Characteristics of Obstructive Sleep Apnea Patients With Hypertension and Factors Associated With Autotitration Acceptance

In order to explore the characteristics and treatment status of obstructive sleep apnea (OSA) patients with hypertension, a retrospective study was conducted on 306 patients admitted from October 2018 to December 2019. According to the apnea hypopnea index (AHI), OSA patients with hypertension were divided into three groups. 69 cases were mild OSA (5 ≤ AHI < 15), 86 cases were moderate (15 ≤ AHI < 30), and 151 cases were severe (AHI ≥ 30). Compared with patients in the mild and moderate groups, the severe group had more male patients, with higher body mass index (BMI) and non-rapid eye movement stage 1 accounted for total sleep time (N1%), and lower non-rapid eye movement stage 2 accounted for total sleep time (N2%), average and minimum blood oxygen. Among all the patients, those who underwent the titration test accounted for 20.6% (63/306). Multivariate analysis showed that sleep efficiency (p < 0.001) and AHI (p < 0.001) were independent factors for patients to accept titration test. OSA patients with hypertension had a low acceptance of titration therapy. These people with higher sleep efficiency and AHI were more likely to receive autotitration.

Risk factors and prediction model of severe pertussis in infants < 12 months of age in Tianjin, China

Background To identify risk factors associated with the prognosis of pertussis in infants (< 12 months). Methods A retrospective study on infants hospitalized with pertussis January 2017 to June 2019. The infants were divided into two groups according to the severity of disease: severe pertussis and non-severe pertussis groups. We collected all case data from medical records including socio-demographics, clinical manifestations, and auxiliary examinations. Univariate analysis and Logistic regression were used. Results Finally, a total of 84 infants with severe pertussis and 586 infants with non-severe pertussis were admitted. The data of 75% of the cases (severe pertussis group, n = 63; non-severe pertussis group, n = 189) were randomly selected for univariate and multivariate logistic regression analysis. The results showed rural area [P = 0.002, OR = 6.831, 95% CI (2.013–23.175)], hospital stay (days) [P = 0.002, OR = 1.304, 95% CI (1.107–1.536)], fever [P = 0.040, OR = 2.965, 95% CI (1.050–8.375)], cyanosis [P = 0.008, OR = 3.799, 95% CI (1.419–10.174)], pulmonary rales [P = 0.021, OR = 4.022, 95% CI (1.228–13.168)], breathing heavily [P = 0.001, OR = 58.811, 95% CI (5.503–628.507)] and abnormal liver function [P < 0.001, OR = 9.164, 95% CI (2.840–29.565)] were independent risk factors, and higher birth weight [P = 0.006, OR = 0.380, 95% CI (0.191–0.755)] was protective factor for severe pertussis in infants. The sensitivity and specificity of logistic regression model for remaining 25% data of severe group and common group were 76.2% and 81.0%, respectively, and the consistency rate was 79.8%. Conclusions The findings indicated risk factor prediction models may be useful for the early identification of severe pertussis in infants.

Study of dynamic changes in the parameters of liver function tests in COVID-19 patients: A hospital-based study in Eastern Nepal

Background: COVID-19 has become a focus of healthcare practitioners worldwide after it was declared as a global pandemic. Although SARS-CoV-2 is primarily affecting the respiratory system, numerous studies have documented its impact on other organ systems, including the liver. This study aims to assess liver function in COVID-19 patients in light of SARS-CoV-2's extremely infectious and pathogenic character. Material and methods: It was a hospital-based retrospective study conducted between January 1, 2021, and July 31, 2021, using data from the Department of Biochemistry at Birat Medical College Teaching Hospital in Nepal. Age, gender, total protein, albumin, AST, ALT, and the AST/ALT ratio were all measured. Results: The median age of COVID-19 patients was 36 years (CI, 25–51), 60 patients (60.0%) were male, 31 patients (31.0%) were obese, and 20 patients (20%) had comorbidities, such as hypertension (14%) and diabetes mellitus (6.0 %). Compared to the non-critical group, the mean values of ALT, AST, ALP, GT, LDH, TBIL, and DBIL were significantly higher in the severe group. On the other hand, total protein and albumin were significantly lower in the severe group than the non-severe group. Conclusion: In COVID-19, aberrant liver function, primarily AST increase, appears to be common. Therefore, direct viral hepatotoxicity during a systemic viral infection must be considered, as well as the possibility of sepsis or worsening of existing liver disease.

