30-day Follow-up Period Research Articles

A randomized trial of MONOFIX® vs. V-loc™ for resection bed suture during robotic partial nephrectomy

BackgroundTo evaluate the clinical efficacy and safety of Monofix®-PDO compared to V-Loc™ for tumor bed suturing during robotic-assisted laparoscopic partial nephrectomy (RAPN).MethodsA randomized, controlled, multicenter, single-blinded trial was conducted across four tertiary institutions. Patients with T1-2 stage renal masses scheduled for RAPN were enrolled. The exclusion criteria included patients not deemed in need of bed suturing, those with a history of prior chemotherapy or immunotherapy, and those with severe systemic diseases or high bleeding tendencies. A total of 174 patients participated and were subjected to permuted block randomization (T1a vs. others), resulting in 88 patients in the V-Loc™ group and 86 in the Monofix®-PDO group. The primary outcome was the resection bed suture time. The secondary outcomes were total suture use time, warm ischemia time, console time (for efficacy), estimated blood loss, hemoglobin change, and 90-day treatment-related adverse events (for safety). All patients were scheduled for follow-up visits for up to three months postoperatively.ResultsThe primary outcome, resection bed suture time, did not significantly differ between the V-Loc™ and Monofix®-PDO groups (4.8 ± 2.6 vs. 4.5 ± 2.6 min, p = 0.531). Secondary outcomes, including total suture used time (5.3 ± 2.8 vs. 4.8 ± 2.6 min, p = 0.289) and warm ischemic time (15.6 ± 5.5 vs. 15.4 ± 5.4 min, p = 0.834), were comparable between the two groups. In terms of safety outcomes, changes in serum hemoglobin levels did not show significant differences on postoperative days 1, 3, and 14 (P = 0.537, 0.353, and 0.840, respectively). No device-related adverse events were observed during the 90-day follow-up period in either group.ConclusionsMonofix®-PDO demonstrated non-inferior to V-Loc in terms of both safety and efficacy in patients undergoing RAPN. This trial is registered on cris.nih.go.kr as KCT0006809 (Registration date: 02/19/2021).

Application of Hand-Sewn Anastomosis in Totally Laparoscopic Radical Resection of Colorectal Cancer with Transanal Specimen Extraction

Objective: To explore the value of hand-sewn anastomosis in totally laparoscopic radical resection of colorectal cancer with transanal specimen extraction. Methods: A retrospective descriptive study was conducted. Clinical data of 54 patients with colorectal cancer who underwent total laparoscopic transrectal specimen extraction surgery between January 2019 and December 2023 at the Department of Gastrointestinal Surgery, Bayannur City Hospital, were collected. All patients underwent digestive tract reconstruction using hand-sewn end-to-end colonic or rectal anastomosis. Intraoperative and postoperative general conditions, pathological results, complications, and follow-up data were analyzed. Results: Among the 54 cases, 37 were male, and 17 were female. The cases included 26 sigmoid colon cancers, 27 high rectal cancers, and 1 descending colon cancer. All patients underwent total laparoscopic radical resection of colorectal cancer with transrectal specimen extraction. The average surgical duration was 187.87 ± 61.36 minutes, with 16 (14–19) minutes required for hand-sewn anastomosis. Intraoperative blood loss was 16 (10–200) mL, with no conversions to open surgery or blood transfusions. Postoperative outcomes included first flatus time of 1 (1–3) day, liquid diet resumption on 2 (2–3) days, postoperative Visual Analog Scale (VAS) pain score of 2 (2–3), and hospital stay duration of 8 (7–9) days. The total hospitalization cost was 41,011 (25,655–148,589) Chinese yuan, with an average cost of 42,558.81 ± 8,599.30 Chinese yuan after excluding three cases with complications. Pathological examination revealed all cases to be adenocarcinomas: 20 well-differentiated, 32 moderately differentiated, and 2 poorly differentiated. All resection margins were negative. An average of 16.85 ± 7.97 lymph nodes were dissected. Pathological staging included 18 stage I, 17 stage II, and 19 stage III cases. Postoperative complications included 2 cases of anastomotic leakage (3.7%), 1 case of anastomotic stricture (1.8%), and 1 case of pulmonary infection (1.8%). No unplanned readmissions or postoperative deaths occurred during the 30-day follow-up period. Conclusion: Hand-sewn anastomosis in totally laparoscopic radical resection of colorectal cancer with transanal specimen extraction is safe and feasible.

Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring.

Sotalol is a class III antiarrhythmic drug used for the management of patients with atrial fibrillation to maintain sinus rhythm. Sotalol-induced QT interval prolongation can be proarrhythmic and is conventionally initiated in an inpatient setting where routine electrocardiographic (ECG) monitoring is available while sotalol reaches the steady state. The emergence of cellular-compatible home ECG devices, such as AliveCor's Kardia Mobile 6L, which offers 6-lead ECG, has made it possible to accurately measure QT intervals outside the hospital. This study aimed to evaluate the safety, feasibility, and patient adherence to protocol-driven, pharmacist-led outpatient sotalol initiation using the Kardia Mobile 6L for remote ECG monitoring and to compare these outcomes with patients completing inpatient sotalol protocol for initiation. Patients who underwent outpatient sotalol initiation through an antiarrhythmic clinic for the treatment of both atrial and ventricular arrhythmias over a period of approximately 3 years, from September 1, 2020, to June 16, 2023, were retrospectively reviewed and compared with a cohort of inpatients initiated on sotalol. The outpatient cohort had a minimum longitudinal follow-up of 90days. A total of 263 patients using the outpatient sotalol initiation protocol were compared with 28 age- and sex-matched inpatients who underwent inpatient sotalol initiation. The outpatient cohort included 179 men (68%), with an age of 68.8 ± 10.1 years, CHA2DS2-VASc score of 3.48 ± 1.43, baseline 12-lead QTc interval of 440.77 ± 33.42ms, and a left ventricular ejection fraction of 57.4% ± 9.23%. Outpatients were started on a median (minimum-maximum) dose of 120 (80-160) mg of sotalol twice a day (120-mg dose; n=227; 86.3%) and ended at a median (minimum-maximum) dose of 120 (60-160) mg twice a day (120-mg dose; n=217; 82.5%). The proportions of patients prescribed low-, moderate-, or high-dose sotalol twice a day (60mg, 80mg, 120mg, and 160mg) at the end of initiation were similar between the inpatient and outpatient groups (P=0.5). The majority (98.9%; 260 of 263) of patients completed the 3-day outpatient initiation. Outpatient adherence was high during the 3-day initiation period among patients with varied age and socioeconomic background; 258 patients (98.1%) completed the ECG on day 1, and 240 (91.3%) completed the ECG on day 3. No significant QTc interval prolongation was observed during the outpatient postinitiation study period. There were similar sotalol discontinuation rates within 30days of initiation in the inpatient vs outpatient cohorts (7% vs 8%; P > 0.90). A total of 17 (6.5%) patients stopped sotalol because of symptomatic bradycardia, and 1 death was observed over a 90-day follow-up period in the outpatient cohort. Outpatient initiation of sotalol through a protocol-driven, pharmacist-led antiarrhythmic clinic is feasible and safe, with high adherence rates in a diverse range of patients using personal remote ECG.

Effects of different endovascular treatments on cerebral perfusion changes and stroke recurrence in patients with intracranial atherosclerosis.

