Clinical Condition Research Articles

Progress in Improving Metabolic Syndrome with Adzuki Bean

Metabolic syndrome (MS) is a clinical condition characterized by the simultaneous onset of abdominal obesity, abnormal blood sugar levels, dyslipidemia, and hypertension. It significantly impacts overall health and exhibits an increasing prevalence with a decreasing age of onset. Metabolic syndrome affects approximately one quarter of the global population, posing a critical threat to human well-being as a major public health concern. Current approaches for prevention and management primarily rely on pharmaceutical interventions or lifestyle modifications; however, their effectiveness remains limited. In recent years, the concept of food-medicine homology has emerged as a novel theory that holds promise in alleviating metabolic syndrome. Adzuki bean, a widely cultivated legume rich in various nutrients and bioactive compounds, has been traditionally recognized in Chinese medicine for its beneficial effects on invigorating QI (vital energy), arming the middle (digestive system), strengthening the spleen (immune function), and eliminating dampness (excess moisture). Numerous studies have demonstrated that adzuki bean can effectively regulate blood sugar levels, lipid profiles, blood pressure while improving gut microbiota imbalances and exhibiting anti-obesity properties to some extent. As such, it can serve as an adjunct therapy for managing metabolic syndrome. Compared to conventional drugs used for this purpose, adzuki bean offers safer alternatives with diverse product options. These findings provide valuable theoretical foundations and practical references for preventing and treating diseases associated with metabolic syndrome.

Diagnosis of sepsis: which clinical and laboratory biomarkers are useful?

The quest for an unequivocal diagnostic tool for sepsis has persisted for decades, but this goal remains elusive. The diagnosis of sepsis is characterized by its complexity, which encompasses dozens of biochemical, hematologic, and immunologic parameters as well as complex microbiological diagnostics. During the last decade, the integration of omics technologies has further complicated this landscape. Despite these advancements, clinical diagnosis remains the gold standard for the diagnosis of sepsis. In the following review, we provide an overview of select diagnostic biomarkers that are deemed readily applicable in routine clinical practice, thus extending beyond the confines of university hospitals. Verification of the reliability and usefulness of a diagnostic parameter generally takes several years, and this process is more difficult in patients with sepsis compared with other patients because of the complexity of this clinical condition. Nevertheless, the introduction of new technologies, the intensive use of bedside diagnostics, and the contribution of omics technologies are moving us toward the realization of personalized medicine and theranostics.

Isolated Intracranial Rosai-Dorfman Disease: A Diagnostic Challenge

Rosai-Dorfman disease (RDD) is a benign condition characterized by abnormal proliferation of white blood cells called histiocytes and an uncommon biological process called emperipolesis, in which a living cell penetrates inside another living cell. Central nervous system involvement in RDD is extremely rare. We report one such rare case of 47-year- old man who presented with right sided focal seizure from 1 year. MRI Brain showed a dural based lesion. On the basis of clinical presentation and radiological findings initial diagnosis made was of en plaque meningioma. Gross total resection of lesion was performed. Initial histopathological diagnosis was of IgG4 related HPM. Post surgery there was significant improvement in patients clinical condition. Intensity of seizure episodes were reduced. However due to persistence of right sided focal seizures, tissue blocks were reviewed and diagnosis of intracranial Rosai-Dorfman disease was made. Upon which further hematologist opinion was taken and whole body PET CT was done which showed solitary uptake in brain. It was observed that characteristic feature of RDD emperipolesis is sometimes masked by storiform fibrosis and lymphocytic infiltration leading to misdiagnosis. Therefore close follow up is required, in case of persistence of symptoms tissue blocks should be reviewed and possibility of intracranial Rosai-Dorfman disease should be considered while dealing with dural based lesions.

