Development of a Drum Tower Severity Scoring (DTSS) system for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome

Background and aims There has been no reliable severity system based on the prognosis to guide therapeutic strategies for patients with pyrrolizidine alkaloid (PA)-induced hepatic sinusoidal obstruction syndrome (HSOS). We aimed to create a novel Drum Tower Severity Scoring (DTSS) system for these patients to guide therapy. Methods 172 Patients with PA-HSOS who received supportive care and anticoagulation therapy in Nanjing Drum Tower Hospital from January 2008 to December 2020 were enrolled and analyzed retrospectively. These patients were randomized into a training or validation set in a 3:1 ratio. Next, we established and validated the newly developed DTSS system. Results Analysis identified a predictive formula: logit (P) = 0.004 × aspartate aminotransferase (AST, U/L) + 0.019 × total bilirubin (TB, μmol/L) − 0.571 × fibrinogen (FIB, g/L) − 0.093 × peak portal vein velocity (PVV, cm/s) + 1.122. Next, we quantified the above variables to establish the DTSS system. For the training set, the area under the ROC curve (AUC) (n = 127) was 0.787 [95% confidence interval (CI) 0.706–0.868; p < 0.001]. With a lower cut-off value of 6.5, the sensitivity and negative predictive value for predicting no response to supportive care and anticoagulation therapy were 94.7% and 88.0%, respectively. When applying a high cut-off value of 10.5, the specificity was 92.9% and the positive predictive value was 78.3%. For the validation set, the system performed stable with an AUC of 0.808. Conclusions The DTSS system can predict the outcome of supportive care and anticoagulation in PA-HSOS patients with satisfactory accuracy by evaluating severity, and may have potential significance for guiding therapy.

A Comparative Study of Different Doses of Lignocaine on Prevention of Etomidate Induced Myoclonus during Induction of Anesthesia

Background and Aims Etomidate, an intravenous (IV) induction agent known for its stable myocardial action, can produce myoclonus which can be detrimental for the cardiac patients. Though lignocaine has proven its efficacy in attenuating the etomidate-induced myoclonus, the ideal dose of lignocaine is not known. The aim of our trial was to analyze two different doses of lignocaine on the occurrence and intensity of etomidate induced myoclonus. Materials and Methods A total of 120 patients were randomly assigned into three groups of 40 each. Patients in group A were injected lignocaine 0.5 mg/kg intravenously, group-B patients were injected lignocaine 1 mg/kg intravenously, and group-C patients were injected saline placebo. After 2 minutes, anesthesia was induced with 0.3 mg/kg of etomidate over 30 seconds. The patients were assessed for myoclonus using clinical severity scoring system during first 2 minutes of induction. Our primary outcome was the incidence of myoclonus. The severity of myoclonus and adverse effects were the secondary outcomes. Results No remarkable variation was found regarding demographic profile among three groups. Incidence of myoclonus in groups A and B was 35% and in group C was 98%, the difference being statistically significant. Both doses of lignocaine reduced the severity of myoclonus up to same extent. Conclusion Pretreatment with IV lignocaine 0.5mg/kg and 1 mg/kg IV remarkably decreased the occurrence and severity of myoclonus induced by etomidate up to same extent.

Computed tomography severity scoring of COVID 19 infected young patients: Is the second wave affecting the young lungs more than the first wave in India?

We evaluated the High Resolution Computed Tomography (HRCT) findings in young patients (< 40 years) infected with the COVID 19 virus and tried to find out any difference in the severity of lung involvement between the first and second wave of the pandemic and whether the notion of young population being more severely affected by the second wave holds true.Two-hundred (200) young patients (<40 years) with RT PCR documented COVID infections undergoing HRCT chest at our institute were included. Group A included young patients infected in the first wave (up to 28 February 2021) while Group B included patients beyond this date. Demographic and clinical data was obtained from the medical records department. HRCT scans were retrieved from the archive and were assessed by two radiologists or CT severity scoring. The mean severity scores were calculated and any statistical difference between Group A and B was sought. CT scans of four fully vaccinated patients were also evaluated.The age and gender distribution among the two groups was comparable. A greater number of patients in group B required hospital admission compared to group A (74% VS 53%). In group A, the mean severity score was 10.1±2.1 with 34 patients (34%) in mild category, 46 patients (46%) in moderate group and 20 patients (20%) in the severe group. In group B, the mean CT severity score was 12.6±2.3 with 20 patients (20%) in mild category, 42 patients (42%) in moderate group and 38 patients (38%) in the severe group.Lung involvement in young patients in the second wave is more severe requiring more hospital admissions. Vaccinated population may well have a milder form of the disease.

