Dead Patients Research Articles

Association between early fluid balance and outcomes in patients receiving continuous renal replacement therapy for cardiac surgery-associated acute kidney injury

Objective: To evaluate the association between fluid balance within 48 hours after initiating continuous renal replacement therapy (CRRT) and 90-day mortality of patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: Adult patients who received CRRT for CSA-AKI for more than 24 hours between January 2016 and December 2021 in the First Affiliated Hospital of Nanjing Medical University were prospectively included. Exposures were fluid input, fluid output, fluid balance and percentage of fluid overload change (defined as weight-standardized fluid input/output difference) within 48 hours after CRRT initiation. The primary outcome was 90-day mortality. The relationship between the exposures and 90-day mortality was determined by restricted cubic spline and segmented Cox regression. Results: The study enrolled 262 patients, and 90-day mortality was 60.3% (158/262). There were 171 males and 91 females, with a median age of 64 (54, 71) years. The dead patients (n=158) had more fluid input [6.43 (5.62, 7.34) L vs 6.07 (5.09, 6.90) L, P=0.013], greater fluid balance [-0.01 (-1.36, 1.34) L vs -0.65 (-1.71, 0.42) L, P=0.005] and higher percentage of fluid overload change [-0.01% (-2.17%, 2.01%) vs -0.85% (-2.49%, 0.52%), P=0.013] within 48 hours after CRRT initiation than the survived patients (n=104). The cumulative fluid balance and fluid overload changes have a "J" curve relationship with 90-day mortality. Higher positive fluid balance (adjusted HR per 1 L increase above 0.5 L=1.33, 95%CI: 1.17-1.50) and greater proportion of fluid overload changes (adjusted HR per 1% increase above 0.7%=1.20, 90%CI: 1.11-1.30) were associated with an increased risk of death. Cumulative fluid input was linearly related to the 90-day mortality. Higher input (adjusted HR per 1 L increase=1.13, 95%CI: 1.03-1.24) was associated with an increased risk of death. The cumulative fluid output showed a U-shaped relationship with risk of death. Both lower output (adjusted HR per 1 L increase below 6.7 L=0.73, 95%CI: 0.58-0.90) and higher output (adjusted HR per 1 L increase above 6.7 L=1.24, 95%CI: 1.01-1.53) were associated with increased risk of death. Conclusion: In patients with CSA-AKI, excessive fluid input, insufficient or excessive output and a positive fluid balance or percentage of fluid overload change within the first 48 hours after CRRT initiation are associated with increased risk of 90-day mortality.

Abstract 4123371: Hyperoxia is not a significant predictor of ICU mortality and is likely a surrogate parameter for reduced native cardiac function in patients supported with VA-ECMO

Intro: Hyperoxia has been associated with adverse outcomes in VA-ECMO patients. Whether hyperoxia represents a mechanism of mortality or is a surrogate for worse cardiac function is unknown. Aim: To determine patient characteristics, lab values, and hemodynamic parameters associated with increased mortality in VA-ECMO patients. Methods: Single-center retrospective cohort study at UCSF in VA-ECMO patients (2020-2023). Patients were categorized into 3 groups: Dead, Advanced Therapy-Free Survivors, and Advanced Therapy Survivors (survived to ICU discharge with LVAD or heart transplant). Wilcox rank sum and two sample proportion tests were performed. In-hospital mortality was evaluated using multiple logistic regression. Results: Of 179 patients, 87 died and 92 survived to ICU discharge. Of the survivors, 22 received advanced therapies. Compared to Advanced Therapy-Free Survivors, Dead patients had higher PaO2 levels (297[95% CI,164-400], p = 0.01). Dead and Advanced Therapy Survivors groups had similarly high PaO2 levels, but the latter group showed less acidosis and were more likely to have HFrEF (59%; 13/22; p = 0.02). ECMO support and VIS scores were similar. The multivariate model showed PaO2 is not associated with mortality (adjusted OR, 1.002 [95% CI, 0.99-1.004]; p = 0.131). Conclusion: Hyperoxia was associated with both death and advanced therapies, but did not predict mortality in a multivariate model. Advanced therapy survivors and patients that died were more likely to have HFrEF, suggesting that high PaO2 at cannulation reflects a proximal mixing cloud due to weak native cardiac function. Future work will analyze ECHO parameters to examine the association between hyperoxia and reduced cardiac output in VA-ECMO patients.