A new right-heart failure staging system in patients with severe tricuspid regurgitation. Prognostic implications

Abstract Objective Our aim was to describe a new right-heart failure (RHF) staging system in patients with severe tricuspid regurgitation (TR). Methods Multicenter, observational, and prospective registry in which all patients with severe TR have been consecutively collected within a 6-month period, classified according to their clinical condition and right ventricular status, and followed up for one year. Results A total of 1247 patients with severe TR [mean age: 76.7±10.5 years, 876 women (70.2%)] were included: 810 (64.9%) met criteria for severe TR, 301 (24.1%) massive TR, and 136 (11%) torrential TR. A new RHF staging was proposed depending on clinical condition, RV dilation and RV systolic dysfunction (Table). The largest group of patients had a normal right ventricle with signs/symptoms of RHF (41%). Death due to refractory HF occurred in 9,2% of patients, hospitalization for HF in 20,8%, and 12,3% underwent TR interventions. In the multivariate analysis the predictors of CV mortality were age, impaired renal function, previous HF admission, massive and torrential TR and Stages III and IV of the new right-heart failure staging system (figure). Conclusion The new RHF staging system accurately stratifies patients with severe TR into prognostic categories.

Active offer of influenza vaccination during hospitalization: a multicenter study in Sicily (Italy)

Abstract Background Every cold season, the Italian health institutions strongly recommend influenza vaccination for categories at risk of complications, however influenza vaccination coverage is over and over far from the desirable target of 95%. After the pilot experience conducted in Palermo during the 2022-23 influenza season, the ‘Vaccinations in the ward’ project was extended to other Sicilian centers in order to evaluate the impact of the vaccination offer strategy in a broader territorial reality and to analyze the determinants of influenza vaccine acceptance among at risk people. Methods The project was conducted at the Umberto I Hospital in Enna and the University Hospitals of Messina and Palermo during the 2023-24 influenza season. A questionnaire was administered to the at risk hospitalized patients to investigate socio-demographic factors, behavioral habits, and clinical condition. Furthermore, influenza vaccination upon discharge was offered. Multivariable logistic regression was performed to identify the determinants of influenza vaccine acceptance. Results Overall, 374 patients with a median age of 65 years (IQR: 50-70) were recruited, of whom 36% had been vaccinated for influenza during the 2022-23 season (n = 136). The patients who accepted influenza vaccination in the ward were 57% (n = 214). The determinants of vaccination adherence were: age (OR: 1.03; p = 0.003); having quit smoking (OR: 2.68; p = 0.017); having received advice on vaccination from general practitioner (OR: 4.9; p < 0.001) and hospital healthcare workers (OR: 7.3; p < 0.001). Conclusions The offer of vaccination in the ward effectively increased influenza coverage among categories at risk of complications. Furthermore, the adoption of correct behavioral habits and the promotion of influenza vaccination by healthcare personnel have played a decisive role in the vaccine acceptance process. These findings could be useful for planning future influenza vaccination campaigns targeted to at risk people. Key messages • Vaccination strategies are needed to increase influenza coverage among at-risk categories. Active offer of influenza vaccine upon discharge can effectively increase vaccination compliance. • The adoption of correct behavioral habits and the promotion of vaccination by healthcare personnel play a decisive role in the influenza vaccine acceptance process among at risk people.

Pretreatment with dual antiplatelet therapy in acute myocardial infarction

Abstract Background Combined antithrombotic therapy prevents thrombus progression and its components embolization, and thus, it has an essential role in coronary microcirculation (re)perfusion in acute myocardial infarction (AMI). Pretreatment with P2Y12 inhibitors, on top of aspirin, before primary angioplasty has not been satisfactorily studied in STEMI. Purpose To investigate the impact of combined antiplatelet therapy on-treatment on the outcome of patients with STEMI. Methods Patients who suffered STEMI during the 7 years (1/2016-12/2022) were included. The analysis is based on population data from the National Health Information System (NHIS). Information on AMIs from the Intervention Module of the Registry of Cardiovascular Operations and Interventions was combined with prescription data from the Registry of Reimbursed Health Services 6 months before MI and identification of deceased patients from the Registry of Death Records. Data from the NHIS covers almost 100% of all cases in the population. Standard descriptive statistics and test were applied in the analysis. Multivariate logistic regression adjusted for clinical and procedural characteristics was adopted to analyze the influence of pretreatment on the risk of 1) out-of-hospital cardiac arrest (OHCA), 2) clinical condition at admission – need of mechanical ventilation and circulatory instability (Killip III,IV), 3) initial TIMI flow through the infarct-related coronary artery (IRA ), and 4) short term mortality. Results The study sample consisted of data from 40,383 STEMIs of which 1,601 patients were on dual antiplatelet therapy (DAPT) with aspirin plus iP2Y12 lasting 1 to 6 months before the event occurred. Patients on chronic oral anticoagulation (N 2101) were excluded. Patients on DAPT versus those without antiplatelet therapy or on aspirin at a daily dose of 100 mg were older, had higher comorbidity rates, and were at higher risk of mortality (Table). The multivariate logistic regression analysis showed that patients on DAPT at the time of MI onset and lasting for at least one month had a higher likelihood of preserved perfusion through the IRA (Odds ratio and 95% Confidence interval, OR (95% CI) 1. 193 (1.074; 1.326), p=0.001). However, the DAPT pretreatment did not reduce the risk of OHCA, the need for mechanical ventilation, or initial circulatory destabilization. It did not positively affect the prognosis of the patients (Figure ). Conclusion The significant benefit of the DAPT pretreatment on the preservation of infarct-related coronary artery flow did not translate into a positive effect on the prognosis of STEMI patients.

