Metabolic syndrome (MetS) is characterized by increased pro-oxidative stress and a chronic inflammation state and their consequent alterations. Several studies have highlighted the protective effect of carotenoids and polyphenols in MetS patients. This study aimed to evaluate the plasma level of selected carotenoids and polyphenols and to determine their relationship with MetS severity, MetS components, and inflammatory markers in Polish adults with metabolic disorders. It was designed as a cross-sectional study. The final study group comprised 275 adults, including 158 women and 117 men. Data were collected on the frequency of consumption of selected food groups. Anthropometric measurements and blood samples were taken to determine the concentration of carotenoids, polyphenols, and indicators (parameters) of metabolic disorders. Plasma concentrations of selected carotenoids and polyphenols were low in adults with MetS. The highest concentrations of carotenoids and polyphenols in the blood were observed for lutein and phenolic acids . Nevertheless, a correlation was found between the individual bioactive compounds and MetS components. In terms of the lipid profile, our study showed that the plasma of the selected carotenoids and polyphenols positively correlated with HDL cholesterol , LDL cholesterol (chlorogenic acid), triglycerides (lycopene), and the total cholesterol (kaempferol). We found that the level of CRP as a marker of inflammation negatively correlated with the concentration of zeaxanthin. In our study group, no relationship was found between the dietary antioxidant intensity and the variables studied, which may be attributed to the low frequency of consumption of the sources of bioactive compounds, such as carotenoids and polyphenols, but also to the metabolic disorders. Further research is needed to determine whether these associations are causally related to the metabolic syndrome or are a result of the pathologies of the syndrome or improper diet with a low intake of vegetables and fruit.  Potentially beneficial anti-inflammatory and antioxidant effects are exhibited by naturally occurring plant-derived bioactive components such as carotenoids and polyphenols ,2,3. CarPolyphenols have also been shown to have antioxidant, anti-inflammatory, and antithrombotic properties. They can improve vascular endothelial functions, insulin secretion, and can lower blood pressure, which is highly beneficial in treating cardiometabolic disorders ,9,10. PoObesity, such as dyslipidemia and hyperinsulinemia, is associated with oxidative stress ,3,12, chThe currently observed increase in the MetS trend is consistently associated with an increased risk of type 2 diabetes (T2D), cardiovascular diseases (CVD), and non-alcoholic fatty liver disease (NAFLD). Thus, MetS is a major global public health problem, increasing mortality, disabilities, and healthcare costs ,21,22. TDue to the limited evidence on plasma carotenoids’ and polyphenols’ concentration in Polish adults with MetS and the fact that MetS is widespread in our country, this study was undertaken. This study aimed (1) to evaluate the plasma level of selected carotenoids and polyphenols and (2) to determine their relationship with MetS severity, MetS components and inflammatory markers in Polish adults with metabolic disorders.This study was conducted according to the guidelines outlined in the Declaration of Helsinki and the Ethics Committee of the Faculty of Human Nutrition and Consumer Science at the Warsaw University of Life Sciences, Poland, on 11 April 2017 (Resolution No. 04p/2017). Before enrolling, all participants provided written informed consent to participate in the study. Additionally, before commencing the interview and measurements, the participants were duly informed about the study’s objectives and potential risks.This study was designed as a cross-sectional study with convenience sampling. As part of the research project, this study encompassed a thorough evaluation of the following: (1) dietary intake, (2) an analysis of anthropometric measurements and body composition, (3) an assessment of metabolic syndrome indicators and inflammation, and (4) a measurement of the plasma levels of carotenoids and polyphenols in individuals with metabolic disorders. Simply put, the individuals involved in this study were selected from patients who received treatment at the Metabolic Diseases Outpatient Clinic in Warsaw, following their initial assessment by a general practitioner. The inclusion criteria were the following: Caucasian and with an age of over 18 years old; a diagnosis of metabolic diseases including obesity, diabetes, hypertension, or/and dyslipidemia (diagnosis of metabolic syndrome); and a signed informed consent from the participants. The exclusion criteria were the following: pregnant or breastfeeding (for women); people with acute chronic diseases  and with large fluctuations in body weight in the last 6 months; and people taking medications that may have affected the results of this study and taking supplements with carotenoids and/or polyphenols. Detailed information on the sample recruitment and the methodology and procedures applied was published previously .Questionnaires were used and filled out by a well-trained researcher to limit ambiguity. The questionnaires included questions about age, sex, education, employment and socioeconomic status, medical history (self-reported illness history and current medications), lifestyle factors , and a family history of chronic diseases.A Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN) ,27 was uA well-trained researcher collected anthropometric data from the participants using standardized techniques and calibrated equipment. Body weight (BW), height (H), waist (WC), and hip (HC) circumferences were measured. Body composition, including fat mass (FM) and fat-free mass (FFM), was assessed by a bioelectrical impedance technique using a multi-frequency (MF) eight-point Tanita Analyzer . Measurements were taken under strictly standardized conditions, twice in light clothing and without shoes, and the averages were calculated. Systolic and diastolic blood pressures  were measured in a sitting position after resting at least 10 min using a standardized sphygmomanometer following the best practice/was consistent with the National Institute for Health and Care Excellence (NICE) . Two conThe day before sampling, participants were asked to fast for at least 12 h and not drink fruit juices. Blood samples were collected in the morning, between 7 a.m. and 9 a.m., by standard venipuncture procedures. The collected blood was centrifuged for 10 min at 5000 rpm at 4 °C and stored frozen (−80 °C) for further analysis.All analyses were performed in a certified laboratory using standard methods. Total cholesterol (CHOL) concentration was determined using the enzyme method with esterase and cholesterol oxidase. High-density lipoprotein (HDL-C) and triglyceride (TG) were determined through the colorimetric non-precipitation method. The LDL cholesterol blood level (LDL-C) was calculated using the Friedewald formula . The fasAccording to the definition by The Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA), based on CRP concentrations, people were classified into 3 groups depending on the degree of risk of cardiovascular diseases and coronary incidents: <1.0 mg/L—low risk; 1.0 to 3.0 mg/L—moderate risk; >3.0 mg/L—high risk .The concentration of carotenoids was determined using a high-performance liquid chromatography (HPLC) method adapted from Wu et al. . Before The concentration of the polyphenols was analyzed by the high-performance liquid chromatography (HPLC) method adapted from Radtke . The con2, thus assuming central obesity). Categorization was also based on two of the following factors: fasting plasma glucose (Glu) ≥ 100 mg/dL; elevated triglycerides (≥150 mg/dL) or being treated for it; low HDL-C  or being treated for it; and elevated BP (systolic SBP ≥ 130 or diastolic DBP ≥ 85 mmHg) or treatment for hypertension.The International Diabetes Federation (IDF) criteria  were useBased on the individual values of MetS components and equations proposed by DeBoer and Gurka , we calcNon-Hispanic White Males = −5.4473 + 0.0125 × waist circumference (cm) − 0.0251 × HDL (mg/dL) + 0.0047 × SBP (mmHg) + 0.8244 × ln(Tri) + 0.0106 × Glu (mg/dL);Non-Hispanic White Females = −7.2536 + 0.0254 × waist circumference (cm) − 0.0120 × HDL (mg/dL) + 0.0075 × SBP (mmHg) + 0.5800 × ln(Tri) + 0.0203 × Glu (mg/dL).Finally, the study group consisted of 275 adults, including 158 women (58%) and 117 men (42%), with an average age of 54 years . Most ofData were presented as a sample percentage (%) for categorical data or mean and standard deviation (SD) and median for continuous data. Before statistical analysis, we conducted the Shapiro–Wilk test to assess the normality of distribution and the Levene test to evaluate the homogeneity of variance. We divided the results according to MetS components (3–5), AntiOxi quartile, and the risk of the cardiovascular incident based on CRP results. The differences between groups were assessed by a Chi2 test for categorical variables, and ANOVA (for parametric distributions) or ANOVA Kruskal–Wallis tests (for nonparametric distributions) with a post-hoc analysis where necessary.2 value was calculated. For the polyphenols, we presented only significant models. Statistical significance was determined with a p-value < 0.05. The statistical analysis was performed using the STATISTICA software version 13.0 .The multivariate linear regression models were calculated to evaluate the associations between plasma carotenoids and polyphenols and the individual MetS components , LDL-C, cholesterol, CRP, and MetS severity. Models were adjusted for sex, age, fat mass (%), education, smoking status, and physical activity. Results of the analysis were expressed as β-coefficients with a 95% confidence interval, and for each model, the RAmong the carotenoids, the highest plasma concentration was found for lutein . Taking The total plasma polyphenol concentration was 79.3 nmol/L, of which 77% were phenolic acids . Among tSignificantly lower concentrations of the total carotenoids were found in people with CRP levels indicating a high degree of CVD risk . For thep = 0.008;) were found between the plasma lycopene concentration and between the total plasma carotenoids and the AntiOxi Index .The analysis of the correlation between MetS severity and plasma carotenoids revealed a non-significant association, after adjusting for potential confounders  . CorrelaAfter adjusting for potential confounders , no significant association was found between the plasma polyphenols and MetS severity . A signiThe plasma concentration of the selected carotenoids and polyphenols and the frequency of consumption of their sources was low in adults with MetS. Among the carotenoids and polyphenols, the highest concentrations in the blood were observed for lutein and phenolic acids, respectively . However, a weak correlation has been discovered between individual bioactive compounds and MetS components. Regarding the lipid profile, our study showed that the plasma of the selected carotenoids and polyphenols was positively correlated with HDL cholesterol , LDL cholesterol (chlorogenic acid), triglycerides (lycopene), and the total cholesterol (kaempferol). It was found that the level of CRP as a marker of inflammation was negatively correlated with the concentration of zeaxanthin and the total carotenoids. Lower plasma carotenoids were associated with more MetS components and inflammation and consequently a higher CVD risk. The low levels of plasma carotenoids in our study group may be related to a low intake of their dietary sources. As pointed out by Toh et al. , plasma In our study, for individual carotenoids, such as lutein and/or zeaxanthin, as well as the total plasma carotenoids, an inverse association with fasting plasma glucose was found. This finding is consistent with other studies that have demonstrated the potential for carotenoids not only to prevent but also treat or alleviate diabetes and its subsequent complications. Dietary carotenoids and plasma β-carotene negatively correlated with fasting plasma glucose, insulin resistance, and HbA1c . A similIt has been proposed that, of the carotenoids, only β-carotene has optimum recommended concentrations to reduce the risk of ischemic heart disease, set at >0.4 μmol/L . In our High plasma concentrations of polyphenol metabolites may reflect the regular and frequent consumption of specific plant products. As examined