In patients with refractory intracranial atherosclerotic disease (ICAD), percutaneous transluminal balloon angioplasty (PTBA) is less complex but typically results in higher postprocedural residual stenosis than percutaneous transluminal angioplasty with stenting (PTAS). This study included patients with symptomatic ICAD with 70-99% stenosis treated with either PTBA or PTAS. All patients underwent preprocedural and postprocedural CT perfusion, which was processed by automated RAPID software. The rate of cerebral perfusion change was defined as the ratio of the volume of perfusion change to the preprocedural perfusion volume. Perioperative complications within a 30-day follow-up period were documented. Baseline characteristics, degree of stenosis before and after procedures, perioperative complications, and the rates of cerebral perfusion change were compared between groups. Patients were followed up for stroke recurrence within 1 year postprocedure, with survival analysis used to examine the relationship between procedure type and recurrence. Between March and December 2021, 107 patients were enrolled: 30 (28.0%) were treated with PTBA and 77 (72.0%) with percutaneous transluminal angioplasty with stenting (PTAS). The PTBA group showed higher postprocedural residual stenosis than the PTAS group (P<0.004). The cerebral perfusion change rates were not significantly different between the groups (P=0.891). Three (3.9%) complications occurred in the PTAS group and none in the PTBA group during the 30-day follow-up. Stroke recurrence did not significantly differ between the procedures (P=0.960). Immediate cerebral perfusion changes and the rate of stroke recurrences have no significant difference between the two groups.

The Impact of Socioeconomic Factors on 90-day Postoperative Readmissions and Cost in Shoulder Arthroplasty Patients

Understanding the impact of Social Drivers of Health (SDOH) on shoulder arthroplasty is pivotal for the development of equitable value-based payment models that enhance the quality of patient care. This investigation aims to understand the influence of Area Deprivation Index (ADI) on hospital admissions, readmissions, and associated costs post-shoulder arthroplasty. We conducted an analysis using US Medicare claims data from 2019 to 2021, identifying patients who received shoulder arthroplasty in either an inpatient or outpatient setting using Current Procedural Terminology (CPT) codes. Our primary outcomes were 90-day unplanned readmissions and post-procedure 90-day care costs. The ADI was our primary exposure variable, calculated at the census block level. Our analysis adjusted for multiple factors using a stepwise modeling approach including patient demographics, 29 Elixhauser comorbid conditions, Medicaid-dual eligibility, and end-stage renal disease status using logistic regression models. A total of 145,435 patients were included in our study. The average age of patients in our cohort was 74.5 years old, with 59.5% being female. Patients in the high ADI group had a higher readmission rate than the lowest ADI group (8.5% vs. 6.0%, p<0.001).When controlling for confounding factors, there was an indepdentent association between high ADI and readmission (OR: 1.28 [95% CI 1.12, 1.46]). Overall, we saw a dose-dependent relationship between ADI and readmission, with the association growing stronger as ADI increased. Conversely, we found a negative association with ADI and high-costs. (High ADI Group OR: 0.80 [95% CI 0.70, 0.91]). Patients in the high SES group had higher healthcare contact days during the 90-day follow-up period, with a median of 16 visits (IQR 8, 23), compared to 13 visits (IQR 6, 22) in the middle SES group and 10 visits (IQR 5, 20) in the low SES group (p<0.001). Socioeconomic disparities significantly influence the outcomes of primary shoulder arthroplasty, as indicated by higher readmission rates for low SES patients. Notably, our analysis shows a strong, independent association between ADI and readmission. Moreover, patients with higher SES incurred greater costs within a 90-day period potentially due to increased resource utilization.

Extensive Dysregulation of Phenylalanine Metabolism Is Associated With Stress Hyperphenylalaninemia and 30-Day Death in Critically Ill Patients With Acute Decompensated Heart Failure.