Assessment of Knowledge and Practices of Nursing Personnel While Caring of Brain Dead Patients Potential for Organ Donation

Introduction Organ donation and transplantation is a life-saving procedure for patients with end-stage organ failure, but it depends on the availability of donor organs. Nurses play a major role to provide care to brain-dead patient potential for organ donation and efficient care to increase the organ’s survival. For years many efforts have been made to create awareness in public regarding organ donation but donors are still very less than demand. Most of the recipients are waiting for organs for more than 6–8 years and many died because of the paucity of donors. Hence, knowledge of nursing personnel is extremely important to the success of organ donation. Objective To assess the knowledge and practices of nursing personnel while caring of brain-dead patients potential for organ donation. Methodology A descriptive research design was adopted to carry out the study. The study was conducted among 30 nursing personnel caring for brain-dead patients from the automatic tube compensation ICU and various units of Nehru Hospital, PGIMER, Chandigarh. Nurses were given questionnaires to fill, including a sociodemographic data sheet and a knowledge questionnaire. The practices of caring for brain-dead patients were observed by using an observation checklist, and a total of 30 observations were made. Results The findings of the study revealed that 50% of nursing personnel had good knowledge about the care of brain-dead patients, 32% had average knowledge, whereas 18% had poor knowledge. There were 42 steps/items of practice regarding care of a brain dead patient. Around one third (38%) of the steps were followed by the participants, some of them followed 57% of the steps. Conclusion Only half of the nursing personnel were possessing good knowledge about the care of brain-dead patients and less than half were doing good practices about the care of brain-dead patients; hence, there is a need to educate the nursing personnel regarding caring of brain-dead patients.

Is Prompt Hyperbaric Oxygen Adjunctive Therapy Able to Reduce Mortality and Amputation in Management of Necrotizing Soft-Tissue Infection?

Background: Necrotizing soft-tissue infection (NSTI) is a rare and serious disease with high morbidity and mortality. Standard therapeutic concepts have included urgent surgical intervention, broad-spectrum antibiotic treatment, and intensive care. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centers, but its benefits remain controversial. Methods: A retrospective analysis was conducted in which 98 patients with a clinical diagnosis of NSTI were treated with standard treatments plus HBOT. The clinical outcomes were wound healing, performance status, hospital length, complication rate, recurrence rate, morbidity (amputation rate), and mortality. Primary or secondary outcomes were compared between the time interval of HBOT and the clinical outcomes. Results: The average times from diagnosis of NSTI to initial HBO treatment and from initial surgery to initial HBO treatment were both significantly longer in dead patients than in surviving patients (P = 0.031; P = 0.020). These two time intervals were both significantly longer in amputated patients than in preserved patients (P = 0.031; P = 0.037). Conclusions: Using combined treatment with early surgical debridement combined with HBOT, it is possible to reduce hospital stay, intensive care unit stay, number of debridements, improve complete wound healing rate, and lower amputation and mortality rates among patients with NSTI. The early onset of HBOT soon after diagnosis, especially during critical conditions, is proved to be associated with higher survival and preservation rates.

The Influence of Arrhythmia on the Outcomes of Pediatric Patients with Idiopathic Dilated Cardiomyopathy.

Children diagnosed with dilated cardiomyopathy (DCM) are at an increased risk of developing arrhythmias, which can significantly affect their overall prognosis. However, the implantation and effectiveness of implantable cardioverter-defibrillators (ICDs) pose challenges in the pediatric population. Therefore, it is crucial to determine the prevalence of arrhythmia-related death in pediatric patients with DCM. This study investigated the correlation between arrhythmias and mortality in pediatric patients with DCM. This retrospective cohort study examined children with idiopathic DCM referred to Rajaie Cardiovascular, Medical, and Research Institute in Tehran, Iran, from 2017 to 2023. All patients underwent a standard 12-lead electrocardiogram, 24-h Holter monitoring, cardiac magnetic resonance imaging, and echocardiography. Patient outcomes, including death, heart transplantation, and survival, were evaluated within one year of Holter monitoring. A total of 178 children (79 males) with a mean age of 83.06 ± 56.41months were included in the study. Overall, 72 deaths (40.4%) and 46 heart transplants (25.8%) were recorded and 60 patients (33.7%) survived. There was no significant association between patients' outcomes with ventricular arrhythmias, late gadolinium enhancement, corrected QT interval, and QRS interval prolongation; however, a significantly higher proportion of dead patients had abnormal heart rate variability (P = 0.034). Heart failure was the leading cause of death, with ventricular arrhythmia accounting for two out of 72 deaths. Both cases of ventricular arrhythmia were associated with severe cardiac dysfunction. Arrhythmia-related mortality is rare in children with idiopathic DCM, with severe heart failure being the primary cause of death in this population. Life-threatening arrhythmias primarily occur in DCM children with more compromised cardiac function.