in the EPIC cohort, the main food items that predicted concentrations of combined polyphenols included cereal-based products and sauces , coffee, and tea . In our We found that among the polyphenols, phenolic acid as a p-coumaric acid and gallic acid were the most detectable in plasma, although no association with MetS severity was observed. Further analysis indicated that only three phenolic compounds were associated with MetS components: p-coumaric acid inversely correlated with the fasting glucose level, but chlorogenic acid was positively correlated with LDL and kaempferol with the total cholesterol. According to our findings, phenolic acids have potential benefits in managing diabetes, which is consistent with previous studies ,47. The Chlorogenic acid is one of the main phenolic acids and is present in coffee and various fruits and, as a nutraceutical, has been proven to be an important compound in the prevention and treatment of MetS due to its antioxidant, anti-inflammatory, hypolipidemic, antidiabetic, and antihypertensive properties ,49. DespSimilarly, the observed relationship between kaempferol and cholesterol is not confirmed in the results of studies by other authors. Animal studies have indicated antioxidant and anti-inflammatory effects and cardioprotective and antihypertensive benefits for kaempferol, but still little is known about its absorption from food and its potential cardioprotective benefits in humans . HoweverAs Koudoufio et al.  highlighDietary intervention studies in people with MetS indicate the potential therapeutic potential of carotenoids and polyphenols ,62,63,64Taken together, our study results and current evidence suggest that carotenoids’ and polyphenols’ intake and their plasma levels and metabolites have the potential to lower inflammation and MetS-related markers ,68,69; hAs emphasized by Singh et al. , the MedTo the best of our knowledge, this was the first such study among Polish adults with metabolic disorders that included multiple factors simultaneously. We assessed the plasma levels of selected carotenoids and polyphenols in association with MetS severity, MetS components, inflammatory markers, and anthropometrics indices and related them to socio-demographic and lifestyle factors. However, the findings of this study should be considered in light of some limitations. First, the design of this epidemiological study only allows for the determination of the association between the variables, not their causal relationship. Although multivariate-adjusted logistic regression  analysis was performed, all additional confounding factors may not have been accounted for. Another limitation of this study may be the use of the FFQ to assess nutrition. Although it is the most commonly used tool in epidemiological studies, it is well known that it has the potential to either overestimate or underestimate dietary intake. Finally, the plasma concentration of the carotenoids and polyphenols demonstrated to associate with MetS and its components should also be considered in relation to their intake and other factors affecting their bioavailability, including diet composition, intestinal microbiota, health status, and individual genetic conditions.It should be noted that some results reported in our study did not reach statistical significance. However, despite these limitations, the findings provide valuable initial insights and associations that add to the existing knowledge on the impact of bioactive compounds, including carotenoids and polyphenols, on the incidence of chronic diseases . It also indicates the need for early nutritional interventions aimed at increasing the supply of these health-important antioxidants by increasing the supply of vegetables and fruits, products enriched with them, or dietary supplements.A low concentration of carotenoids and polyphenols in the plasma of adult Poles with MetS was associated with an improper diet with a low consumption of plant products, including vegetables and fruit. Promoting and adapting a diet that includes elements of the Mediterranean in local conditions in MetS patients, and thus also in patients at a high risk of cardiovascular diseases, is the most important lifestyle modification strategy in the therapeutic management aimed at limiting the progression of metabolic syndrome. Health professionals should promote this type of diet as part of patient education in our specific environmental and cultural settings. However, it is still unclear whether plasma antioxidant levels are causally related to metabolic syndrome or are the result of the pathology of the syndrome, requiring further investigation.


At the subscale level, child non-enrolment in a school was found to independently predict parent distress (PD) and parent-child dysfunctional interaction (P-CDI). Frequent hospital visits were statistically and significantly associated with the difficult child (DC) and P-CDI subscales. The study established high parental stress in mothers and caregivers raising children with developmental disabilities. Lack of access to school was an independent factor that consistently increased parental stress. There is a need for support and directed intervention programs aimed at supporting mothers and caregivers of children with developmental disabilities, which will enhance their parenting abilities.Although acceptable levels of parental stress are experienced by all parents who raise children, this stress is substantially higher among parents who raise children with developmental disabilities. Sociodemographic determinants further exacerbate parental stress among parents in rural communities, which are disadvantaged in many ways. This study aimed to quantify parental stress among mothers and female caregivers of children with developmental disorders and investigate factors associated with such stress in rural Kwa-Zulu Natal, South Africa. A cross-sectional quantitative survey was used, in which the Parenting Stress Index-Short Form (PSI-SF) and a sociodemographic questionnaire was administered to mothers and caregivers who were raising children aged 1 to 12 years old who were living with developmental disabilities. The PSI-SF scores were used, where a total score of ≤84 percentile was categorised as normal/no parenting stress, 85–89 percentile was categorised as high parental stress, and scores of ≥90 were classified as clinically significant. The sample of 335 participants consisted of 270 (80.6%) mothers and 65 (19.4%) caregivers. Their ages ranged from 19 to 65 years, with a mean of 33.9 (±7.8) years. The children were mostly diagnosed with delayed developmental milestones, communication difficulties, epilepsy, cerebral palsy, autism, ADHD, cognitive impairment, sensory impairments, and learning difficulties. The majority (52.2%) of the participants reported very high-clinically significant stress levels (≥85%ile). The four factors that independently and significantly predicted high parental stress were the advanced age of mothers and caregivers ( The burden of developmental disability due to impairment in physical, learning, language or behaviour is increasing globally, with many children living with disabling and long-term health conditions. The affected children experience compromised optimal development and lack adequate access to essential health and education opportunities that can serve their specific needs ,2,3,4. MBeing a parent of or raising a child comes with normal parental stress, which is distinct and emanates explicitly from a range of responsibilities or roles associated with being a parent . While pParenting and childhood are intrinsically related, occurring within a socially constructed environment which is predominantly bound by cultural and socioeconomic status. This then raises the crucial need to understand the relationship between parenting and the parenting context. A child’s developmental context, as determined by the physical and social environment, is the strongest predictor of the child’s developmental outcomes. Meaning that a compromised home environment negatively influences the child’s cognitive and social development. Therefore, the analysis of a child’s development should extend to the family and the social context in the child’s life . The socThe family is a critical component of a child’s socialisation, thus a need to conceptualise and understand disability within the geographic and social context, including the African context. In many African communities, the family bonds are not only between the biological parents and the child. However, they are a very complex phenomenon that includes extended family members and siblings , which cAlthough there are many contributory factors and histories behind child developmental disabilities, they often co-occur with chronic health conditions. On the other hand, several chronic health conditions contribute to disability . RegardlThe emotional and support needs of children with disabilities and their families are dynamic and often complex. Parents raising a child with a disability often face numerous challenges relating to social isolation, emotional stress and depression, grief and financial problems. Recent studies suggest that some cultural beliefs exacerbate stigmatisation ,21, whicA range of social environment factors, including sociodemographic status, maternal education, parental self-efficacy, and access to knowledge on the child’s development, directly influence parental competence to promote the child’s physical and social well-being and thus determine the child’s developmental outcomes. Other sociodemographic variables related to child development include family income and parental educational level . A poor Although reports of uniquely high parental stress on parents and caregivers raising children with disabilities, there is a dearth of studies specific to the South African context. Moreover, South African rural communities are reported to have increased levels of poverty and inadequate education ,28, as wA cross-sectional quantitative survey was used, in which a sociodemographic questionnaire and Parenting Stress Index-Short Form were administered to mothers and caregivers who were raising children with developmental disabilities.The study was conducted in a regional public hospital that is dedicated to women and children under the age of 12 years receiving services in King Cetshwayo District (KCD) of Kwa Zulu Natal province, South Africa. Although the rural KCD is characterised by poverty and unemployment, they have access to primary health care through the residents’ primary health care clinics or mobile clinics. Most of the KCD population depends on government public health services, and only 8.7% have access to medical aid. The district has one public tertiary institution, one regional hospital, and the mother and child hospital where the study was conducted. The regional hospital is a referral facility for 16 district hospitals within the region. The specialised neurodevelopmental clinic in this hospital provides services to more than 1500 children annually for follow-ups or initial medical assessment and treatment.The study population consisted of mothers and caregivers of the estimated 1500 children aged 1–12 years who have developmental disabilities and attend the specialised neurodevelopmental clinic and rehabilitation services in this regional hospital. A caregiver should have lived/cared for the child in the past six months.n = 335).Using the Raosoft sample size calculator for an estimated population size of 1500, a confidence level of 95% and a 5% margin of error, a minimum sample size of 306 was calculated. The final total sample size of mothers and caregivers was three hundred and thirty-five  and the Province of KwaZulu Natal Health Research and Knowledge Management Committee, respectively, and then the regional hospital for permission to collect data. Within the neuro-developmental clinic, the researcher approached mothers and caregivers who were visiting the clinic for services required for their children while they were waiting in the outpatient department and recruited them to participate in the study. Those who agreed were directed to a separate room where data collection took place.Participants in this study were IsiZulu-speaking mothers raising a child with developmental disabilities, caregiver needed to have been with the child for at least six months and have a full understanding of the child’s health needs. In this study, inclusion criteria also related to the demographic characteristics of the child . Clinical characteristics . Exclusion criteria related to acquired