Stress hyperphenylalaninemia predicts elevated mortality rates in patients with acute decompensated heart failure (ADHF). This study investigated the metabolic pathways underlying this association and identified a unique metabolic phenotype underlying the association between stress hyperphenylalaninemia and adverse outcomes in ADHF. This was a retrospective cohort study. We enrolled 120 patients with ADHF in an intensive care unit (60 with a phenylalanine level ≥112 μM, 60 with a phenylalanine level <112 μM), and 30 controls. Plasma phenylalanine-derived metabolites were measured, and participants were evaluated for 30-day death. Patients with ADHF had extensive activations of the alternative pathways for metabolizing phenylalanine, leading to the levels of phenylalanine-derived downstream metabolites 1.5 to 6.1 times higher in patients with ADHF than in the controls (all P<0.001). Extensive dysregulation of these alternative pathways significantly increased phenylalanine levels and contributed to a distinct metabolic phenotype, characterized by increased phenylalanine, tyrosine, homogentisic acid, and succinylacetone levels but decreased benzoic acid and 3,4-dihydroxyphenylalanine levels. Throughout the 30-day follow-up period, 47 (39.2%) patients died. This distinct metabolic phenotype was associated with an increased mortality rate (odds ratio, 1.59 [95% CI, 1.27-1.99]; P<0.001). A multivariable analysis confirmed the independent association of this metabolic phenotype, in addition to phenylalanine and tyrosine levels, with 30-day death. In patients with ADHF, extensive dysregulation of the alternative pathways for metabolizing phenylalanine was correlated with stress hyperphenylalaninemia and a distinct metabolic phenotype on the phenylalanine-tyrosine-homogentisic acid-succinylacetone axis. Both stress hyperphenylalaninemia and metabolic dysregulation on this axis were associated with poor outcomes.

Early surgical outcome for Tetralogy Of Fallot In An African Setting; A Tanzanian experience using retrospective analysis of hospital data

BackgroundTetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the early results of children undergoing primary complete TOF repair at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac center in Eastern Africa.MethodsA retrospective cohort study of children ≤ 18 years undergoing primary TOF complete repair between 2019 and 2021 was conducted. Patients with complex TOF and those with obvious genetic syndrome were excluded. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays.ResultsThe I02 children underwent primary TOF complete repair were majority male (65.7%; n = 67), with a median age of 3.0 years (IQR: 2–6), ranging from 3 months to 17 years.Only 20 patients (19.6%) were below one year of age. Almost all (90%; n = 92) were underweight, with a mean BMI of 14.6 + 3.1 kg/m2 Haematocrits were high, with a median of 48.7 (IQR: 37.4–59.0). The median oxygen saturation was 81% (IQR:72–93). Over a third of patients (38.2%; n = 39) needed Trans annular patch (TAP) during surgery. The median ICU stay was 72 h (IQR:48–120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7–11), with 70 patients (68.2%)experiencing an extended hospital stay of > 7 days. Bacterial sepsis was more common than surgical site infection (5.6%; n = 6 vs. 0.9%;n = 1). No patient needed re-operation for the period of follow up. The in-hospital mortality rate was 5.9%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to age, sex, levels of hematocrit and saturations, presence of medical illnesses, and placement of TAP.ConclusionTOF repairs in this African setting at a national cardiac referral hospital face challenges associated with patients’ older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It’s important to address these issues to improve outcomes in these settings.

WP2.14 - Lung Mycetoma - Chronicles from the Pandemic

Abstract Introduction COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection. Case Study A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period. Conclusion Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.

Results of a Pilot Trial Assessing the Effects of Proper Oral Hygiene and a Probiotic Dietary Supplement on Oral Health in Volunteers with Oral Malodor.

Persistent malodor affects many people worldwide and is usually associated with poor dental hygiene. This pilot trial aimed to determine whether proper dental hygiene (DH) and a probiotic dietary supplement support oral health in volunteers with persistent malodor. Volunteers (n = 35) were randomly assigned to the probiotic or placebo cohort. The probiotic cohort (n = 20) brushed and flossed their teeth twice daily and used probiotics for 30 days; the placebo cohort (n = 15) followed the same hygiene practices and used the placebo. The intervention phase was followed by a 30-day follow-up period. Measured outcomes were malodor and tongue-coating scores, probiotic DNA levels, salivary cytokines, and salivary pH. DH and probiotics significantly decreased malodor (~50% during intervention) and tongue coating scores (~45% during intervention). These changes remained through the course of the trial. The probiotic DNA levels increased in the probiotic cohort and dropped in the placebo cohort after the intervention started. The malodor moderately correlated with the tongue coating P. acidilactici level. The addition of probiotics increased IL-10 levels during the intervention and decreased IL-8, TNF-α, and IL-6 by the end of the study. People with malodor may benefit from using DH and probiotics. Additional trials are needed to definitively establish the benefits of probiotic dietary supplements.

