relationship between s Cys C and prognosis.The receiver operating characteristic(ROC)curve was used to demonstrate the sensitivity and specificity of s Cys C and its optimal cut-off value for predicting death.RESULTS There were significant differences in age,s Cys C,creatinine,C-reactive protein,serum albumin,creatine kinase-MB,alkaline phosphatase,lactate dehydrogenase,neutrophil count,and lymphocyte count between the two groups(P<0.001).Multivariate logistic regression analysis showed that s Cys C was an independent risk factor for death in patients with COVID-19(Odds ratio=1.812,95%confidence interval[CI]:1.300-2.527,P<0.001).The area under the ROC curve was 0.755(95%CI:1.300-2.527),the cut-off value was 0.80,the specificity was 0.562,and the sensitivity was 0.865.CONCLUSION s Cys C is an independent risk factor for death in patients with COVID-19.Patients with a s Cys C level of 0.80 mg/L or greater are at a high risk of death.