TRATAMENTO COM METILFENIDATO E LISDEXANFETAMINA EM ADULTOS COM TDAH: UMA REVISÃO DA LITERATURA

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that, although frequently diagnosed in childhood, can persist into adulthood. ADHD has negative impacts on the quality of life and functioning of daily activities of individuals with this pathology. Treatment aims to improve the clinical and social condition and pharmacological treatment associated with non-pharmacological measures is recommended. Among pharmacotherapy, psychostimulants are the most recommended, with the first and second drugs being methylphenidate (Ritalin, Concerta) or lisdexamfetamine (Venvanse), respectively. However, these medications can have different effects, especially when consumed in the long term. Methodology: Articles published in journals indexed in the Scientific Electronic Library Online (SCIELO), National Library of Medicine/NLM (MEDLINE), UpToDate and National Library of Medicine/NLM (PUBMED) databases and websites recognized worldwide in the period 2014 were evaluated. to 2024. Results: After completing the data collection phase, 47 relevant articles were identified to compose the analysis of the proposed topic. Discussion: Based on the articles cited, it was observed that psychostimulants have good efficacy in treating ADHD, however, few studies have evaluated their long-term effects and with a significant number of study participants. Conclusion: Adults with ADHD should receive adequate treatment, aiming for a better quality of life and both methylphenidate and lisdexamfetamine are good therapeutic options, proving to be relatively effective and safe.

Impaired right ventricular strain is associated with worse prognosis in patients with liver cirrhosis

Abstract Introduction Cirrhotic cardiomyopathy is a complication of liver cirrhosis accounting for significant morbidity and associated with reduced patient survival. It is characterized by reduced afterload, increased cardiac output, and diastolic dysfunction. However, there are limited data regarding the prognostic significance of right ventricular (RV) mechanics. Novel echocardiographic techniques such as speckle tracking echocardiography can detect subclinical myocardial dysfunction early in the course of non-ischemic myocardiopathies. Purpose To investigate the prognostic role of RV free wall strain (RVFWS) in patients with liver cirrhosis. Methods We prospectively enrolled 70 patients with liver cirrhosis in stable clinical condition. Patients with coronary artery disease, valvular heart disease, ongoing alcohol consumption or poor acoustic window were excluded from the study. Transthoracic echocardiography was performed and RVFWS was calculated from RV focused 4-chamber views using a dedicated software. Since RVFWS was as expected negative in all patients, absolute values were used for all calculations. Clinical and laboratory examination was also performed in all patients and the Model for End-Stage Liver Disease (MELD) score a widely used tool for assessing liver disease severity was calculated. All-cause mortality at 24 months was the primary endpoint and was available in all patients. Results Mean RVFWS in the cohort was 27.4±6.3% and using a lower normal limit of 20%, reduced RVFWS was detected in six patients. According to the Spearman coefficient analysis, RVFWS was correlated with MELD (rho=0.274, p=0.023) indicating increased values in patients with more advanced liver disease. According to the univariate Cox-regression proportion hazard models RVFWS as a continuous variable was not significantly correlated with worse two year survival (HR: 1.01 (0.95-1.08, p=0.658). Interestingly, among conventional echocardiographic parameters basal RV diameter (p=0.004) and right atrial end-systolic area (p=0.008) were associated with increased risk for the primary endpoint. The association of the primary endpoint with other parameters of RV systolic function was also not statistically significant. The Multivatiate Cox Regression survival analysis, which incorporated age, sex, MELD, hemoglobin, systolic blood pressure and cardiac output, showed that among echocardiographic parameters for the evaluation of the RV, only RVFWS showed a tendency to be associated with worse survival (p=0.062). When patients were stratified into tertiles according to RVFWS values, those in the first tertile (with lower absolute RVFWS values) had significantly increased hazard for the primary endpoint (HR: 5.82, 2.18-15.8, P<0.001) (figure 1). Conclusions RVFWS values are within normal limits in most patients with liver cirrhosis. When adjusted for the severity of the liver disease, reduced RVFWS values are associated with worse prognosis in cirrhotics.

