Predictive value of comorbid conditions for COVID-19 mortality

In this paper, we aim at understanding the broad spectrum of factors influencing the survival of infected patients and the correlations between these factors to create a predictive probabilistic score for surviving the COVID-19 disease. Initially, 510 hospital admissions were counted in the study, out of which 310 patients did not survive. A prediction model was developed based on this data by using a Bayesian approach. Following the data collection process for the development study, the second cohort of patients totaling 541 was built to validate the risk matrix previously created. The final model has an area under the curve of 0.773 and predicts the mortality risk of SARS-CoV-2 infection based on nine disease groups while considering the gender and age of the patient as distinct risk groups. To ease medical workers’ assessment of patients, we created a visual risk matrix based on a probabilistic model, ranging from a score of 1 (very low mortality risk) to 5 (very high mortality risk). Each score comprises a correlation between existing comorbid conditions, the number of comorbid conditions, gender, and age group category. This clinical model can be generalized in a hospital context and can be used to identify patients at high risk for whom immediate intervention might be required

The Impact of Prenatal Vitamin D on Enamel Defects and Tooth Erosion: A Systematic Review

This systematic review aims to synthesize the available evidence investigating the role of Vitamin D in enamel defects and tooth erosion in children, as well as to critically evaluate the quality of these studies, and provide an evidence-based summary of the potential implications of prenatal Vitamin D deficiency in dental health

A Systematic Review of Telemedicine-Driven Pulmonary Rehabilitation After the Acute Phase of COVID-19

This systematic review aimed to evaluate the effectiveness of telemedicine-driven PR in patients recovering from the acute phase of COVID-19, assessing variations in telerehabilitation practices, and identifying the degree of change in mental health, physical health, quality of life, and lung function

Influence of Antiphospholipid Antibody-Associated Thrombophilia on the Risk of Preterm Birth: A Systematic Review

The primary hypothesis of this study is that aPL-associated thrombophilia significantly increases the risk of preterm birth. We hypothesize that this risk may be modulated by several factors, such as the specific type of aPL present, the patient's history of thrombotic events, and co-existing autoimmune disorders. Additionally, it was assumed that the effect of aPL-associated thrombophilia on preterm birth may be mediated by complications such as preeclampsia and intrauterine growth restriction. By addressing these re-search questions, this systematic review aims to improve our understanding of APS's impact on preterm birth, providing valuable insights for clinicians and researchers alike. Therefore, we have conducted a systematic review focusing on the influence of aPL-associated thrombophilia on the risk of preterm birth, aiming to quantify the risk of preterm birth associated with aPL-associated thrombophilia. Secondly, we plan to elucidate the effect of various clinical and demographic factors on this risk. Lastly, we hope to identify gaps in the current knowledge base, thus providing direction for future research

Predictors for COVID-19 Complete Remission with HRCT Pattern Evolution: A Monocentric, Prospective Study

There are growing concerns that some COVID-19 survivors may acquire fibrosis and other irreversible lung abnormalities. The purpose of this prospective study was to assess the rate and predictors of complete resolution of COVID-19 pneumonia by pursuing a hypothetical relation between time and imaging pattern evolution using HRCT findings. A monocentric prospective cohort study with a consecutive-case enrolment design was implemented during a five-month period, having a total of 683 post-COVID patients eligible for inclusion and 635 evaluations with complete follow-up for chest HRCT. The target for post-COVID evaluations consisted of performing HRCT 90 days after a confirmed SARS-CoV-2 infection. The studied patients had an average age of 54 years, ranging between 18 and 85 years old, and an average duration from the first symptoms until HRCT was performed of 74 days. At the post-COVID follow-up, 25.8% had a complete imagistic remission. The most common appearance with HRCT was “ground glass” in 86.6% in patients with persistent COVID-19, followed by reticulations, present in 78.8%, and respectively pleural thickening in 41.2% of cases. The mean total HRCT scores were statistically significantly higher in patients older than 65 years (10.6 ± 6.0) compared to the 40–65 group (6.1 ± 6.1) and the 18–40 age group (2.7 ± 4.8) (p < 0.001). Chest HRCT is a “time window” in documenting temporal persistent radiologic features of lung injury 90 days after SARS-CoV-2 infection, determining the pathologic basis of so-called “long COVID”. The complete remission was associated with a significantly higher average follow-up period and a significantly lower average patient age. Persistent HRCT features of ground glass, reticulation, and pleural thickening are associated with a higher total CT score and older age