Dynamic changes of platelets before and after surgery predict the prognosis of patients with aneurysmal subarachnoid hemorrhage

ObjectiveThis investigation explored the association between postoperative/preoperative platelet ratio (PPR) and the incidence of unfavorable outcomes within 90 days in individuals with aneurysmal subarachnoid hemorrhage (aSAH). MethodsThis investigation, utilizing data from 2015 to 2022, concentrated on patients diagnosed with aSAH, categorizing them into four groups based on PPR quartiles. The association between PPR levels and clinical outcomes—comprising in-hospital complications, mortality, and modified Rankin Scale (mRS) scores at discharge and 90 days after that—was evaluated through logistic regression analyses. To explore potential non-linear associations between PPR levels and outcomes, restricted cubic spline (RCS) regression was applied. Further, mediation analysis was performed to elucidate the role of in-hospital complications in modulating the impact of PPR levels on 90-day outcomes. ResultsThis study analyzed data from 948 patients. Upon adjustment for confounding variables, it was observed that patients in the higher quartiles showed reduced incidences of anemia, hypoproteinemia, and pneumonia, alongside a decreased frequency of unfavorable outcomes within a 90-day follow-up period. The RCS analysis indicated a linear association of PPR with pneumonia, hypoproteinemia, and adverse 90-day outcomes (p for nonlinear = 0.61, 0.52, and 0.96, respectively). Moreover, the association of PPR with anemia was found to be nonlinear (p for nonlinear = 0.01). Mediation analysis further indicated that anemia and pneumonia significantly influenced the association between PPR and unfavorable outcomes at 90 days, accounting for 15.49 % and 27.61 % of the effect, respectively. ConclusionsThis study establishes a significant correlation between decreased PPR levels and 90-day adverse outcomes following aSAH, potentially relating to pneumonia and anemia.

Benzodiazepine receipt in adults with psychogenic non-epileptic seizures in the USA

BackgroundCharacterising benzodiazepine (BZD) prescribing to individuals with psychogenic non-epileptic seizures (PNES) is important for optimising PNES outcomes, but existing data is lacking.MethodsUsing a nationwide administrative claims database (2016–2022), incident PNES...

An emergency department transitional care team prevents unnecessary hospitalization of older adults: a mixed methods study.

Older adults with acute functional decline may visit emergency departments (EDs) for medical support despite a lack of strict medical urgency. The introduction of transitional care teams (TCT) at the ED has shown promise in reducing avoidable admittances. However, the optimal composition and implementation of TCTs are still poorly defined. We evaluated the effect of TCTs consisting of an elderly care physician (ECP) and transfer nurse versus a transfer nurse only on reducing hospital admissions, as well as the experience of patients and caregivers regarding quality of care. We assessed older adults (≥ 65 years) at the ED with acute functional decline but no medical indication for admission. Data were collected on type and post-ED care, and re-visits were evaluated over a 30-day follow-up period. Semi-structured interviews with stakeholders were based on the Consolidated-Framework-for-Implementation-Research, while patient and caregiver experiences were collected through open-ended interviews. Among older adults (N = 821) evaluated by the TCT, ECP and transfer nurse prevented unnecessary hospitalization at the same rate (81.2%) versus a transfer nurse alone (79.5%). ED re-visits were 15.6% (ECP and transfer nurse) versus 13.5%. The interviews highlighted the added value of an ECP, which consisted of better staff awareness, knowledge transfer and networking with external organizations. The TCT intervention in general was broadly supported, but adaptability was regarded as an important prerequisite. Regardless of composition, a TCT can prevent unnecessary hospitalization of older adults without increasing ED re-visiting rates, while the addition of an ECP has a favourable impact on patient and professional experiences.