ACE inhibitor and angiotensin receptor blocker use during pregnancy: data from the ESC Registry of pregnancy and cardiac disease (ROPAC)

Abstract Background and Aims Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester due to the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and to evaluate the impact on perinatal outcomes. Methods The Registry of Pregnancy and Cardiac disease (ROPAC) is a prospective, global registry of pregnancies in women with structural heart disease. Outcomes were compared between women who used ACE-Is or ARBs and those who did not. Multivariable regression analysis was performed to assess the effect of ACE-I or ARB use on the occurrence of congenital anomalies. In addition, the perinatal outcomes of patients who stopped ACE-Is and/or ARBs before pregnancy were assessed. Results ACE-I (n=35) and/or ARB (n=8) were used in 42 (0.7%) of the 5739 ROPAC pregnancies. Women who used ACE-Is or ARBs more often came from a low-or-middle-income country (57% vs 40%, p=0.021), had chronic hypertension (31% vs 6%, p<0.001), or a left ventricular ejection fraction <40% (33% vs 4%, p<0.001). No pregnancy terminations due to fetal anomaly were reported. ACE-I use during the first trimester was independently associated with an increased risk of congenital anomaly (OR 3.1; 95% CI 1.0-9.3). No adverse fetal or neonatal effects were seen when ACE-I and/or ARB were discontinued prior to pregnancy. Conclusions ACE-Is and ARBs are seldom used during pregnancy and based on our data, ACE-Is should also be avoided in the first trimester due to a higher risk of congenital anomalies. Preconception counseling is crucial to discuss the potential risks of these medications, and to evaluate the clinical condition and, if possible, the woman can be switched to an alternative medication.

Accidental Detection of Cocaine in Urine in Pediatric Patients: Case Series and Literature Review

Infantile occult exposure to cocaine in domestic environments represents a complex clinical and medico-legal problem, which can be associated with abuse and neglect and with potential short- and long-term health risks for children. The authors present a retrospective study on 764 children under 14 years old who accessed the Emergency Department of IRCCS Meyer from 2016 to 2023 and were included in the GAIA (Child and Adolescent Abuse Group) protocol for suspected maltreatment and abuse, and for which a urine toxicology analysis was performed. The aim is to discuss the medico-legal implications and highlight the need for a thorough evaluation and management of such situations. Urine screening tests for substances of abuse (e.g., cocaine, opiates, etc.) were performed with an EMIT® Siemens VIVA-E drug testing system (Siemens, Newark DE) in 124 cases for which the child’s clinical condition raised suspicion of intoxication, or the family context indicated distress or substance abuse dependency. The screening results revealed the presence of cocaine and its main metabolite, benzoylecgonine, in the urine of 11 children. In one case, a single girl was brought to the Emergency Department by staff from the facility where she and her mother were staying. In most of the cases, children were brought to the Emergency Department by their parents who accessed the Emergency Department due to various clinical manifestations (drowsiness, agitation, seizures, hypotonia, diarrhea, vomiting, etc.), except for one case of eye trauma suspected to be caused by abuse or neglect by one of the parents. Three of the children did not have signs or symptoms attributable to substance exposure, whilst eight of the cases presented some of the symptoms associated with occult infant exposure to cocaine, such as neurological manifestations, seizures, gastrointestinal symptoms, and respiratory depression. The probable mode of intake was mostly through breastfeeding and continuous environmental exposure due to domestic contamination or inhalation of “crack”. In the case of a 12-hour-old infant, there was probable prenatal in utero exposure. All the children were hospitalized, some for medical reasons and others solely as a precautionary measure for proper care. In all cases, a report was made to the Prosecutors as required by the Italian Penal Code, as well as to the Court of Minor. The study highlighted the importance of a multidisciplinary approach involving pediatricians, social workers, and forensics, as well as close collaboration with the relevant authorities, as the Gaia service at IRCCS Meyer offers. The occasional detection of cocaine in cases that showed no suspicion of intoxication led to a modification of the procedure and the development of a standardized protocol at IRCCS Meyer both in terms of prevention and in the detection and interception of hidden cases, in order to intervene early and initiate the necessary care pathways (secondary prevention). This protocol includes routine toxicological urine testing in all suspected or confirmed cases of child abuse, not just in those where symptoms might suggest a suspicion of intoxication.