medical conditions such as surgical injuries and other childhood diseases.The data was collected by the researcher and a trained researcher assistant. On the day of data collection, the individual participants who were invited and agreed to participate in the study were invited to a private space where their privacy was ensured. The purpose of the study was explained, and the participant was given an opportunity to ask questions or seek clarifications, which was followed by the administration of the informed consent. A researcher-developed socio-demographic questionnaire was administered first, which was followed by the PSI-SF. Participants who could administer the tools were encouraged to do so, and those who could not be assisted by the researcher or research assistant. The tools were in isiZulu, which is the common language used in the region. The data was collected over a period of eight months.The PSI-SF is a valid and reliable measurement tool derived from the longer Parental Stress Index long-form of 120 items . It is aThe researcher followed the COVID-19 regulations and adhered to the institutional guidelines. Such guidelines included the wearing of protective clothing, frequent washing of hands, and the use the sanitiser for all participants and the researcher/assistant.p-value of 0.05.STATA 17 was used to analyse data. Covariates were presented as mean values (standard deviations). Sociodemographic data were analysed descriptively and presented as frequencies, proportions and percentages. The PSI-SF percentile scores determined the presence and severity of parental stress. The total score on the PSI-SF was first analysed according to the three categories as outlined in the manual normal (16–84th percentile), high (85–89th percentile), and clinically significant (≥90th percentile). The total score on the PSI-SF was further dichotomised into the ≤84% percentile and ≥85% percentile, the latter indicating high-clinically significant stress. Pearson’s chi-square association test explored associations between parental stress levels and sociodemographic variables. Multivariate logistic regression analysis was conducted for the sociodemographic variables statistically significantly associated with parental stress measures in the three subscales and the total stress, using a This study received ethical clearance from the Sefako Makgatho Health Science University Research Ethics Committee (SMUREC) and the Province of KwaZulu Natal Health Research and Knowledge Management Committee. Permission to conduct the study was obtained from the hospital’s ethical committee, and informed consent was received from mothers and caregivers.The 335 participants consisted of 270 (80.6%) mothers and 65 (19.4%) caregivers. Their ages ranged from 19 to 65 years, with a mean of 33.9 (±7.8) years. The majority  were younger than 35 years, single  and resided in a rural community . Sixty-five (19.4%) were caregivers/not biological parents; most caregivers were grandparents. The rest of the socio-demographic variables are reflected in The children cared for were aged 1 to 12 years, with a mean age of 5.6 (±3) years. Most of the children were boys , 4 years and younger , born in a hospital , with a history of previous hospitalisation , and residing in King Cetshwayo district . The children were reported by the mothers and caregivers as diagnosed with developmental delayed milestones , communication difficulties , epilepsy , cerebral palsy , and autism . Other diagnoses reported by mothers and caregivers included ADHD, mental, sensory impairments, and learning difficulties.Most participants  reported visiting the hospital monthly for healthcare services, including rehabilitation services , and 58.8% (n = 196) visited the tertiary hospital for the specialised level of care. Access to school, either at a special school level or a mainstream school, was reported for only 35.3% (n = 118) of the children. The majority  reported not attending for various reasons, including the unavailability of suitable schools and financial problems. Among those not attending school, 35% (n = 76) were ≥5 years old and awaiting school placement. Children enrolled at school were reported to be at local mainstream or at creche  and only 30.1% (n = 33) at a school for children with special needs. The rest of the socio-demographic variables are reflected in The parental stress index scores ranged from 48 to 178, with a mean of 116 (±23.5) scores. Results showed that 52.2% (n = 175) of mothers’ and caregivers’ scores were clinically significantly stressed, 6.3% (n = 21) were highly stressed, and 41.5% (n = 139) were not stressed.The PSI scores were first determined at ≤84 percentiles , 85–89 percentile  and ≥90 percentiles  and were then dichotomised into normal (≤84 percentiles) and high-clinically significant (≥85 percentiles). As shown in p = 0.00), multiple health needs (p = 0.00) and school enrolment (p = 0.03). Several factors were found to be associated with DC. Mother and caregiver-related factors were the places of residence (p = 0.05) and level of education (p = 0.04). Child-related factors were the child’s gender (p = 0.03), history of hospitalisation (p = 0.02), having more than one (multiple) diagnoses (p = 0.00), communication difficulties (p = 0.00), other disorders reported (p = 0.03), and the frequency of hospital visits (p = 0.03) were found to be significantly associated with the mothers and caregiver’s perception of the child’s difficult behaviour (DC). Similarly, P-CDI had common factors with DC, and this included the history of hospitalisation after birth (p = 0.02), diagnosis of multiple disorders (p = 0.01), communication difficulties (p = 0.01), diagnosis with other disorders (p = 0.05), and frequency of hospital visits (p = 0.00). Unlike other subscales, P-CDI was found to be significantly associated with the age of initial intervention (p = 0.03) and diagnosis of delayed developmental milestones (p = 0.01).p = 0.01), history of hospitalisation (p = 0.04), diagnosis with more than one developmental disorder (p = 0.02), communication difficulties (p = 0.00), diagnosis of delayed developmental milestones (p = 0.00), having multiple health needs (p = 0.01), frequency of hospital visit (p = 0.00), and the child school enrolment (p = 0.04). Differently from the subscale’s factors, visiting tertiary-level hospitals for specialised care was found to be associated with high total parental stress (p = 0.02). The age of mothers and caregivers  was found to be statistically significantly associated with parental stress.Child-related factors found to predict high total parental stress scores were the child’s gender (p = 0.018), diagnosis with more than one disorder , communication difficulties , delayed developmental milestones , the frequency of hospital visit  and school enrolment .The following child-related factors were statistically significantly associated with high total parental stress, the child’s gender , child’s multiple health needs  and visiting tertiary level hospitals visits . These factors were less likely to increase parental stress, as the odds ratio was below one.Although the association was significant for the following factors, it was however not statistically significantly associated with parental stress. The history of hospitalisation  and the age of mothers and caregivers  were statistically significantly associated with parental distress.At the Chi-square test of association level, parental distress was statistically significantly associated with the age of mothers and caregivers, multiple health needs and school attendance. These variables were used to build a multivariate logistic regression model for the PD subscale. Two factors independently predicted parental distress. The child school enrolment , the child’s diagnoses with more than one developmental disorder  and the frequency of hospital visits .Difficult child at the chi-square level was statistically significantly associated with place of residence, level of education, gender of the child, history of hospitalisation, multiple diagnoses, communication difficulties, diagnosis with other disorders, and frequency of hospital visits. These factors were used to build a multivariate logistic regression model for the DC subscale. Three factors were found to independently predict the DC subscale. Communication difficulty  and the child’s school enrolment .Seven variables were purposefully included in this multivariable regression model to determine factors that predicted P-CDI. These were variables found to be significant at the Chi-square analysis level, history of hospitalisation, multiple diagnoses, communication difficulty, developmental disorders, other diagnoses, age of intervention, school attendance and sanitation facility. In this current study, P-CDI was found to be statistically significantly predicted by two factors. The frequency of hospital visits , caring for a child with multiple diagnoses , non-school enrolment , and monthly hospital visit  were statistically and significantly associated with increased total parental stress  and independently predicted the subscale scores . Four factors independently predicted high parental stress. The age of mothers and caregivers ≥36 years  of the primary caregivers of children with cerebral palsy suffered from clinically significant stress . Recent In this study, factors that relate to the parent’s view of the child’s temperament, defiance, noncompliance, and demandingness, were the most provoking factors increasing parental stress in mothers and caregivers raising children with developmental disabilities, which supports previous findings that reported these as provoking factors that increased parenting stress . In the The relationship between chronic health conditions and developmental disabilities in children is complex, as several chronic health conditions contribute to disability, making the child’s condition complex . The curLiterature has reported that multiple diagnoses have an increased emotional burden on the parents, as well as a financial burden for health-associated services ,42. The Education is essential, and lack of access to it compromises optimal development ,4. The sParenting stress outcome was independently associated with the age of the mother or caregiver, where older mothers and caregivers reported higher stress compared to those who were 35 years and younger. The finding that the age of mothers and caregivers are statistically associated with parental stress is similar to that found among parents of children with spinal bifida [One of the strengths of this study was the larger sample size from which the quantitative results were drawn. This study used 335 participants who were mothers and caregivers of children with developmental disorders. This study sample, however, did not include the fathers of the children. This study only focused on the parental stress of mothers and caregivers raising children with disabilities; hence a comparison with those raising typically growing children could not be made. The study population was dominantly African, isiZulu-speaking women. Therefore, the results cannot be generalised to other races. The child’s diagnosis was as reported by the mother or caregiver, and no patient information reviews were done. Future research studies should also consider the severity of the child’s disability.It is recommended that support for mothers and caregivers who are raising children with disabilities be integrated into the services intended to benefit the child. The parenting capacity of mothers with elevated stress levels is compromised, with further disadvantages for the development of the child. Interventions to address the stress levels of the mother are, therefore, a necessity to support the affected child.The study established high parental stress in mothers and caregivers raising children with developmental disabilities. Because stress compromises function and social interactions, the affected mothers’ ability to provide the necessary support for their children is decreased and therefore needs attention. In particular, not only does lack of access to school an independent factor that consistently increases parental stress, but it also violates the rights of the children, who should, as per the requirements of the constitution, be provided with quality education for their needs. Mental health services should therefore include the provision of services that target mothers who are raising children with disabilities. Specific interventions are also required for custom-made services for the children and their parents.