Evaluation of Negative Pressure Dressings for Closed Surgical Incisions in Decreasing Surgical Site Infections After Emergency Laparotomy: A Randomized Controlled Study.

Objectives The aim of this study is to compare the effectiveness of negative pressure dressings (NPDs) versus conventional dressings for closed surgical incisions after emergency midline laparotomy, focusing on their impact on surgical site infection (SSI) rates, wound dehiscence, hospital stay duration, and cosmetic outcomes. Methods The randomized controlled study was conducted over 24 months, involving 80 patients aged 18-65 years who had peritonitis and underwent emergency midline laparotomies. Patients with diabetes mellitus, a BMI >35 kg/m², immunocompromised conditions, or those requiring re-exploration within 30 days of surgery were excluded. The participants were randomly assigned into two groups using a computer-generated randomization table: Group A, the case group, consisted of 40 patients who received NPDs, while Group B, the control group, included 40 patients who received conventional dressings. Data were recorded in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with a p-value of <0.05 considered statistically significant. Results The overall occurrence of SSIs within the 30-day follow-up period was significantly lower in the NPD group compared to the conventional dressing group (30% vs. 70%, p < 0.05). The mean duration of hospital stay was 14.85 ± 10.43 days for the NPD group and 15.4 ± 9.75 days for the control group, with no statistically significant difference (p = 0.712). The mean Vancouver Scar Scale score was 5.3 ± 2.47 in the NPD group and 6.5 ± 2.14 in the control group, also showing no statistically significant difference (p = 0.11). Conclusions NPDs significantly reduced the incidence of SSIs compared to conventional dressings, but they did not have a significant impact on scar cosmesis or the duration of hospital stay.

Personalized Nutrition Therapy without Weight Loss Counseling Produces Weight Loss in Individuals with Prediabetes Who Are Overweight/Obese: A Randomized Controlled Trial.

Obesity stands out as a primary risk factor for diabetes. Attaining healthy weight loss, especially reducing body fat, is important in managing prediabetes and preventing progression to full diabetes and its co-morbidities. This study examined the effects of personalized nutrition therapy (PNT) combined with continuous glucose monitoring (CGM) on body weight and composition in individuals with prediabetes. A total of 30 individuals with prediabetes who were overweight or obese were assigned randomly to either the treatment, observed CGM data plus PNT, or the control group which was blinded to their blood glucose results throughout the study. Both groups were provided with dietary recommendations for calorie intake and macronutrient distribution, coupled with personalized goal setting for glucose control and healthy eating, without any specific emphasis on weight reduction or changes in physical activity. Regular visits were scheduled every 10 days to perform measurements and replace CGMs. Data were analyzed using General Linear Model with repeated measures. Over the 30-day follow-up period, both groups experienced significant reductions in weight and fat mass. The treatment group exhibited two-fold greater reductions in both weight and fat mass, a significant decrease in carbohydrate intake, and a significant increase in time spent on physical activitycompared to the control group. In addition, compliance was notably higher in the treatment group. These findings indicate that overweight or obese individuals with prediabetes can achieve weight loss and improved body composition through personalized education for glucose control, without exclusively emphasizing weight loss as the primary objective. Additionally, the real-time feedback provided by CGM enhances these improvements.

Effect of Amalakyavaleha in the Management of Pandu Roga w.s.r. to Iron Deficiency Anemia in Children

Anemia is a prevalent issue among children, characterized by a deficiency in red blood cells or hemoglobin. The primary causes, such as iron deficiency is the most common nutritional deficiency anemia, are often straightforward to address. In Ayurveda, it is correlated to Pandu Roga based on similarities in clinical features and offers various herbal remedies and dietary guidelines, known as Pathya Palan, specifically targeting anemia. It means the disease condition in which the skin of the person is discolored like Haridra or greenish tinge and other peculiar signs and symptoms include Hridayaspandanam, Roukshyam, Swedabhava, Shrama and its consequences. It is not a disease entity as such but is the manifestation of different diseases. There is pallor on the skin due to a deficiency of Rakta Dhatu (blood tissue) either in the form of hemoglobin and or red blood cells (RBCs). This study aimed to evaluate the effectiveness of Amalakayavleha and Pathya Palan in managing anemia. The study was conducted at the OPD of Balroga, Rajiv Gandhi Ayurvedic College and Hospital Paprola Dist. Kangra HP. The method involved assessing patients before and after treatment with a 30-day follow-up period. The results indicated that Amalakyavaleha and Pathya Palan were indeed effective in managing anemia in children.