Non-surgical management of methicillin-sensitive Staphylococcus aureus bacteremia-related mediastinitis

Background: Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus. Case presentation: In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess. Conclusion: We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach.

FAS system diagnostic and prognostic value in patients with chronic heart failure

The authors conducted the descriptive literature synthesis to present the structure and mechanism of the FAS family action, the purpose of determining the concentration of biomarkers in blood serum, the relationship of various FAS ligands levels with the patient’s clinical condition - the HF functional class (FC), as well as the sFASL using possibility to predict the HF course. The review analyzed 22 studies on the FAS system biomarkers participation in the HF pathogenesis and the relationship of their serum concentrations with the HF severity. A threshold sFASL value of 0.0999 ng/ml is associated with this pathology unfavorable course, while the increase in sFASL degree directly correlates with an increase in the FC of HF, the progression and death risks.

EXPRESS: Disgust drivers do not impact on the altered body in action representation in anorexia nervosa.

Disgust is a powerful emotion, that evolved to protect us from contamination and diseases; it also cores to very human feelings, such as shame. In anorexia nervosa, most of the knowledge on disgust regards food. However, disgust can be elicited by varied drivers, including body-related self-disgust, which may be more central to this condition. Here, we investigate in depth how disgust triggers related to the body influence altered representations in anorexia nervosa.Women with anorexia nervosa and healthy women performed the Hand Laterality Task, in which they were asked to judge the laterality of hands without and with a disgust charging feature (i.e. with a body product or with a body violation). We computed accuracy and reaction time for the effect of biomechanical constraints, an index of motor imagery. We also measured the general disgust sensitivity through a self-report questionnaire.Participants with anorexia nervosa were overall less accurate and slower compared to controls, suggesting a non-canonical (i.e. not based on motor imagery) approach to solving the task. However, they showed the same pattern of responses as controls for disgust-charged stimuli, despite reporting higher levels of disgust sensitivity.Our results suggested the absence of specific effects of disgust drivers on the (altered) body in action representation in anorexia nervosa. We discuss this evidence focusing on the role of the psychopathological symptoms characterizing anorexia nervosa. We also reflect on the efficacy of experimental methodologies used to detect alterations in body representation in this clinical condition.

Treating Chronic Tendinopathy: Physical Therapy, Surgery and Other Form of Therapy

Introduction: The term "tendinopathy" refers to pathological changes in tendons. The previously used term "tendonitis" does not fully capture the nature of the condition, as inflammatory changes, when present, are secondary to degenerative damage. Tendinopathies are quite common in the general population. Aim: The aim of this review is to characterize various types of tendinopathies, with a focus on both conservative and surgical treatment methods, in order to organize available information that may be helpful for clinicians in their practice. State of Knowledge: Chronic tendinopathies develop as a result of multiple factors. The most significant include improper exercise techniques, excessive strain, and musculoskeletal system abnormalities. Summary (Conclusions): The approach to tendinopathy treatment should vary depending on the patient's clinical condition and provoking factors. Physiotherapy plays the most important role, along with supportive methods such as analgesic pharmacotherapy and cryotherapy. Surgical intervention may be necessary in cases where conservative treatment fails.