There are numerous cases where artificial intelligence (AI) can be applied to improve the outcomes of medical education. The extent to which medical practitioners and students are ready to work and leverage this paradigm is unclear in Iran. This study investigated the psychometric properties of a Persian version of the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) developed by Karaca, et al. in 2021. In future studies, the medical AI readiness for Iranian medical students could be investigated using this scale, and effective interventions might be planned and implemented according to the results.P ≤ 0.05 was considered as the level of statistical significance.In this study, 502 medical students (mean age 22.66(± 2.767); 55% female) responded to the Persian questionnaire in an online survey. The original questionnaire was translated into Persian using a back translation procedure, and all participants completed the demographic component and the entire MAIRS-MS. Internal and external consistencies, factor analysis, construct validity, and confirmatory factor analysis were examined to analyze the collected data. A Four subscales emerged from the exploratory factor analysis , and confirmatory factor analysis confirmed the four subscales. The Cronbach alpha value for internal consistency was 0.944 for the total scale and 0.886, 0.905, 0.865, and 0.856 for cognition, ability, vision, and ethics, respectively.The Persian version of MAIRS-MS was fairly equivalent to the original one regarding the conceptual and linguistic aspects. This study also confirmed the validity and reliability of the Persian version of MAIRS-MS. Therefore, the Persian version can be a suitable and brief instrument to assess Iranian Medical Students’ readiness for medical artificial intelligence. The origin of artificial intelligence (AI) can be traced back to the 1950s when artificial neural networks were created .Numerous healthcare concerns can be solved globally using AI and its various applications, such as making and simplifying diagnoses, big-data analytics, administration, and overall clinical decision-making , 4. MoreAI is highly technical, requiring computer science knowledge and mathematical understanding as the basic foundations . Trainin(a) the need for AI in the curricula of undergraduate medical education (UME), (b) recommending such a curricular delivery, (c) suggesting AI curriculum contents, particularly a focus on the ethical aspects of machine learning (ML) and AI, (d) integrating AI into UME curricula, and (e) the need for cultivating the uniquely human skills on empathy for patients in the face of AI-driven development and challenges [Therefore, it is imperative to integrate technical and non-technical principles of AI with medical students. However, the current medical schools’ teaching approaches are limited in their coverage of AI in their curricula . Our revallenges .These days, students in medical and dental schools have a good understanding of AI concepts, an optimistic attitude regarding it, and are interested in seeing AI incorporated into their curricula . Thus, tA psychometric measurement tool that is reliable and valid has been developed by Karaca, et al. . to asseWhatsApp and Telegram, where the link to the MAIRS-MS survey was posted online. Two thousand three hundred thirty-eight students were eligible as the research population. The completed surveys were received from 502 medical students .The sample population for the present study was selected from among the Iranian medical students at the Faculty of Medicine, Mashhad University of Medical Sciences, using convenience sampling. The students were informed through Email and social media messages, such as The study participants responded to questions related to demographics, such as gender, age, and the curriculum of the Doctor of Medicine (MD) program. The questions covered the basic science, preclinical, and clinical aspects of their MD curriculum in addition to those specific to MAIRS-MS.Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS): MAIRS-MS was provided by Karaca, et al. [, et al. . with 22Prior to the actual Persian translation, the consent of the original questionnaire’s author was obtained via Email. Initially, each item of the English questionnaire was translated into Persian by two academic experts in English translation. Secondly, another two bilingual university instructors examined each of the translated items in terms of meaning, accuracy, wording, spelling, and grammar. Then, a back translation to English and a comparison of the original questionnaire with the back-translated one were made. As a result of their suggestions and feedback, necessary revisions were made to the survey questions. Thirdly, five faculty members specializing in AI checked each of the items to ensure that the exact meaning was achieved by translation. All of these individuals were fluent in both Persian and English languages. Based on subsequent feedback from experts, the wording of seven questions was revised. Finally, the final Persian version of the questionnaire was approved, consisting of 22 questions, each on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree).To conduct data analysis, the steps were carried out as follows.(a) one eigenvalue criterion based on Kairs and Guttman [(b) parallel analysis and Velicer’s MAP test based on Hayton [(c) the scree test proposed by Cattell [Exploratory factor analysis was led by cross-validation for half of the sample n = 251) using principal axis factoring with varimax rotation , 20. The Guttman , 22, (b)n Hayton , 24, and1 using pConfirmatory factor analysis was performed on the sample’s other half (n = 251) to cross-validate the analysis. The good fit indices examined in this study were Chi-square, Chi-square/df, root mean square error of approximation, the goodness of fit index, comparative fit index, normed fit index, non-normed fit index, adjusted goodness of fit index, incremental fit index, relative fit index, and standardized root mean square residual.Each dimension’s internal consistency reliability coefficient  was calculated.The intra-class correlation coefficient was conducted to determine inter-rater reliability.SPSS-23 was used to calculate exploratory factor analysis, internal consistency, and stability of the questionnaire. LISREL-8.70 software was also used to calculate the confirmatory factor analysis.Out of 502 medical students aged 17 to 36, the mean age was 22.66(± 2.767), with 55% of the sample being female. The participants in each curricular phase of the MD program consisted of basic science (146 (29%)), preclinical (115(23%)), and clinical (241 (48%)). The mean, standard deviation, maximum and minimum, skewness, and kurtosis of scores obtained from the collected data are shown in Table 2 = 7478.39; df = 231; P ≤ 0.00001). Also, the scree diagram shows the four mentioned factors with eigenvalues greater than one  revealed an acceptable fit of the model with respect to the data.In order to evaluate the conceptual model of the original version of the questionnaire, confirmatory factor analysis was applied using LISREL-8.70 software. This was performed on the sample’s second half n = 251) to cross-validate the analysis. The estimation method in the confirmatory factor analysis was the maximal likelihood, assuming that the observed indicators follow a continuous and multivariate normal distribution. As shown in Fig. 51 to cro2), and average variance extracted (AVE) were calculated for each factor (Table P ≤ 0.05) . Therefore, the finding indicated that the construct validity for all questions was established. In addition, the results showed that the AVE index was greater than 0.50. The AVE index represented the average variance extracted for each factor by its questions. Thus, the larger the index, the greater the fit [Since values above 0.90 for the variables were acceptable, the values, as shown in Table or Table . The res the fit , 33.Cognition subscale (decreased Chi-square = 67.02), the error covariance between questions 3 and 4 on the Cognition subscale (decreased Chi-square = 51.25), and the error covariance between questions 10 and 11 on the Ability subscale (decreased Chi-square = 42.33) was released due to the correlation between the error covariance in these items. Modifying the original model improved the RMSEA by approximately 0.02 (decreased from 0.094 to 0.079).To modify the original model, the error covariance between questions 1 and 2 on the Reliability: Cronbach alpha was used to investigate the internal consistency of the MAIRS-MS questions. The respective values for the Cognition, Ability, Vision, and Ethics subscales were: 0.886, 0.905, 0.865, and 0.856. Also, the Cronbach alpha value for the total scale was 0.944. These values, which were similar to those of the original questionnaire, demonstrated the data’s acceptable internal consistency and reliability. In addition, the composite reliability coefficients for the subscales were 0.972 (Cognition), 0.884 (Ability), 0.879 (Vision), and 0.894 (Ethics). The composite reliability coefficient for the total scales was 0.981. Finally, the inter-rater reliability was determined for each of the subscales as follows: 0.703 (Cognition), 0.753 (Ability), 0.979 (Vision), and 0.715 (Ethics). The Cronbach alpha intra-class correlation coefficient for the total scale was 0.871.AI has transformed healthcare procedures  and is vThe present study was conducted to determine the psychometric properties of the Persian version of MAIRS-MS. The scale consisted of 22 items, and exploratory factor analysis revealed that the MAIRS-MS had four factors: cognition, ability, vision, and ethics. The preliminary results showed high consistency of the Persian version with the original questionnaire with respect to each of the four factors. Our detailed statistical analyses indicated an acceptable validity of all questions on the Persian version of the MAIRS-MS. The reliability analyses of that version led to high values representing its reliability. Hence, this study established the validity and reliability of the Persian version of MAIRS-MS.Despite the lack of explicit opinions on the effects of AI on healthcare delivery and/or medical education, several studies have developed scales to evaluate the attitude, knowledge, and readiness of healthcare professionals and medical students on the introduction of AI in medicine and medical education. MAIRS-MS has been developed as a 4-subscale tool to assess cognition, ability, vision, and ethics among the currently available scales. The original version has been evaluated as a highly valid and reliable tool for monitoring medical students’ perceived readiness toward AI technologies and applications . In thisFurther, Boillat, et al. developed a questionnaire to capture medical students’ and physicians’ familiarity with AI in medicine and the challenges, barriers, and potential risks linked to the democratization of this new paradigm. The scale consisted of 31 items under five factors, such as familiarity with medical AI, education and training, challenges and barriers in medical AI and its implementation, as well as the risks linked to medical AI . AlthougDue to the impact of AI in medicine and medical education, several studies have evaluated medical students’ opinions on AI aiming at bringing further improvement to this method. Abid, et al. investigated Pakistanis medical students’ attitudes and readiness toward AI . In the Finally, as a strong finding of the current study, it can be stated that we evaluated the psychometric properties of a novel and beneficial questionnaire among Iranian medical students and explored their readiness for AI in their curricula. In future studies, the student’s readiness for having AI components in the medical curricula will be further investigated using the translated scale developed in the current study, and its efficacy and potential will be assessed in greater detail and from different perspectives.The findings of this study revealed that the Persian MAIRS-MS was essentially equivalent in nature to the original one regarding the conceptual and linguistic aspects. This study also confirmed the validity and reliability of the Persian MAIRS-MS. Therefore, the Persian version can be a suitable and brief instrument to assess the readiness of Iranian medical students with respect to the inclusion of AI in their medical education and its impact on their future medical practice.