Association of intravenous digoxin use in acute heart failure with rapid atrial fibrillation and short-term mortality according to patient age, renal function, and serum potassium.

Intravenous digoxin is still used in emergency departments (EDs) to treat patients with acute heart failure (AHF), especially in those with rapid atrial fibrillation. Nonetheless, many emergency physicians are reluctant to use intravenous digoxin in patients with advanced age, impaired renal function, and potassium disturbances due to its potential capacity to increase adverse outcomes. We investigated whether intravenous digoxin used to treat rapid atrial fibrillation in patients with AHF may influence mortality in patients with specific age, estimated glomerular filtration rate (eGFR), and serum potassium classes. A secondary analysis of patients included in in the Spanish EAHFE cohort, which includes patients diagnosed with AHF in the ED. 45 Spanish EDs. Two thousand one hundred ninety-four patients with AHF and rapid atrial fibrillation (heart rate ≥100 bpm) not receiving digoxin at home, divided according to whether they were or were not treated with intravenous digoxin in the ED. The relationships between age, eGFR, and potassium with 30-day mortality were investigated using restricted cubic spline (RCS) models adjusted for relevant patient and episode variables. The impact of digoxin use on such relationships was assessed by checking interaction. The median age of the patients was 82 years [interquartile range (IQR) = 76-87], 61.4% were women, 65.2% had previous episodes of atrial fibrillation, and the median heart rate at ED arrival was 120 bpm (IQR = 109-135). Digoxin and no digoxin groups were formed by 864 (39.4%) and 1330 (60.6%) patients, respectively. There were 191 deaths within the 30-day follow-up period (8.9%), with no differences between patients receiving or not receiving digoxin (8.5 vs. 9.1%, P = 0.636). Although analysis of RCS curves showed that death was associated with advanced age, worse renal function, and hypo- and hyperkalemia, use of intravenous digoxin did not interact with any of these relationships ( P = 0.156 for age, P = 0.156 for eGFR; P = 0.429 for potassium). The use of intravenous digoxin in the ED was not associated with significant changes in 30-day mortality, which was confirmed irrespective of patient age or the existence of renal dysfunction or serum potassium disturbances.

Factors affecting mortality in COVID-19-associated pulmonary aspergillosis: An international ID-IRI study

BackgroundThis study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). MethodsIn this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. ResultsA total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ≥65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ≥65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). ConclusionThis study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.

Prognostic Value of the Advanced Lung Cancer Inflammation Index Ratio in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Cohort Study.

Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) carries a high mortality risk. Inflammation and nutrition are involved in the pathogenesis and prognosis of both AMI and CS. The advanced lung cancer inflammation index ratio (ALI) combines the inflammatory and nutritional status. Our present study aimed to explore the prognostic value of ALI in patients with CS following AMI. In total, 217 consecutive patients with AMI complicated by CS were divided into two groups based on the ALI admissions cut-off: 12.69 and 12.69. The primary endpoint of this study was 30-day all-cause mortality. The secondary endpoints were gastrointestinal hemorrhage and major adverse cardiovascular events (MACEs), including 30-day all-cause mortality, atrioventricular block, ventricular tachycardia/ventricular fibrillation, and nonfatal stroke. The association of ALI with the study endpoints was analyzed by Cox regression analysis. During the 30-day follow-up period after admission, 104 (47.9%) patients died and 150 (69.1%) suffered MACEs. The Kaplan-Meier analysis revealed significantly higher cumulative mortality and lower MACE rates in the low-ALI group compared to the high-ALI group (both log-rank p 0.001). The 30-day mortality rate was significantly higher in patients with ALI 12.69 compared to ALI 12.69 (72.1% vs. 22.6%; p 0.001). Furthermore, the incidence of MACEs was higher in patients with ALI 12.69 (85.6% vs. 51.9%; p 0.001). The receiver operating curve showed that ALI had a modest predictive value (area under the curve [AUC]: 0.789, 95% confidence interval [CI]: 0.729, 0.850). After multivariable adjustment, ALI 12.69 was an independent predictor for both 30-day all-cause mortality (hazard ratio [HR]: 3.327; 95% CI: 2.053, 5.389; p 0.001) and 30-day MACEs (HR: 2.250; 95% CI 1.553, 3.260; p 0.001). Furthermore, the addition of ALI to a base model containing clinical and laboratory data statistically improved the predictive value. Assessing ALI levels upon admission can provide important information for the short-term prognostic assessment of patients with AMI complicated by CS. A lower ALI may serve as an independent predictor of increased 30-day all-cause mortality and MACEs.