Prognostic Value of ISS and TRISS Scores in Tunisian Terrorism Victims.

Injuries caused by terrorism attacks are one of the urgent problems of the society and the health system. In this work, we aimed to assess the injury severity score (ISS) and trauma injury severity score (TRISS) in Tunisian military combatants injured during terrorism attacks. A total of 153 victims of terrorism admitted to the Military Hospital of Tunis between January 2012 and January 2017 were included. Among them, 107 survived and 46 died (43 victims died at the terrorist attack scene and 3 died in the hospital). All dead patients were autopsied. Injury severity scores and TRISSs were then calculated by 2 professors in the anesthesia-resuscitation department, and the agreement level was assessed using the Bland and Altman curve. We obtained a strong agreement between the 2 experts when assessing the TRISS and ISS. Using the Bland and Altman curve, an agreement between the 2 experts was obtained between 0 to 40 and 60 to 75 for the ISS and between 0 to 25 and 75 to 100 for the TRISS. Moreover, we detected a high level of ISS and TRISS, especially in deceased victims compared to survivors (P <.001). To predict mortality, we revealed by the receiver operating characteristic curve high sensitivity and specificity (more than 90%) before day 28 of hospital stay as well as for ISS and TRISS. Regarding the mechanism of injury, patients injured by gunshot have higher ISSs and TRISSs than those injured by explosion (P < .001). Injury severity scores and TRISSs showed a high reliability to predict the mortality rate in Tunisian victims of terrorism.

Base Deficit, International Normalized Ratio, and Glasgow Coma Scale (BIG) is a Predictor Tool for Survival and Mortality of Pediatric Trauma Patients.

An accurate estimate of the survival and mortality at the initial trauma evaluation is essential to ensure appropriate triage and stratification of the patients for progressive care. One of the recognized tools for predicting mortality is the BIG Score, composed of admission base deficit, international normalized ratio (INR), and Glasgow Coma Scale (GCS). This study evaluates the BIG scale in predicting survival and mortality rates among pediatric trauma patients. Pediatric trauma patients, aged <18 years, visiting the emergency department of a tertiary hospital in the North of Jordan from 2014 to 2019 were included. Demographic data, trauma details, and lab results were collected. The BIG score for each patient was calculated. A receiver operator characteristic (ROC) curve was generated to determine the best suitable BIG cutoff point and its probabilities. A total of 424 patients were included in this study. About two-thirds of the patients were males (n=298). The mean±SD of pH and GCS values were significantly lower among dead patients (6.0±2.5, 3.7±3.9, respectively) in comparison to alive ones (7.3±2.7, 11.5±5.5, respectively) (p=0.026, p<0.001, respectively). On the other hand, base deficit and INR values were significantly higher among dead patients (6.5±6.2, 1.9±2.5, respectively) than alive ones (1.9±3.6, 0.8±0.5, respectively), (p<0.001). The BIG score with a cutoff point of ≥10.0 has a high sensitivity (88.5%) and specificity (76.3%) for mortality prediction. The survival rate was correctly predicted in 100% of patients with a BIG score between 2.1 and 6. Also, the best survival predictions were seen in intubated patients (100%), followed by RTA-related trauma and ICU admission with decreasing frequency. The current study has shown the added value of the BIG score as a simple and rapid tool to predict prognosis in pediatric trauma settings. The BIG score with a cutoff point of ≥10.0 is highly efficient in predicting pediatric trauma patients' mortality rates. However, the BIG score demonstrates greater accuracy in predicting survival outcomes compared to its ability to predict mortality among pediatric trauma patients.

Infective Endocarditis-Predictors of In-Hospital Mortality, 17 Years, Single-Center Experience in Bulgaria.