Acoustic neuroma is one of the most common tumors in the cerebellopontine angle area. Patients with acoustic neuroma have clinical manifestations of the cerebellopontine angle occupying syndrome, such as tinnitus, hearing impairment and even hearing loss. Acoustic neuromas often grow in the internal auditory canal. Neurosurgeons need to observe the lesion contour with the help of MRI images, which not only takes a lot of time, but also is easily affected by subjective factors. Therefore, the automatic and accurate segmentation of acoustic neuroma in cerebellopontine angle on MRI is of great significance for surgical treatment and expected rehabilitation. In this paper, an automatic segmentation method based on Transformer is proposed, using TransUNet as the core model. As some acoustic neuromas are irregular in shape and grow into the internal auditory canal, larger receptive fields are thus needed to synthesize the features. Therefore, we added Atrous Spatial Pyramid Pooling to CNN, which can obtain a larger receptive field without losing too much resolution. Since acoustic neuromas often occur in the cerebellopontine angle area with relatively fixed position, we combined channel attention with pixel attention in the up-sampling stage so as to make our model automatically learn different weights by adding the attention mechanism. In addition, we collected 300 MRI sequence nuclear resonance images of patients with acoustic neuromas in Tianjin Huanhu hospital for training and verification. The ablation experimental results show that the proposed method is reasonable and effective. The comparative experimental results show that the Dice and Hausdorff 95 metrics of the proposed method reach 95.74% and 1.9476 mm respectively, indicating that it is not only superior to the classical models such as UNet, PANet, PSPNet, UNet++, and DeepLabv3, but also show better performance than the newly-proposed SOTA (state-of-the-art) models such as CCNet, MANet, BiseNetv2, Swin-Unet, MedT, TransUNet, and UCTransNet. Although these tumors are typically non-life-threatening, postoperative morbidity can be associated with injury to the facial nerve, cochlear nerve, cerebrospinal fluid leaks, and other wound complications. Permanent facial paralysis can occur in 3 to 5% of cases, and up to 22% of patients may experience cerebrospinal fluid leaks . FortunaAt present, in the medical field, manual segmentation is mainly used in brain tumor segmentation. Manual segmentation is to manually outline the tumor area in all tumor MRI image slices. Although manual segmentation is accurate, it is time-consuming, laborious and subjective, which is not conducive to the timely diagnosis and treatment of patients. Therefore, scholars have been exploring automatic segmentation methods. In the early stage, people mainly focused on traditional segmentation methods, such as threshold segmentation , watershWith the rapid development of artificial intelligence in recent years, deep learning methods have been successfully applied to the field of medical images. Deep learning models solve the problems of poor accuracy and strong dependence on data in traditional automatic segmentation methods, such as threshold segmentation, region segmentation, and clustering segmentation, and have made great progress in medical image segmentation. AlexNet , VGG Si, GoogLeNUndoubtedly, CNN represents a very promising method for image processing. However, its convolution operation has limitations, especially for samples with large texture differences, resulting in weak performance. In recent years, scholars have proposed several solutions to address this issue. For instance, Furthermore, Transformer has emerged as an alternative architecture designed for sequence-to-sequence prediction, and its success has been widely demonstrated in various fields such as machine translation and natural language processing NLP; . In variIt is worth noting that acoustic neuromas have different shapes and may grow into the inner auditory canal, which is challenging for accurate feature extraction. We believe that the combination of ASPP, attention mechanism and Transformer can solve this challenge well. Therefore, we propose a novel model called ACP-TransUNet for accurate segmentation of acoustic neuromas, with TransUNet as the core framework. Specifically, the ASPP module is added to increase the receptive field, enabling more accurate and noticeable extraction of tumor features during the segmentation process. We also incorporate the CPAT module, which combines channel attention  and pixeOur main contributions are as follows:Our proposed ACP TransUNet combines Transformer and CNN to capture the global and local features of the segmentation target.In the down-sampling process, the ASPP module is added after the convolutional neural network to gain contextual information at multiple scales and resolutions.In the up-sampling process, channel attention and pixel attention are used to improve model performance and accuracy by weighting important features.2.2.1.UNet has become the most commonly used method to accurately segment lesions in medical segmentation tasks, and Transformer has also become a structural system that replaces the self-attention mechanism. TransUNet combines Transformer with UNet as a powerful alternative for medical image segmentation, possessing the advantages of both. To compensate for the loss of feature resolution due to Transformers, TransUNet adopted a hybrid CNN-Transformer architecture to exploit the detailed high-resolution spatial information of CNN features and the global context encoded by Transformers. Inspired by U-Shape, the attention features encoded by Transformers are combined with different high-resolution CNN features during upsampling to achieve precise localization. This design enables the model to preserve the advantages of Transformer and also facilitates the segmentation of medical images. On the one hand, Transformer encodes the tokenized image patches of the convolutional neural network (CNN) feature map as an input sequence for feature extraction; on the other hand, the decoder up-sampling the encoded features, and then combines them with the feature map in CNN to achieve accurate positioning . Current2.2.Channel attention was first proposed in SE-Net and achieved excellent performance. In CBAM , channelwhere In recent years, channel attention has been widely used to solve medical challenges. Yuan et al. improved the accuracy of automatic vessel segmentation in fundus images by embedding an adaptive channel attention module to automatically rank the importance of each feature channel . Du et a2.3.The channel attention aims to obtain a ttention  is able where Pixel attention not only reduces the number of parameters, but also eliminates unnecessary pooling operations that can lead to image smoothing . Relying3.3.1.In this section, we describe our ACP-TransUNet with more details. The ACP-TransUNet model proposed in this paper is based on the TransUNet  model, aGiven an input image with resolution where The Transformer  layer iswhere In the up-sampling process, we added CPAT modules in each layer to weight the important features in recovering the image size to improve the performance and accuracy of the model.3.2.Acoustic neuromas vary in shape. Some are irregular in shape and grow into the inner auditory canal, while some have clear boundary. Therefore, we need a larger receptive field to extract the feature of acoustic neuromas. The ordinary convolution structure cannot fully extract features, so in this paper we choose to use ASPP module to strengthen the ability of the model to segment objects at different scales. As shown in 3.3.Given an intermediate feature map where 4.In this section, we introduce the details of the experimental data and results. In order to verify whether ACP-TransUNet can effectively and accurately segment acoustic neuromas, we first performed comparative experiments and ablation experiments on all test sets . To test the accuracy of the model’s segmentation effect in a single view, we also conducted multi-view evaluation, performing a comparison experiment and ablation experiment on the three views separately. The results are discussed in detail below. Among them, ACP-TransUNet achieves 95.74% Dice Similarity Coefficient on the test set, and Hausdorff 95 reaches 1.9476 mm, which are superior than other models.4.1.We selected MRI images of sagittal view, coronal view and transverse view of patients with cerebellopontine angle (CPA) acoustic neuroma diagnosed by experts in Tianjin Huanhu Hospital from January 2019 to January 2022, with all the patients signing informed consent. The scanning equipment we used was Siemens Skyra 3.0 T MRI scanner, which could collect magnetic resonance images of multiple sequences. However, compared with other sequences, T1WI-SE could better distinguish the lesion and its surrounding adjacent tissues. Therefore, this paper adopts contrast - enhanced fast low-angle shot 2-dimensional sequence (T1_fl2d) with Gd-GDPA. Scanning parameters are as follows: slice thickness is 5 mm; slice interval, 1.5 mm; echo time (TE), 2.46 ms; repetition time (TR), 220 ms. After screening, a total of 300 magnetic resonance images of acoustic neuromas were selected in this paper, in which the ratio of training set, verification set and test set is 8: 1: 1 and each part has no cross.4.2.To avoid the deviation of the experimental results caused by the inconsistent data format, the training, verification and test MRI images in this paper are all set to the same format. Because the dataset is small, to improve the generalization ability of the model, the images are subjected to data augmentation processing such as inversion and flipping. In order to save training resources, the images are set to 4.3.https://console.cloud.google.com/storage/vit_models/. In addition, we use the Adam optimizer  that was trained on the ImageNet21k dataset. The pre-training model can be found at the following link: ptimizer  to optim4.4.In order to objectively evaluate the results of different models, this paper uses the Dice Similarity Coefficient  and Haus4.5.To verify the validity of the proposed model, we compared several classical networks such as PANet , PSPNet The results show that ACP-TransUNet achieved the best performance on the test set, with a Dice value of 95.74% and a Hausdorff 95 value of 1.9476 mm. Compared with the original UNet network proposed by In the comparative experiments, our scheme achieved optimal Dice and Hausdorff 95 values, outperforming other network models. Specifically, our scheme improved Dice by 2.63% (PSPNet), 2.28% (DeepLabv3), 1.08% (UNet++), 1.86% (PANet), 10.42% (CCNet), 0.79% (MANet), 5.88% (BiseNetv2), 4.28% (Swin-Unet), 2.48% (MedT), 0.72% (TransUNet), and 0.68% (UCTransNet), respectively. Hausdorff 95 was increased by 1.2669 mm (PSPNet), 2.4962 mm (DeepLabv3), 1.8268 mm (UNet++), 2.3923 mm (PANet), 3.3072 mm (CCNet), 1.8007 mm (MANet), 3.7427 mm (BiseNetv2), 4.3982 mm (Swin-Unet), 2.8318 mm (MedT), 2.0561 mm (TransUNet), and 2.127 mm (UCTransNet), respectively. The corresponding segmentation effect in In comparison experiments, for some regular acoustic neuromas, such as the tumor shown in the sagittal view, it can be seen that the selected networks can achieve basic segmentation of the tumor except for BiseNetv2 and MedT. However, comparing the internal filling and boundary of the segmentation map, only ACP-TransUNet is closest to Ground Truth; for the part that shows irregular shape and grows into the internal auditory canal, as shown in the coronal view, PSPNet, PANet, CCNet, BiseNetv2 and MedT cannot well segment some tumors growing in the