Exploring Pregnancy Outcomes Associated with SARS-CoV-2 Infection

Background and Objectives: The ongoing pandemic proved to be a tremendous challenge to all economic layers, healthcare, and people safety. As more than one year elapsed since the beginning of the COVID-19 pandemic, a multitude of medical studies involving the SARS-CoV-2 virus helped researchers and medical practitioners in understanding the effects it has on all sorts of patients until effective vaccines were finally developed and distributed for mass vaccination. Still, the SARS-CoV-2 and its new variants remain a potential threat towards all categories of patients, including a more delicate group represented by pregnant women. Thus, the current study aims to investigate the potential effects on obstetrical outcomes after a positive SARS-CoV-2 infection. Materials and Methods: This single-center prospective cohort study investigated the pregnancy outcomes in a total of 1039 eligible pregnant women between 30 August 2020 and 30 January 2021. Multiple patient characteristics and obstetrical outcomes were tested and analyzed in a multivariate regression model to establish potential risks determined by a COVID-19-positive pregnancy towards the mother and the newborn. Results: In the study sample, there were 938 pregnancies included without COVID-19 and 101 pregnant women identified with a positive COVID-19 infection. COVID-19 was significantly associated with a 2-fold increase in the risk of premature rupture of membranes and 1.5 times higher risk of preterm birth with emergency c-sections and lower APGAR scores. Also, significantly more newborns were given birth prematurely, with lower APGAR scores after the mothers were infected with SARS-CoV-2. Conclusions: A third-trimester infection with SARS-CoV-2 is a significant risk factor for preterm birth via an emergency cesarean section, a premature rupture of membranes, and a lower APGAR score in newborns, as compared with pregnancies where COVID-19 was not identified

Novel Expression of Thymine Dimers in Renal Cell Carcinoma, Demonstrated through Immunohistochemistry

Despite significant developments in renal cell carcinoma (RCC) detection and molecular pathology, mortality has been steadily rising. Advanced RCC remains an incurable disease. Better clinical management tools, i.e., RCC biomarkers, have yet to emerge. Thymine-dimers (TDs) were traditionally considered photo-dependent pre-mutagenic lesions, occurring exclusively during ultra-violet light exposure. Non-oxidative, direct, and preferential byproducts of DNA photochemical reactions, TDs, have recently shown evidence regarding UVR-independent formation. In this study, we investigate, for the first time, TD expression within RCC tumor tissue and tumor-adjacent healthy renal parenchyma using a TD-targeted IHC monoclonal antibody, clone KTM53. Remarkably, out of the 54 RCCs evaluated, 77.8% showed nuclear TD-expression in RCC tumor tissue and 37% in the tumor-adjacent healthy renal parenchyma. A comprehensive report regarding quantitative/qualitative TD-targeted immunostaining was elaborated. Two main distribution models for TD expression within RCC tumor tissue were identified. Statistical analysis showed significant yet moderate correlations regarding TD-positivity in RCC tissue/tumor-adjacent healthy renal parenchyma and TNM stage at diagnosis/lymphatic dissemination, respectively, indicating possible prognostic relevance. We review possible explanations for UVR-independent TD formation and molecular implications regarding RCC carcinogenesis. Further rigorous molecular analysis is required in order to fully comprehend/validate the biological significance of this newly documented TD expression in RCC

Characterization and Outcomes of SARS-CoV-2 Infection in Overweight and Obese Patients: A Dynamic Comparison of COVID-19 Pandemic Waves