New correlations between ocular parameters and disease severity in Spanish patients with Gaucher’s disease Type I

Background Gaucher’s disease is associated with a high variety of structural and functional abnormalities in the eye, which do not always affect visual acuity. The purpose of this study was to analyse ocular features in Spanish patients with Gaucher’s disease type I, and to investigate their possible correlation with phenotypic and burden parameters of this entity. Methods This cross-sectional observational study compared parameters belonging to 18 eyes from 9 Spanish patients with Gaucher’s disease Type I with 80 eyes from 40 healthy controls. Complete ophthalmological examination included choroidal and retinal thickness maps with swept source optical coherence tomography. Systemic analysis included genotype, plasmatic biomarkers, [ferritin, chemokine ligand 18 (CCL18) and chitotriosidase (ChT)] and severity scoring systems results [“Gaucher Disease Severity Score Index Type I" (GauSSI-I) and “Gaucher disease severity scoring system” (GD-DS3)]. Results Nine subjects (18 eyes) were cases (female: 55.5%, mean age 45 years; male: 44.5%, mean age 36 years) and 40 subjects (80 eyes) were controls (female: 49%, mean age 50 years; male: 51%, mean age 55 years). There were no statistically significant differences when comparing ocular parameters (visual acuity; axial length, refractive errors, corneal parameters, lens, retinal and choroidal thickness) between case and control subjects (p>0.05). A statistically significant moderate correlation was observed between lower retinal thickness and choroidal quadrants thickness and greater disease severity scores. A lower central retinal thickness also correlates with higher biological plasmatic levels, and has a statistically significant association with the most affected patient with genotype N370S/Del 55pb. Conversely, higher pachymetry involves a more severe plasmatic concentration of biomarkers. Conclusions Our results suggest that pachymetry, and retinal and choroidal thickness, are associated with burden biomarkers and disease severity index scores in Spanish patients with Gaucher’s disease Type I.

Automated quantification of COVID-19 pneumonia severity in chest CT using histogram-based multi-level thresholding segmentation

Background Chest computed tomography (CT) has proven its critical importance in detection, grading, and follow-up of lung affection in COVID-19 pneumonia. There is a close relationship between clinical severity and the extent of lung CT findings in this potentially fatal disease. The extent of lung lesions in CT is an important indicator of risk stratification in COVID-19 pneumonia patients. This study aims to explore automated histogram-based quantification of lung affection in COVID-19 pneumonia in volumetric computed tomography (CT) images in comparison to conventional semi-quantitative severity scoring. This retrospective study enrolled 153 patients with proven COVID-19 pneumonia. Based on the severity of clinical presentation, the patients were divided into three groups: mild, moderate and severe. Based upon the need for oxygenation support, two groups were identified as follows: common group that incorporated mild and moderate severity patients who did not need intubation, and severe illness group that included patients who were intubated. An automated multi-level thresholding histogram-based quantitative analysis technique was used for evaluation of lung affection in CT scans together with the conventional semi-quantitative severity scoring performed by two expert radiologists. The quantitative assessment included volumes, percentages and densities of ground-glass opacities (GGOs) and consolidation in both lungs. The results of the two evaluation methods were compared, and the quantification metrics were correlated. Results The Spearman’s correlation coefficient between the semi-quantitative severity scoring and automated quantification methods was 0.934 (p < 0.0001). Conclusions The automated histogram-based quantification of COVID-19 pneumonia shows good correlation with conventional severity scoring. The quantitative imaging metrics show high correlation with the clinical severity of the disease.

MANEJO DE DERMATITIS ATÓPICA CRÓNICA CON MEDICINA BIORREGULADORA

La dermatitis atópica se reconoce cada vez más como una enfermedad multifactorial y heterogénea con diferentesfenotipos moleculares o celulares que caracterizan a diferentes poblaciones.Los estudios continúan aclarando las interacciones clave entre los genes de susceptibilidad, los factores ambientales, elmicrobioma, la integridad de la barrera deteriorada y la desregulación inmunológica.La identificación de subconjuntos inmunes, incluidos Th17, Th22 y Th9, ha cambiado los paradigmas de la enfermedad.de Th1 / Th2 bifásico conducido a una enfermedad compleja de múltiples ejes.En la clínica se puede evaluar con escalas que miden las áreas corporales comprometidas en gravedad y síntomas delpaciente, dos de ellas son:• SCORAD (Severity scoring atopic dermatitis)• EASI (Eczema Area and SeverityIndex).Los protocolos de manejo incluyen intervención farmacológica y no farmacológica en los que contiene los emolientes conurea y la fototerapia; dentro de los manejos farmacológicos encontramos los corticoides tópicos como pilar fundamental,seguido por inhibidores tópicos de la calcineurina. Se pueden encontrar intervenciones sistémicas con corticoidessistémicos, metrotexato, micofelonato, aziatropina, inhibidores selectivos de la interleucina 4 y 13. Y en casos agudos eluso de antihistamínicos y si se documenta sobreinfección manejo antibiótico con cefalosporina de 1ra línea.