internal auditory canal. Although UNet++ and MANet could segment the tumors in the internal auditory tract, the segmentation results were inferior to the rest of the networks. DeepLabv3, UNet and TransUNet performed comparably to ACP-TransUNet for segmenting the tumors in the internal auditory tract, but UCTransNet and ACP-TransUNet outperformed the rest of the models in terms of edge detail. However, in the transverse (tra), only TransUNet and ACP-TransUNet can well segment the acoustic neuroma. We noticed that the models containing Transformer structures  were deficient in processing edge details, which may be explained by the limited Transformer localization ability caused by insufficient low-level details. After adding the CPAT module and ASPP module, the segmentation map edge contours have been greatly improved.4.6.To further verify the effectiveness of the model, we conduct comparative experiments and ablation experiments on the segmentation effects of the coronal, sagittal and transverse views in the test set, respectively. The results of the multi-view evaluation in the comparative experiments are shown in It can be seen that although the Hausdorff 95 is not as good as MANet in the transverse view, our model is generally better than other models through the evaluation of dice and Hausdorff 95 values. Dice values of the coronal view, sagittal view and transverse view reached 94.88, 95.45 and 96.45% respectively; and the Hausdorff 95 values reached 2.541 mm, 1.4056 mm and 1.902 mm, respectively.4.7.To demonstrate the efficacy of the incorporation module, we performed two groups of ablation experiments based on the principle of “fixing two items and changing one item.”4.7.1.We examine four different experimental configurations to verify the efficacy of adding attention modules, i.e., TransUNet with ASPP (TransUNet+ASPP) as the baseline, and further with channel attention (TransUNet+ASPP+C), pixel attention (TransUNet+ASPP+P), and CPAT module (TransUNet+ASPP+CPAT). From When we added channel attention to “TransUNet+ASPP,” not only the Dice and Hausdorff 95 of “TransUNet+ASPP+C” in When we added pixel attention to “TransUNet+ASPP,” the Dice and Hausdorff 95 of “TransUNet+ASPP+P” in The results of “TransUNet+ASPP+CPAT” in 4.7.2.To demonstrate the efficacy of the ASPP module, two different experimental configurations were studied, i.e., TransUNet with CPAT (TransUNet +CPAT) as a baseline and further addition of the ASPP module (TransUNet +CPAT+ASPP). 5.At present, the results of Dice and Hausdorff distance of our model in acoustic neuroma segmentation have reached our expectations. Given the fact that acoustic neuromas vary in shape--some with irregular shape and growing into the inner auditory canal, while some with clear boundary, we need a larger receptive field to extract the feature of acoustic neuromas. As ordinary convolution structure cannot fully extract features, we added the ASPP module. Furthermore, since acoustic neuromas often occur in the cerebellopontine angle area with relatively fixed position, we intended to make our model automatically learn the weights at different scales by adding the attention mechanism. Therefore, we added the channel attention and pixel attention in the up-sampling, so that the channel information and pixel information are combined to better explore the channel characteristics and pixel characteristics while restoring the original input image size. In the comparison experiments, we can see that most of the networks with the added Transformer structure achieve good results in segmentation of acoustic neuromas, for example, the Dice value of these networks is almost equal to that of ACP-TransUNet. However, Hausdorff 95 cannot be comparable to ACP-TransUNet. which is due to Transformer’s inadequacy to capture low-level details and its limited positioning ability. Given that, we combined ASPP and attention mechanism to make up for this deficiency. In the ablation experiment, it is observed that the segmentation performance of the model becomes better and better with the addition of ASPP and CPAT modules, proving the effectiveness of our choice to add the modules.However, there are still problems existing in the current work. For example, in the multi-view evaluation, we did not achieve desirable segmentation results in the transverse view. The Hausdorff 95 value of our model in the transverse view is 1.902 mm. That figure is inferior to the MANet, which reached 1.8365 mm in the comparison experimental. The reasons we believe are of two aspects. First, it could be explained by the relatively low importance of channel weight in the down-sampling of acoustic neuromas in the transverse view direction. But the addition of pixel attention could make all the pixels of the feature map generate attention coefficient, which makes up for the disadvantage of using channel attention alone. Second, although the addition of ASPP module would increase the receptive field, making each convolution output contain a large range of information, the information of smaller tumors in the transverse view could be lost. Given that, in our future work, we will gradually increase the dataset and study the performance changes when increasing or decreasing the single direction module. In addition, our current research task is to achieve accurate segmentation of acoustic neuromas. We hope that the application of ACP-TransUNet will not be limited to acoustic neuromas, so its effectiveness in segmenting other medical images will also be the focus of our future experimental research.In our research work, the improvement of the accuracy of acoustic neuroma segmentation means that we need to abandon some indicators in some aspects. We have considered trade-offs in these issues. First, the addition of ASPP module, attention mechanism and deeper transformer layer means longer training time and larger model parameters. We believe that the medical segmentation task is different from other segmentation tasks that pursue timeliness (such as face segmentation). Between lightweight and precision, we prefer the latter. Second, since Transformer lacks the inductive bias of convolution, it requires more sample size than CNN. Transformer needs to learn this kind of information from a large amount of data. Considering the precious resources and insufficient data support of current medical images, instead of choosing to train from scratch, we resort to pre-trained models to achieve the same or even better performance than CNN. In the future, we will conduct research for Transformer on small-scale datasets.6.In this paper, we proposed a novel model named ACP-TransUNet based on the improved TransUNet structure, with all the data on the basis of MRI images. Through deep learning, we realized the automatic and accurate segmentation of acoustic neuromas in the cerebellopontine angle region. Dice and Hausdorff 95 reached 95.74% and 1.9476 mm respectively, and the dividing boundary was closer to the gold standard. The overall effect of segmentation was significantly improved, which was valuable for clinical application and auxiliary physician diagnosis. With decreased intervention of human factors, we greatly improved the diagnostic efficiency and reliability. In addition, the ASPP module was introduced into ACP-TransUNet, which not only increases the receptive field and obtains multi-scale and multi-resolution background information, but also makes the features contained in the sequence of the imported Transformer more accurate and significant. The CPAT module with sequential channel attention and pixel attention is added to the upsampling process so that channel information and pixel information are combined to improve model performance and accuracy by weighting important features. The experimental results show that our model can effectively segment acoustic neuroma. Compared with other methods, the proposed method has different degrees of performance improvement in the segmentation of acoustic neuroma.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.ZZ and HB: conceptualization. HB: methodology, formal analysis, supervision, and funding acquisition. ZZ: software, data, writing original draft preparation, and visualization. ZZ, HB, and QM: validation. JL and XZ: investigation. YY: resources. HB, QM, and CZ: writing review and editing. QM: project administration. All authors contributed to the article and approved the submitted version.This work was supported in part by National Natural Science Foundation of China (61201106) and Tianjin Research Innovation Project for Postgraduate Students (2022SKY126).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


A prospective single-center study was conducted to compare the safety and outcomes of vasopressors administered via a PVC vs. a central venous catheter (CVC) in patients presenting with CS over a 12-month period. Results: A total of 1100 patients were included; of them, 139 (12.6%) required a vasopressor treatment due to shock, with 108 (78%) treated via a PVC and 31 (22%) treated via a CVC according to the discretion of the treating physician. The duration of the vasopressor administration was shorter in the PVC group compared with the CVC group . Phlebitis and the extravasation of vasopressors occurred at similar rates in the PVC and CVC groups . Nevertheless, the bleeding rate was higher in the CVC group compared with the PVC group . Conclusions: The administration of vasopressor infusions via PVC for the management of patients with CS is feasible and safe in patients with cardiogenic shock. Further studies are needed to establish this method of treatment.Background: Vasopressors are frequently utilized for blood pressure stabilization in patients with cardiogenic shock (CS), although with a questionable benefit. Obtaining central venous access is time consuming and may be associated with serious complications. Hence, we thought to evaluate whether the administration of vasopressors through a peripheral venous catheter (PVC) is a safe and effective alternative for the management of patients with CS presenting to the intensive cardiovascular care unit (ICCU). Methods:  Intravenous (IV) vasopressors are frequently utilized in critically ill patients with circulatory shock to raise their blood pressure and improve organ perfusion . VasopreAn inadvertent arterial puncture or cannulation, lung injuries, local and systemic infections, and venous thrombosis are among the most commonly associated adverse events . OverallFurthermore, CVC insertion is time consuming and may hinder the prompt initiation of vasopressor therapy . Delays Contemporary observational studies and meta-analyses have reported conflicting data regarding the occurrence of local adverse events due to peripheral vasopressor extravasation. Several studies have demonstrated a relatively low incidence of complications and morbidity associated with vasopressors infused via PVCs ,13,14,15All patients were admitted to a tertiary care medical center ICCU at the Shaare Zedek Medical Center  over a 12-month period between January 2022 and December 2022. Vasopressors for the treatment of shock were administered either via a CVC or via a PVC. The decision to administer vasopressors via a CVC or via a PVC was made according to the discretion of the treating senior cardiologist. Of note, the administration of vasopressors through a peripheral line is the standard approach in our center for the initial management of patients suffering from shock. However, when additional medications with potential toxicity, multiple vasopressors, fluids at a high rate, and/or blood products are co-administered, a CVC is generally preferred. Hence, overall, patients with a central venous