There are few data on the dynamics of SARS-CoV-2 viral manifestations in obese and overweight persons during each of the five waves that occurred in Romania during the last two years. As such, the purpose of this research was to characterize the variance in case severity, symptomatology, ICU hospitalizations, and mortality among overweight and obese individuals infected with the SARS-CoV-2 virus. We included 250 overweight and obese patients admitted to hospital with COVID-19, where 50 patients were selected from each of the five pandemic waves that existed in Romania until March 2022. A total of 113 patients with normal body mass index were included in the study. They were matched with overweight and obese patients by age, gender, and cardiovascular comorbidities to avoid the effect of confounding factors. Between the five waves of the COVID-19 pandemic in Romania, the present investigation found substantial changes in overweight and obese patient features. Obesity increases the risk of hospitalization, severe complications, and mortality from COVID-19. However, this unique demographic is disproportionately affected by obesity-related comorbidities, which contribute to these adverse outcomes. We advocate for the development of new guiding principles for the formulation of healthcare strategies aimed at high-prevalence special populations such as overweight and obese individuals, while also promoting pandemic containment and avoiding the recurrence of pandemic waves with the same guidelines that proved detrimental in terms of economic and human life loss

Liver Impairment and Hematological Changes in Patients with Chronic Hepatitis C and COVID-19: A Retrospective Study after One Year of Pandemic

Background and Objectives: The COVID-19 pandemic is an ongoing public health emergency. Patients with chronic diseases are at greater risk for complications and poor outcomes. The objective of this study was to investigate the liver function abnormalities and clinical outcomes in patients with COVID-19 and chronic hepatitis C. Materials and Methods: This retrospective, single-center study was conducted on a cohort of 126 patients with a history of hepatitis C, confirmed with COVID-19 between 01 April 2020 and 30 December 2020. Several clinical outcomes were compared between patients with active and non-active HCV infection, and the risks of liver impairment and all-cause mortality in active HCV patients were analyzed using a multivariate logistic regression model. Results: Among 1057 patients under follow-up for chronic HCV infection, 126 (11.9%) were confirmed with COVID-19; of these, 95 (75.4%) were under treatment or achieved SVR, while in the other 31 (24.6%), we found active HCV replication. There was a significantly higher proportion of severe COVID-19 cases in the active HCV group as compared to the non-active HCV group (32.2 vs. 7.3%, p < 0.001). Multivariate analysis showed that age, sex, alanine aminotransferase, C-reactive protein, procalcitonin, and HCV viral load were significant independent risk factors for liver impairment and all-cause mortality. The length of stay in hospital and intensive care unit for COVID-19 was significantly higher in patients with active HCV infection (p-value < 0.001), and a higher proportion of these patients required mechanical ventilation. Conclusions: Active HCV infection is an independent risk factor for all-cause mortality in COVID-19 patients

Comparative Analysis of Antibiotic Resistance in Acute Cholangitis Patients with Stent Placement and Sphincterotomy Interventions

In response to rising concerns over multidrug resistance patterns in acute cholangitis patients, this retrospective study was conducted at the Emergency County Hospital Timisoara, Romania, encompassing patients treated between August 2020 and August 2023. The study aimed to investigate the influence of prior interventions, specifically sphincterotomy (with or without stent placement), on the current clinical and microbiological profiles of acute cholangitis patients. By differentiating between patients with a history of sphincterotomy and the endoscopic retrograde cholangiopancreatography (ERCP)-naïve, we assessed the resistance of bacterial strains to antibiotics by the Tokyo Guidelines 2018, using bile cultures from 488 patients. The study identified various multidrug-resistant organisms, with a total multidrug resistance incidence of 19.9%. Significant variations were observed in the distribution of specific microorganisms and resistance patterns across different intervention groups. Patients with previous interventions, particularly those with both sphincterotomy and stent, exhibited elevated white blood cells (WBC) and C-reactive protein (CRP) levels in comparison to their ERCP-naïve counterparts. This group also presented a striking prevalence of two bacteria in their bile cultures at 50.0%, compared to 16.1% in ERCP-naïve individuals. Regarding multidrug resistance, the prior sphincterotomy with stent placement had a prevalence of 50.0%. The presence of ESBL bacteria was also significantly higher in the same group at 28.7%, contrasting with the 8.9% in ERCP-naïve patients. Additionally, the same group had a higher burden of Klebsiella spp. infections, at 37.2%, and Enterococcus spp. at 43.6%. On the antibiotic resistance front, disparities persisted. Piperacillin/Tazobactam resistance was notably more rampant in patients with a previous sphincterotomy and stent, registering at 25.5% against 11.1% in the ERCP-naïve group. This study underscores a substantial discrepancy in multidrug resistance patterns and antibiotic resistance among acute cholangitis patients with previous manipulation of the bile ducts, without expressing significant differences by the type of stent used