Despite enormous developments in medicine, infective endocarditis (IE) remains an ongoing issue for physicians due to increased morbidity and persistently high mortality. Our goal was to assess clinical outcomes in patients with IE and identify determinants of in-hospital mortality. Material and methods: The analysis was retrospective, single-centered, and comprised 270 patients diagnosed with IE from 2005 to 2021 (median age 65 (51-74), male 177 (65.6%). Native IE (NVIE) was observed in 180 (66.7%), prosthetic IE (PVIE) in 88 (33.6%), and cardiac device-related IE (CDRIE) in 2 (0.7%), with non-survivors having much higher rates. Healthcare-associated IE (HAIE) was 72 (26.7%), Staphylococci were the most prevalent pathogen, and the proportion of Gram-negative bacteria (GNB) non-HACEK was significantly greater in non-survivors than survivors (11 (15%) vs. 9 (4.5%), p = 0.004). Overall, 54 (20%) patients underwent early surgery, with a significant difference between dead and alive patients (3 (4.5%) vs. 51 (25.1%, p = 0.000). The overall in-hospital mortality rate was 24.8% (67). Logistic regression was conducted on the total sample (n = 270) for the period 2005-2021, as well as the sub-periods 2005-2015 (n = 119) and 2016-2021 (n = 151), to identify any differences in the trend of IE. For the overall group, the presence of septic shock (OR-83.1; 95% CI (17.0-405.2), p = 0.000) and acute heart failure (OR-24.6; 95% CI (9.2-65.0), p = 0.000) increased the risk of mortality. Early surgery (OR-0.03, 95% CI (0.01-0.16), p = 0.000) and a low Charlson comorbidity index (OR-0.85, 95% CI (0.74-0.98, p = 0.026) also lower this risk. Between 2005 and 2015, the presence of septic shock (OR 76.5, 95% CI 7.11-823.4, p = 0.000), acute heart failure (OR-11.5, 95% CI 2.9-46.3, p = 0.001), and chronic heart failure (OR-1.3, 95% CI 1.1-1.8, p = 0.022) enhanced the likelihood of a fatal outcome. Low Charlson index comorbidity (CCI) lowered the risk (OR-0.7, 95% CI 0.5-0.95, p = 0.026). For the period 2016-2021, the variable with the major influence for the model is the failure to perform early surgery in indicated patients (OR-240, 95% CI 23.2-2483, p = 0.000) followed by a complication of acute heart failure (OR-72.2, 95% CI 7.5-693.6. p = 0.000), septic shock (OR-17.4, 95% CI 2.0-150.8, p = 0.010), previous stroke (OR-9.2, 95% CI 1.4-59.4, p = 0.020) and low ejection fraction (OR-1.1, 95% CI 1.0-1.2, p = 0.004). Conclusions: Knowing the predictors of mortality would change the therapeutic approach to be more aggressive, improving the short- and long-term prognosis of IE patients.

Evaluation of cardiac biomarkers among dead and alive COVID-19 patients in Southwest Iran.

The need to understand the global burden of heart failure following the pandemic has arisen as a result of an increase in papers that support cardiac involvement in coronavirus disease 2019 (COVID-19). Therefore, the current study aims to provide a more thorough explanation of the function and use of cardiac biomarkers in dead and alive COVID-19 patients. All patients who were referred and admitted to Razi Hospital, Ahvaz, Iran, from March 2020 to March 2021 with a diagnosis of COVID-19 were included in this study. During the study period, 753 patients were hospitalized with a diagnosis of COVID-19. In total, 157 cases died from the disease (case fatality rate: 20.84%). Pre-existing cerebrovascular accidents (CVAs) were more frequent in dead cases (14% vs. 6.4%). It was observed that atrial fibrillation was normal in most of the alive cases in comparison to dead patients (P value = 0.014). Moreover, it was seen that CRP, IL-6, and procalcitonin were increased in dead patients. Also, an association was found between ejection fraction (EF) value and death rate (P value = 0.035). The higher frequency of positive troponin occurring in the dead group suggested a possible adverse effect on the mortality rate (22.3% vs. 16.4%). Adults with COVID-19 commonly have cardiac manifestations, including symptoms of myocardial damage. In light of the recognized utility of troponin, ejection fraction, procalcitonin, IL-6, and CRP in COVID-19 patients with suspected myocardial damage, we should develop a safe and precise diagnostic algorithm that may contain patients' clinical histories and additional variables that may facilitate the prediction of myopericarditis.

Deciphering gender disparities in laboratory biomarkers among deceased COVID-19 patients in Erbil city-Iraq: A retrospective study

Introduction: SARS-CoV-2 was a new strain of the Coronaviridae family. It caused the coronavirus disease in December 2019 that first arose in Wuhan, China, and it developed into a worldwide health issue. COVID-19 gives rise to a wide range of symptoms which can range from having no symptoms to having extensive fatal pneumonia. Objectives: The purpose of the study was to figure out how infecting the virus could influence and impact the various laboratory biomarkers among dead male and female patients. Patients and Methods: The data and statistics were obtained from the dead patients of West Emergency Hospital and the data was investigated directly. The investigation was conducted from June 1st to November 1st, 2020. Epidemiological, clinical as well as lab data of approximately 659 dead cases of SARS-CoV-2 infected individuals were examined in that period. A real-time polymerase chain reaction (RT-PCR) technique was applied to confirm infecting of SARS-CoV-2. The deceased cases were categorized into 2 fractions, which were a male and female group. The male group had 407 individuals and the female group had 252 individuals. Results: This study revealed that the male cases had lower lymphocyte and platelet counts than females but substantially higher levels of urea and creatinine, also the male cases were older compared to the female cases. However, D-dimer and C-reactive protein (CRP ) levels did not indicate any notable differences between the two groups. Conclusion: The study showed a gender-situated differences in the laboratory biomarkers of dead COVID-19 cases.