access are in a higher degree of shock compared to patients with a peripheral vascular access. A vasopressor treatment was administered in accordance with the European Society of Cardiology (ESC) guidelines for heart failure in patients with cardiogenic shock  and withInclusion criteria: All patients were ≥18 years old and presented with hemodynamic shock requiring vasopressor administration.Exclusion criteria: Patients <18 years old and pregnant women were excluded from the study.Definitions:2 and a pulmonary capillary wedge pressure (PCWP) of ≥15 mm Hg [1. Cardiogenic shock was defined as a systolic blood pressure (SBP) <90 mm Hg that was refractory to fluid resuscitation with clinical and laboratory evidence of end-organ dysfunction in the setting of suspected cardiac dysfunction and/or right heart catheterization with a cardiac index (CI) of ≤2.2 L/min per m15 mm Hg .Patients with CS were further classified according to the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification to A, B, C, D, or E .2. Septic shock was defined as a suspected or confirmed infection, plus hyperlactatemia (≥2.0 mmol/L), and the requirement of vasopressors to maintain a mean arterial pressure (MAP) of 65 mm Hg or higher after an IV fluid load of at least 20 mL/kg over 60 min [3. Sepsis-induced decompensation together with an acute myocardial infarction or chronic heart failure was defined as combined shock.Vasopressor administration: vasopressors were administered under strict invasive blood pressure monitoring for the shortest period necessary. The PVC was placed preferably in a vein proximal to the wrist via (at least) a 20 G cannula. A second peripheral venous access was routinely obtained for backup and the administration of other IV drugs. The CVC was inserted under ultrasound guidance and after a strict sterile preparation technique. Each vasopressor was given according to specific protocols that included the drug dilution, concentration, and rate of initial and maximal pressor dose. An inspection of the venous access site was performed daily.Data were prospectively and anonymously documented in an electronic case report form (eCRF). The data were checked for accuracy and out-of-range values by the study coordinator.The demographic data, presenting symptoms, comorbid conditions, and a physical examination were systematically recorded. Laboratory, imaging, hemodynamic, and clinical course data were collected as well. Patients with shock were stratified according to the vasopressor administration route , the decision of which was made according to the discretion of the treating senior cardiologist.The vasopressor type, the concentration, and the duration of administration were all recorded as well.431-21-SZMC; approved on 28 February 2022) with an exemption from informed consent.The study was approved by the SZMC Institutional Review Board  , a blood stream infection (BSI) , phlebitis, extravasation, and bleeding.The secondary outcomes included: the hospitalization length and the mortality rate. The mortality rate was derived from The Israeli Ministry of Internal Affairs medical record database, which is continuously updated by every medical center in Israel.t-test and the Mann–Whitney test were performed for the comparison of normally and non-normally distributed continuous variables, respectively.The patients’ characteristics were presented as numbers (%) for categorical variables, and as means (SD) or medians (IQR) for normally and non-normally distributed continuous variables, respectively. A comparison of categorical variables was achieved using a chi-squared test and Fisher’s exact test. Student’s p < 0.05 was considered statistically significant. The analyses were carried out using SPSS Statistics for Windows, version 25.0 .Mortality was analyzed by applying a stepwise backward Cox proportional hazards model. All tests were two-sided. p < 0.01), while the proportion of people belonging to the female gender was similar in both groups. Patients in both groups had similar rates of diabetes mellitus (DM), hypertension, dyslipidemia, prior coronary artery disease, peripheral artery disease, and cerebrovascular accidents. The etiologies for shock were: cardiogenic, 120 (86%); septic, 11 (8%); combined (cardiogenic and septic), 5 (4%); and hemorrhagic, 3 (2%). The patient characteristics and shock types are presented in A total of 1100 patients were included in the study. Of them, 139 (12.6%) required vasopressor treatment due to shock. Patients in the CVC group were, on average, 8 years younger than those in the PVC group (72 (±12.3) years old vs. 64 (±19.6) years old, respectively, The drug therapy was administrated via a PVC in 108 (78%) patients and via a CVC in 31 (22%) patients. A peripheral IV cannula was placed above the wrist in all patients. A CVC was placed in the jugular vein in nearly half (45%) of the cases, followed by the femoral vein (29%) and subclavian vein (26%). One hundred and eleven patients (80%) were successfully managed with one vasopressor. The most administered vasopressor agent was noradrenaline (94%), followed by dopamine (12%). The characteristics of the venous access and vasopressor treatment are presented in p = 0.8). Phlebitis and extravasation occurred at similar rates in both groups . Although the total number of events was small, there was a higher rate of local adverse events seen at higher doses (41–60 mcg/min) of noradrenaline when compared to lower doses. All cases were managed conservatively.The adverse events during hospitalization are reported in p = 0.5.A CLABSI occurred in only one patient with a CVC  and a BSI occurred in only two patients with a PVC , with p < 0.05). The mean length of admission was shorter in the PVC group .Overall, 406 days of vasopressor treatment were monitored during the study period. The duration of the vasopressor treatment was shorter in the PVC group compared to the CVC group .The in-hospital mortality rate was 20% (28/139), with a higher mortality rate in the CVC group compared to the PVC group (36% (11/31) vs. 16% (17/108), respectively, The present study sought to evaluate the safety and efficacy of vasopressors introduced via a PVC in patients presenting mainly with CS to a tertiary care medical center ICCU. To our knowledge, this is the first study to show the safety and feasibility of vasopressors administered at conventional doses via a PVC in patients with CS managed in a contemporary ICCU. Our main findings were the following: (1) the administration of vasopressors via a PVC is feasible in patients with less severe degrees of shock and (2) the administration of vasopressors via a PVC is safe, with a lower incidence of local adverse events when compared to a CVC.CS is the leading cause of death in acute myocardial infarctions (AMIs), and it is characterized by tissue hypoperfusion and hypoxia related to a low cardiac output . It is oNationwide databases examining the temporal trends in CS have shown inconsistent data regarding the incidence of CS. While some studies demonstrate an increase in the overall incidence of CS in recent years , others CS complicates approximately 5–10% of AMIs, with a higher incidence in ST-elevation myocardial infarctions, and it is more frequently seen among women and patients >75 years old ,23.p = 0.027, and 47% vs. 34%, p = 0.025, respectively). Thus, in the current era, the only intervention with a proven mortality benefit in CS complicating AMIs is early revascularization, either with a percutaneous coronary intervention or a coronary artery bypass grafting surgery with a class I indication in contemporary guidelines [The clinical and hemodynamic heterogenicity of CS, with only a few randomized clinical trials evaluating the various therapeutic approaches and recommendations, leads to uncertainties as to the best treatment strategies. Thus, the management of CS is often challenging and requires an early diagnosis and the institution of high-quality interdisciplinary care . When tridelines . MCS is idelines . Short-tidelines .Vasopressors are an essential part of the treatment for patients with shock and should be initiated early in septic shock . In contNevertheless, vasopressors are frequently administered in patients with CS and hypotension to maintain vital organ perfusion . Thus, rSimilar to our analysis, studies evaluating the administration of vasopressor drugs in critically ill patients via peripheral venous access reported a low overall risk for local complications (4–7%) without significant morbidity ,34,35.However, in contrast to previous studies that included heterogeneous groups of patients, our study included almost exclusively (86%) patients in CS. Shock secondary to a low cardiac output is a complex clinical entity associated with unique challenges. For instance, MCS devices introduced via large-bore vascular access are emerging as a cornerstone in the management of CS , though Finally, the vasopressor infusion and hospitalization length were longer and the mortality rates were higher in the CVC group. Not surprisingly, we adopted a more liberal approach for CVC insertion in more complex patients. Such patients required a more aggressive treatment, including higher vasopressor doses, the administration of more than one vasopressor, fluid resuscitation, blood products, and additional IV medications. Therefore, the higher fatality rate shown in the CVC group is probably related to a selection bias.Our study has several limitations. First, the study was not a randomized study, and the administration of vasopressors was at the discretion of the senior cardiologist, which may have caused a selection bias, though patients in the CVC group were younger and had similar co-morbidities to the PVC group. Indeed, the longer vasopressor administration and hospitalization length and the increased mortality rate reported in the CVC group indicate a higher degree of morbidity among patients in the CVC group. Second, our primary goal was not to prove the superiority of a PVC over a CVC, but to evaluate the safety and efficacy of the PVC approach. Third, the etiologies leading to the CS were not analyzed. Finally, there was no long-term follow-up.CS is a complex clinical entity associated with a high mortality rate and limited therapeutic approaches with a proven clinical benefit. Thus, the management of such patients is often challenging, and doubts as to the best treatment strategies often arise. Vasopressors are frequently infused to patients in CS, although the preferred route of administration has not been determined. A central venous line is an effective form of vascular access for the delivery of medications and fluids. However, CVC insertion requires proper training, is time consuming, and is associated with a high rate of adverse events. In contrast, the insertion of peripheral venous catheters is relatively simple with a low incidence of adverse events. Studies that have evaluated the safety and feasibility of peripherally administered vasopressors in patients with shock report a complication rate of up to 7%, with most of them minor and managed conservatively. However, prior studies included patients with different types of shock. In our analysis, the vast majority of patients had CS. In this unique population, we found that the administration of vasopressors via a PVC in CS patients is feasible and safe, at least in the initial stages of CS, with a similar, if not lower, rate of complications. Further studies are needed to establish this method of treatment. The adoption of dedicated protocols and local guidelines focusing on the management of intravascular catheters may further reduce the incidence of adverse events in patients presenting with CS.