Morbidity, mortality and clinico-laboratory profile of COVID-19 related illness in children: a retrospective observational study from a tertiary care centre in India

Background: As India is poised for a third wave of SARS Co-V2 infection with a large unvaccinated pediatric population, it becomes imperative and pertinent for a study to find out its demographic, clinico-laboratory profile, and outcome in children with COVID-19 disease and its related illness.Methods: This is a retrospective observational study undertaken for Children and Adolescent admitted in the department of pediatrics of a teaching and tertiary care referral hospital, Delhi.Results: The median age of admitted children with COVID-19 disease was 11 years with an interquartile range 3 to 16 years. The median duration of hospital stay was 10 days (mean: 18±14 days). Mortality was 9/62 (14%). Recovery in non-severe (asymptomatic, mild, moderate) was 41/41 (100%), and in severe and critical illness including MISC was 42.8% (9/21). Mortality in severe and critical patients managed in SARI and COVID ward was 44% (8/18). Death among MISC patient in PICU was 33% (1/3). Difference in CRP rise was significant in severe and non-severe group of COVID-19 (p=0.017).Conclusions: Even though the morbidity and mortality associated with COVID-19 infection and related illness seems to be miniscule, the infection causes significant illness in the subgroup of children who requires hospitalization and can be fatal in those with comorbidity.

Correlation between Levels of Serum Lipoprotein-Associated Phospholipase A2 and Soluble Suppression of Tumorigenicity 2 and Condition of Acute Heart Failure Patients and Their Predictive Value for Prognosis

Objective. To explore the correlation between levels of serum lipoprotein-associated phospholipase A2 (LP-PLA2) and soluble suppression of tumorigenicity 2 (sST2) and condition of acute heart failure (AHF) patients and their predictive value for prognosis. Methods. The data of patients who complained of acute dyspnea and were treated in our hospital (January 2018–January 2020) were selected for review analysis, and those diagnosed with AHF by means of chest films, physical examination, cardiogram, and color Doppler ultrasonography (CDS) were selected as the study objects. The patients were split into the mild group (I or II, 55 cases) and the severe group (III or IV, 50 cases) according to the clinical condition grading standard in Guidelines for Diagnosis and Treatment of Acute Heart Failure. In addition, 105 healthy individuals examined in our medical center in the same period were selected as the control group. The serum LP-PLA2 and sST2 levels of all study objects were measured to analyze the correlation between these levels and AHF condition. Readmission due to heart failure and all-cause death were regarded as the endpoint events, and after one year of follow-up visits, the occurrence of the endpoint events in patients of the two groups was recorded, and with the endpoint events as the variable, the patients were divided into the event group and nonevent group to establish a logistic regression analysis model and analyze the merit of serum LP-PLA2 and sST2 in evaluating patient outcome. Results. The patients’ general information such as age and gender between the severe group and the mild group were not statistically different ( P > 0.05 ), and the levels of high-sensitivity c-reactive protein (CRP), hemoglobin, creatinine, and uric acid of the severe group were greatly different from those of the mild group ( P < 0.001 ), the comparison result of serum LP-PLA2 and sST2 levels was severe group > mild group > control group ( P all <0.001), and the serum LP-PLA2 and sST2 levels of the severe group were, respectively, 275.98 ± 50.68 ng/ml and 2,122.65 ± 568.65 ng/ml; among 105 AHF patients, 50 of them had endpoint events (47.6%), including 36 in the severe group (36/50, 72.0%) and 14 in the mild group (14/55, 25.5%), and the event group presented greatly higher serum LP-PLA2 and sST2 levels than in the nonevent group ( P < 0.001 ); according to the logistic regression analysis, serum LP-PLA2 and sST2 had independent predictive value for prognosis of AHF patients, which could be used as the independent predictive factors for 1-year prognosis. Conclusion. Serum LP-PLA2 and sST2 have a good diagnosis value for the condition and prognosis of AHF patients, which shall be promoted and applied in practice.

D-Dimer Analysis in COVID-19 Patients

The COVID-19 incidence is increasing around the world. Some countries are experiencing worsening conditions, evendeaths. One coagulation marker that noticeably increases in COVID-19 patients is D-dimer. This study aimed to analyzeD-dimer levels of COVID-19 patients. Retrospective study using medical records of 84 COVID-19 patients, conducted fromApril to August 2020 at UNHAS Hospital. Patients were grouped based on the severity of the disease as non-severe andsevere. D-dimer levels were measured using the Alere Triage® D-dimer with the fluorescent immunoassay method. Thestatistical test used was Mann-Whitney, D-dimer prognostic levels were calculated with ROC analysis to get the cut-off.Significant if the p < of 0.05. The sample consisted of 74 non-severe and ten severe COVID-19 patients, mostly in the 30-39age group. D-dimer levels in non-severe (0.31±0.38 μg/L) significantly differ from severe group (3.09±2.56 μg/L) (p<0.001).The Receiver Operating Characteristics (ROC) curve showed D-dimer sensitivity and specificity of 90.0% and 89.2%,respectively at the ≥ 0.80 μg/L cut-off, Negative Predictive Value (NPV) of 98.5%, and Positive Predictive Value (PPV) of52.9%. D-dimer levels increased in severe COVID-19 patients due to an increased inflammatory response resulting inexcessive thrombin. The ROC D-dimer curve indicated a cut-off rate of 0.80 μg/L, providing optimal sensitivity andspecificity. D-dimer has a significant difference in non-severe and severe COVID-19 patients and shows good value todetermine the severity of COVID-19 disease with a cut-off value ≥ 0.80 μg /L.