Eagle Syndrome: The Huge Socioprofessional Impact of a Minor Lengthening of the Styloid Process

agle Syndrome (ES) is a rare clinical condition presenting with anterolateral neck pain and potential serious complications. This case report details a head nurse in the emergency room (ER) with a severe throbbing headache, trismus, left-sided dysphagia, left otalgia, gum pain, and a very intense left-sided headache, associated with ipsilateral facial hypoesthesia. The patient met the International Classification of Headache Disorders (ICHD-3) criteria for headaches attributed to inflammation of the stylohyoid ligament, establishing the diagnosis of Eagle syndrome. Chronic headaches associated with ES, as observed in this case, can impact concentration, comprehension, communication, and work performance, leading to economic loss. This prompts the question: Are individuals with ES capable of working under intense physical and psychological conditions? The paper proposes a management strategy for ES patients, emphasizing the need for further research on the impact of ES on occupational fitness, as no published studies currently address this concern.

Impenetrable Abdomen: A Case Report of Endoscopic Sleeve Gastroplasty Performed in Patient with Huge Paramedian Laparocele.

Bariatric surgical techniques have demonstrated scientific efficacy and interventional safety; however, these approaches are not universally appropriate for all patients. The term "impenetrable abdomen" refers to the inability to achieve surgical access to the abdominal cavity, a condition that may arise from several underlying factors. Endoscopic sleeve gastroplasty (ESG) is proposed as a safe and effective technique in this subgroup of patients with obesity. A 56-year-old Caucasian woman with an impenetrable abdomen due to the presence of a large left paramedian laparocele underwent ESG (Fig. 1) to our unit. An abdominal computed tomography (CT) scan revealed a substantial laparocele in the left paramedian region, involving the tenuous loops, mesentery, and part of the transverse colon. The patient body mass index (BMI) at presentation was 47.15 kg/m2 (116 kg per 1.57 m). Comorbidities included obstructive sleep apnea syndrome (OSAS), requiring nocturnal continuous positive airway pressure (CPAP) therapy, hepatic steatosis, hypertension, hypertriglyceridemia, and hypovitaminosis D. The case was discussed with our multidisciplinary board team (MDT), who agreed to proceed with the ESG. The endoscopic procedure was performed in the supine position, using the Overstitch device and lasted 58 min. No intraprocedural or post-procedural complications/adverse events have been observed. The patient resumed a liquid diet on the first postoperative day and was discharged from the hospital 24 h after the procedure in good clinical condition. Regular outpatient follow-up visits showed significant reduction of the BMI at 6 months post-procedure with a value of 34.9 kg/m2 compared with the initial value of 47.1 kg/m2. Additionally, the patient's use of nocturnal CPAP for OSAS was successfully discontinued suggesting an improvement in her respiratory condition as a result of weight loss. Moreover, there was a notable reduction in the pharmacological management required for arterial hypertension. These outcomes underscore the positive impact of selecting the most appropriate therapeutic strategy for each patient with obesity through a multidisciplinary team approach. In our experience, we confirm that endoscopic sleeve gastroplasty is both feasible and safe in patients presenting with an impenetrable abdomen. Despite the minimally invasive approach, this technique has proven effective in terms of body weight loss and reduction of obesity related compared with bariatric surgery.

Review of Interleukin-6 and Cardiopulmonary Bypass-Related End-Organ Injury Along With the Potential for Mitigation With Tocilizumab.

Cardiopulmonary bypass (CPB) is essential for the conduct of open-heart procedures. While lifesaving, CPB can be associated with significant end-organ injuries believed to result from inflammatory responses triggered by the extracorporeal surfaces encountering cellular elements in the blood stream. In this review, we discuss the role of interleukin-6 (IL-6) and the potential for Tocilizumab, an anti-IL-6 receptor antibody, in mitigating these effects. We compare the inflammatory responses in CPB and cytokine storm, a clinical condition in which Tocilizumab has been effectively implemented. Finally, we examine why corticosteroids, used to reduce the morbidity of CPB, may not effectively reduce IL-6 levels.