COVID-19 prognostic risk factors, therapeutic protocols, and clinical outcomes in pediatric cases are still under investigation.  This historical cohort study evaluated the survival time of hospitalized children (1 month–18 years old) with COVID-19 admitted from March 2020 to August 2021 to an educational hospital in Yazd, Iran. The follow-up of patients was performed at least one month after discharge.  From 183 hospitalized cases, 24 children were deceased. The median age of patients was 5.41, and 54.2% were male. The survival rate after one-month follow-up was 0.88, and the most significant predictors associated with survival time were the male sex, positive history of hospitalization, lymphopenia, hypoxia, and length of stay more than two weeks using Bayesian Cox regression analysis.  Accurate estimation of the impact of predictors on poor outcomes may help healthcare providers use therapeutic protocols based on risk factors and healthcare requirements of each patient to improve their survival. Coronavirus disease COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) started in Wuhan, China, in December 2019 and was stated as a pandemic and public health emergency by the World Health Organization. Iran reported the first death due to COVID-19 among Middle East countries, and a mortality rate of 2%  has been announced in Iran until March 2023 9 caused . In addiThe present paper is written based on the STROBE statement for reporting historical cohort studies . In this2sat)), patients who suffered from multisystem inflammatory syndrome of children (MIS-C) which was diagnosed based on the WHO criteria, laboratory findings , and chest CT-scan findings (pattern and severity score) of 183 patients were collected from medical records. The severity of the disease is defined based on WHO recommendations definition in three categories: nonsevere , severe , and critical  [Demographic data (age and sex), underlying diseases, preadmission, on-admission clinical symptoms, length of hospital stay (day), PICU admission, vital signs on admission  , 15. Bashttps://www.rstudio.com/) and packages survival, KMsurv, spBayesSurv, and coda. The significance level of 0.05 was regarded as statistically significant.Continuous and categorical variables were described using the mean ± SD and frequency (percentage). In order to compare the difference of explanatory variables in survived and deceased groups, the Pearson chi-square and Fisher exact tests were used. Cramer's V and Eta were considered as the measure of association between independent variables and outcome. The Kaplan–Meier method and the log-rank test were performed to estimate and compare the survival functions in different categories of each explanatory variable. Using a stepwise process, the Cox proportional hazards model was fitted, including significant independent variables in univariate analysis. In the multivariate approach, Bayesian survival analysis was conducted to estimate significant independent variables to overcome a few outcomes. The survival analysis was conducted using RStudio (RStudio Team (2020), RStudio: integrated development for R. RStudio, PBC, Boston, MA URL n = 24) of children with COVID-19 died that most aged 1–5; however, the association between the age groups and death was insignificant. The previous hospitalization, PICU admission, abnormal long CT findings, O2sat, patient intubation, ventilator support, and length of hospital stay were significant among all variables. The strength of the relationship between death and variables, including ventilatory support (Cramer's V = 0.52), PICU admission (Cramer's V = 0.49), and patient intubation (Cramer's V = 0.48), was the highest . Thirteen percent ( highest . As showP = 0.04). Fifty-three children received remdesivir, and the death rate was 33%, showing no significant difference between the two groups. In addition, only 10.5 percent of children received favipiravir, and all survived. No significant difference in the mortality rate was observed among other drugs used for patients , and the differences between the two groups were significantly meaningful , elevated CPK value above 200 (U/L), and duration of hospitalization of more than one week could increase the risk of death by more than threefold. As shown in Furthermore, the hazard ratio of death was 14 times more in intubated patients. The recent history of hospitalization, hypoxia . In addition, the hospitalization duration of more than two weeks would increase the hazard of death to 89% for children.Bayesian survival analysis was regarded as a practical statistical approach for predicting survival rates in such data where the occurrence of outcome was not high. As mentioned in the result section, only 13% of hospitalized children with COVID-19 died, and the patients' overall survival rate on the 10Since the global research on mortality and survival in children with COVID-19 was insufficient or the data collected were limited, this study was undertaken to record and report a large subset of relevant variables. Moreover, in this research, each patient was followed at least one month after discharge, which was not investigated in other studies. According to the data, 183 patients aged between 1 month and 18 years old were admitted to Shahid Sadoughi Hospital in Yazd between March 2020 and August 2021. The findings of this study included detailed demographics, clinical characteristics, paraclinical data, medications, and their association with survival probabilities. The mortality rate of hospitalized children with COVID-19 was reported as 5.3% in Iran and tripled in children with underlying diseases . In thisSimilarly, Oliveira et al. found that the mortality rate in children younger than 20 was 7.8% (15). The death rate could vary in different studies based on substantial differences among countries in epidemiological features, healthcare system, access to standard treatments, and length of follow-up. From studies in China and a meta-analysis in Taiwan, the majority of children with COVID-19 (more than 90%) were reported in mild to moderate status, significantly higher than the observed rate of this research [In this study, children aged between 5 and 13 years old suffered more from COVID-19 (33%), which was similar to the results of other studies of Dong et al., Mahmoudi et al., and Swan et al. such as the Center for Disease Control report (CDC report) in the United States . CompareFurthermore, previous studies represented a significantly higher mortality rate in hospitalized children with comorbidities, which was not found in this study. In this study, 24% of the patients were complicated by MIS-C, which was higher than in similar studies . As ment2sat lower than 95% was the presenting symptom in 41% of hospitalized Brazilian children, but its association with the mortality rate was not investigated [2sat lower than 94% was common among infected children, and there was a negative association between death frequency and oxygen saturation percent [Most studies reported fever and cough as the frequent symptoms among hospitalized children with COVID-19. Dyspnea and chest pain were declared as the third and fourth most frequent symptoms in children with severe disease who were admitted to Children's Hospital in New York City, but no significant difference was observed in the frequency of these symptoms in comparison with patients without a severe disease . Similarstigated . Based o percent , 18, 34.The result showed that the mortality rate in patients with high AST (U/L) and CPK (U/L) and children with lymphopenia would increase considerably. According to one systematic review published in 2020, hypoalbuminemia, lymphopenia, leukocytosis, elevated interleukin level 6, and prolonged PT time were effective laboratory features associated with the mortality rate in children with COVID-19 . Like th2sat <90.5% seemed to be a reliable predictor for patient survival which was not found in this investigation [In this research, the significant risk factors of death related to COVID-19 were a positive history of hospitalization, hypoxia, lymphopenia, elevated serum levels of AST and CPK, need for intubation and ventilatory support, and length of hospital stay of more than one week. Compared with studies of Oliveira et al., Gӧtzinger et al., and Swann et al., there was a weak relationship between underlying diseases and mortality risk , 18, 22.tigation .The most feature of this study was the estimation of the survival rate of COVID-19 inpatient children and its association with predictive factors through two different statistical approaches. Also, this study had two other strengths. First, all of the important variables related to the mortality of COVID-19 patients were recorded, and the survival rate based on the different categories of these variables was evaluated. Second, the children were followed precisely at least one month after discharge. However, some important limitations of the current study were the small population of patients in a single center. In addition, the data were collected from the electronic records of the patients, which had some missing information that affected the outcomes of the study.Since SARS-CoV-2 is a novel virus and the number of infected children is not limited, this study provided a proper statistical method to evaluate the association of demographical and clinical profiles and laboratory findings with the survival of hospitalized children. The findings suggested that specific subgroups of children, including boys and those with a positive history of hospitalization and underlying diseases, are at higher mortality risk. The presence of lymphopenia and hypoxia also significantly increases the mortality risk in children with COVID-19. In addition, hospitalization for more than two weeks increases the risk of developing complications from COVID-19 and even death. These results underscore the need for improved therapeutic protocols to control hospital mortality rates. It is recommended that physician pay more attention to clinical and paraclinical risk factors which could increase the severity and mortality in pediatric patients.