Targeted Metabolomics Analysis of Bile Acids in Patients with Idiosyncratic Drug-Induced Liver Injury

Drug-induced liver injury (DILI) is rare but clinically important due to a high rate of mortality. However, specific biomarkers for diagnosing and predicting the severity and prognosis of DILI are lacking. Here, we used targeted metabolomics to identify and quantify specific types of bile acids that can predict the severity of DILI. A total of 161 DILI patients were enrolled in this prospective cohort study, as well as 31 health controls. A targeted metabolomics method was used to identify 24 types of bile acids. DILI patients were divided into mild, moderate, and severe groups according to disease severity. A multivariate analysis was performed to identify characteristic bile acids. Then the patients were divided into severe and non-severe groups, and logistic regression was used to identify bile acids that could predict DILI severity. Among the enrolled DILI patients, 32 were in the mild group, 90 were in the moderate group, and 39 were in the severe group. Orthogonal partial least squares-discriminant analysis (OPLS-DA) modeling clearly discriminated among the different groups. Among the four groups, glycochenodeoxycholate (GCDCA), taurochenodeoxycholate (TCDCA), deoxycholic acid (DCA), Nor Cholic acid (NorCA), glycocholic acid (GCA), and taurocholic acid (TCA) showed significant differences in concentration between at least two groups. NorCA, GCDCA, and TCDCA were all independent risk factors that differentiated severe DILI patients from the other groups. The area under the receiver operating characteristic curve (AUROC) of GCDCA, TCDCA, and NorCA was 0.856, 0.792, and 0.753, respectively. Together, these three bile acids had an AUROC of 0.895 for predicting severe DILI patients. DILI patients with different disease severities have specific bile acid metabolomics. NorCA, GCDTA, and TCDCA were independent risk factors for differentiating severe DILI patients from less-severe patients and have the potential to predict DILI severity.

The Relationship Between Delirium and Statin Use According To Disease Severity in Patients in the Intensive Care Unit

Background There have been few earlier studies on the efficacy of statins in the prevention of delirium. However, the results were controversial. The aim of this study was to investigate the association between the use of statins and the occurrence of delirium in a large cohort of patients in the intensive care unit (ICU), considering disease severity and statin properties, which were not sufficiently considered in the previous works. Methods We obtained clinical and demographical information from 3604 patients admitted to the ICU of Gangnam Severance Hospital from January 2013 to April 2020. This included information on daily statin use and delirium state, as assessed by the Confusion Assessment Method for ICU. We used inverse probability of treatment weighting and categorized the ICU patients into four groups based on the Acute Physiology and Chronic Health Evaluation II score (group 1: 0-10 - mild; group 2: 11-20 – mild to moderate; group 3: 21-30 – moderate to severe; group 4: > 30 - severe). We analyzed the association between the use of statin and the occurrence of delirium in each group, while taking into account the properties of statins. Results Comparisons between statin and non-statin patient groups revealed that only in group 2, patients who were administered statin showed significantly higher occurrence of delirium (p=0.004, odds ratio [OR]=1.58) compared to the patients who did not receive statin. Regardless of whether statins were lipophilic (p=0.036, OR=1.47) or hydrophilic (p=0.032, OR=1.84), the occurrence of delirium was higher only in patients from group 2. Although both lipophilic and hydrophilic statins in group 2 were associated with delirium, neither showed a greater association than the other. Conclusions The use of statins may be associated with the increases in the risk of delirium occurrence in patients with mild to moderate disease severity, irrespective of statin properties, as revealed by results from a large cohort study.

An Emerging Marker Predicting The Severity of Covid-19: Neutrophil-Lymphocyte Count Ratio

Objective: To assess the efficacy of neutrophil-lymphocyte count ratio in predicting the severity of covid-19 Materials and Methods: The patients with positive results for COVID-19 were shifted to COVID ITC, CMH, Multan. The clinical histories of confirmed patients of COVID-19 during February 2020 to May 2021 were reviewed. The patients were divided into 4 classes, mild, common, severe, and fatal, according to guidelines of COVID-19 i.e., trial version 7. Data was collected regarding age, sex, smoking history, temperature, epidemiological history, clinical symptoms, and laboratory findings of all included patients including NLCR. Results: The mean NLCR of Mild and Severe Group was 2.77±1.23 and 20.31±4.45, respectively, (p=0.000). (Table. II). The area under the curves of NLCR was larger than neut, suggesting the optimal performance of NLCR with cut-off value 5.89. The sensitivity and specificity of NLCR was 85% and 95%, respectively. (Table. III). Conclusion: It can be concluded that an increase in NLCR levels can indicate that the covid-19 disease is moving towards exacerbation. NLCR can be recommended as a novel and highly sensitive and specific indicator for severity prediction in Covid-19 patients. Keywords: Emerging, Marker, Severity, Covid-19, Neutrophils, Lymphocytes, Ratio

Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia

Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD).Methods: Preterm infants (&lt;32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use.Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p &lt; 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency.Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.