Proses Asuhan Gizi Terstandar pada Pasien dengan Autoimun dan Sirosis Hepatis

Liver cirrhosis is a pathological condition of the liver that defines the end stage of hepatic fibrosis. Liver cell damage will lead to disruption of the liver structure and increased vascularization, causing enlargement of blood vessels in the gastric and esophageal areas. Liver cirrhosis is often caused by history of infection with hepatitis B virus or hepatitis C virus. Other causes include a family history of liver disease, excessive alcohol consumption, and a history of autoimmune disease. Providing a liver diet as one of the standardized Nutrition Care Process (NCP) for this disease aims to achieve and maintain optimal nutritional status without burdening liver function. The purpose of the case study is to find out the process of standardized nutritional care process for patients with autoimmune and liver cirrhosis through providing a liver diet. The case study was conducted in September 2023 at patients in Hospital X Surabaya. After monitoring and evaluation, the patient’s energy, protein, fat, and carbohydrates intake domains increased even though they had not yet reached the fulfillment target (<80%), the patient’s biochemistry domain was not received because the monitoring time was short, the patient’s physical/clinical condition continued to improve until the third day. The progress of the patient’s recovery over three days always increases. Starting with the stabilized appetite, the food intake received by patient increases so the patient’s physical and clinical condition continues to improve.

Prevalence of an empty colon in patients with acute and chronic small intestinal mechanical obstruction: A retrospective radiographic study in 100 dogs and cats

Small intestinal mechanical obstruction (SIMO) is a common clinical condition, with radiographic studies typically focusing on the small intestine. However, the colon's appearance in SIMO has not been extensively studied. This retrospective study aimed to determine the prevalence of an empty colon on radiographs of dogs and cats with confirmed SIMO. Pre-surgical abdominal radiographs of 100 patients (68 dogs and 32 cats) with surgically confirmed mechanical ileus and a control group of 30 dogs and 20 cats with non-obstructive gastrointestinal (GI) disease and one without GI disease, respectively, were evaluated. The colon was assessed for content (none/collapsed, gas, faeces) and segmental distribution (ascending, transverse, descending colon) and correlated to the duration of clinical signs (acute, chronic). A colon was classified as empty when ≥2/3 was collapsed and/or gas-filled. The overall prevalence of an empty colon in cases of mechanical ileus was 61% (p=0.028), with 49/68 in dogs (72.1%) and 12/32 in cats (37.5%), p=0.001 between dogs and cats. Clinical signs duration did not influence the prevalence 28/61 (45.9%) acute, 33/61 (54.1%) chronic, p=0.522. However, acute cases had more empty colon segments (2/3 segments: 6/28, 21.4%; 3/3 segments: 22/28, 78.6%) than chronic cases (2/3 segments: 23/33, 69.7%; 3/3 segments: 10/33, 30.3%; p≤0.001). In the control groups, the prevalence of an empty colon was 64% (p=0.048) with and 38%, p=0.048) without GI disease, with no statistical difference between dogs and cats. An empty colon can be a supporting radiographic finding in diagnosing patients with GI disease, including SIMO, in addition to other established characteristic features. Dogs are more likely to have an empty colon in the presence of mechanical ileus.

ACCI-HBV-ACLF: A Novel Predictive Model for Hepatitis B Virus-Related Acute-On-Chronic Liver Failure.

Early identification of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) holds crucial importance in guiding clinical management and reducing mortality. However, existing scoring systems often overlook patient's underlying clinical condition, which significantly impacts prognosis. Use the age-adjusted Charlson comorbidity index (aCCI) to evaluate the patient's complications to develop a more precise model for predicting transplant-free mortality in HBV-ACLF patients. Nine hundred and six patients were included for investigation and were segregated into a training cohort and a temporal validation cohort according to the chronological order of admission in a ratio of 7:3. In the training cohort, univariate analysis, logistic regression analysis and LASSO regression analysis were used to construct a prognostic model and it was subsequently validated in a temporal validation cohort and an external validation cohort. We found total bilirubin, neutrophils, international normalised ratio and aCCI exhibited significant associations with 28-day transplant-free mortality and established a novel prognostic model, named aCCI-HBV-ACLF. The model demonstrated strong predictive performance, with area under the receiver operating characteristic curve (ROC) values of 0.859 for 28-day mortality, 0.822 for 90-day mortality. In the temporal validation cohort, aCCI-HBV-ACLF achieved area under the ROC values of 0.869 for 28-day mortality and 0.850 for 90-day mortality. In the external validation cohort, aCCI-HBV-ACLF had area under the ROC values of 0.868 for 28-day mortality and 0.888 for 90-day mortality. This study proposes a new prognostic model, which achieved excellent predictive ability for 28-/90-day transplant-free mortality rates among patients with HBV-ACLF.