Early Diagnostic and Management of Acute Heart Failure: Can Cardiogenic Shock be Prevented?

Background: Heart failure is a growing health concern, affecting about 2% of the adult population. It emphasizes the importance of recognizing and addressing a specific subgroup of patients suffering from acute heart failure (AHF). AHF is described as a critical clinical condition often overlooked in diagnosis, leading to catastrophic outcomes if not promptly identified. Given its potential severity, understanding the unique characteristics of AHF, along with appropriate therapeutic interventions, is crucial for improving patient outcomes and reducing mortality rates. Methods: The study included 20 patients with heart failure and reduced ejection fraction who presented with decompensated clinical conditions characteristic of acute heart failure. Data were collected preoperatively, perioperatively, and postoperatively up to a 30-day follow-up period. Results: The primary outcome was the 30-day mortality, which was found to be 20%. Among the patients with AHF, 60% had congestive heart failure with an average ejection fraction of 29.8%, indicating severe ventricular dysfunction. Additionally, 45% of patients presented with chronic kidney injury, characterized by a low mean glomerular filtration rate and elevated urea and creatinine levels. The presence of acute congestive and retention syndrome was evident in these patients, exacerbating the underlying disease. Notably, 10% of patients required left ventricular assistance devices, and associated procedures were performed as part of the surgical management of heart failure. Conclusion: The failure to recognize the diagnosis of this serious acute condition can quickly lead to patient’s death. Although, AHF showed 30-days high mortality rate, early diagnose, decongestive therapy and myocardial revascularization had avoided worst outcomes in cardiogenic shock.

Perioperative fluid balance and early acute kidney injury after lung transplantation

BackgroundPostoperative acute kidney injury (AKI) after lung transplantation (LTx) is an important factor affecting the short-term outcomes. The focus item of transplantation centers is how to improve the incidence of AKI through optimal management during the perioperative period. ObjectiveThe purpose of the study is to investigate the influence of perioperative volume in the development of early AKI following LTx. MethodThe study involved patients who had undergone LTx between October 2018 to December 2021 at China-Japan Friendship Hospital in Beijing. The patients were monitored for AKI occurring within 72 hours after LTx, as well as the renal outcomes within 30 days. The perioperative volumes were compared and analyzed to determine the impact on various clinical outcomes. Results248 patients were enrolled in the study ultimately, with almost half of them (49.6 %) experiencing AKI. 48.8 % of AKI patients received continuous renal replacement therapy (CRRT), with 57.7 % recovered by the end of the 30-day follow-up period. A J-shaped relationship was demonstrated between perioperative volume and AKI incidence. Moreover, maintaining a positive fluid balance would increase the 30-day mortality and lead to poor renal outcomes. ConclusionPerioperative volume is an independent risk factor of early AKI after LTx. Positive fluid balance increases the risk of AKI, 30-day mortality, and adverse renal prognosis. The LTx recipients may benefit from a relatively restrict fluid strategy during and after the lung transplantation.