The effect of tocilizumab administration on inflammatory markers in COVID-19 patients

BackgroundThe COVID-19 outbreak was declared a worldwide emergency as a result of its rapid spread. The number of people infected with COVID-19 is increasing rapidly around the world, and pneumonia can develop in COVID-19 cases. The monoclonal antibody tocilizumab blocks the interleukin-6 receptor, which in turn reduces inflammation.Aimof the workThe study aims to determine how tocilizumab affects inflammatory markers, laboratory indices, and oxygen therapy.Subjects and methodsThis retrospective observational study aimed to assess the effect of tocilizumab on inflammatory markers, laboratory parameters, and short-term outcomes in COVID-19 cases. Data was collected from 55 patients with COVID-19 who tested positive for SARS-CoV-2 using PCR. These patients were admitted to Ain Shams University Specialized Hospital—Obour between June 1, 2021, and May 31, 2022.ResultsAfter tocilizumab administration, C-reactive protein levels decreased significantly, but there was no statistically significant change in hemoglobin, serum ferritin, or D-dimer levels. Following tocilizumab administration, the leukocyte counts, and platelet count increased significantly. There was a significant correlation between the presence of comorbidities in the studied patients (e.g., heart failure, post-renal transplantation, and hepatitis C virus) and the risk of mortality. The study's final result showed a significant decrease in platelet count in dead patients compared to discharged patients after receiving tocilizumab. Regarding oxygen therapy following tocilizumab administration, the use of face masks and non-rebreather facemasks was high in dead patients, while nasal prong usage was high in discharged patients. After receiving tocilizumab, there was an increase in the mean liters of oxygen required in dead patients compared to discharged patients.ConclusionAfter administration of tocilizumab in COVID-19 hospitalized patients who have progressing disease, there was highly and significantly decrease in CRP level with no statistically significant alteration in the levels of hemoglobin, serum ferritin, and D-dimer and an increase in TLC and platelets was observed. Following tocilizumab administration, there was a decrease in oxygen demands, an improvement in oxygen therapy and oxygen saturation. Tocilizumab is a recommended therapy option.

Phase angle is a predictor of overall 5-year survival after head and neck cancer surgery

ObjectiveTo evaluate the ability of the variables Muscle Mass percentage (%MM), Body Fat percentage (%BF), Phase Angle (PhA), and Standardized Phase Angle (SPhA) to predict overall survival rates in individuals with surgically treated HNC. MethodsA prospective cohort study of surgically treated HNC patients was carried out between 2017 and 2022 at a cancer referral center in Feira de Santana, Bahia. All subjects were seen by an experienced dietitian the week before surgery. During this visit, patients had their sociodemographic and clinical data collected, as well as anthropometric measurements (weight and height) and BIA variables. In this study, postoperative overall 5-year survival was defined as the time in months between the date of surgery and the date of death, regardless of the cause of death. Patients were followed up after surgery until death. ResultsSeventy-eight older adult patients were consecutively included. Patients had a median age of 65.5-years, were mostly men (83.3%), and most had low education levels (62.3%) and low household income, ranging from zero (19.2%) to the minimum wage (60.2%). They were mostly alcohol drinkers (91%) and tobacco smokers (87.2%). Glottic cancer was diagnosed in 48.7% of patients, with 44.8% of cases with stage-IV disease. Forty (51.2%) deaths were recorded in the follow-up period, with a median survival time of 39 months. Variables %MM, %BF, and SPhA were not significantly different between groups (alive vs. dead patients). PhA was considered an independent predictor of overall survival, with an accuracy of 69% (95% CI 0.57‒0.80). When comparing survival curves, patients with a preoperative PhA < 6.8° were more than twice as likely to die during follow-up (HR = 2.38; p = 0.02; 95% CI 1.14‒4.97). ConclusionOut of the assessed BIA variables, preoperative PhA was considered a good predictor of overall survival after HNC surgery. Level of evidence3.

Clinicopathological analysis of gastric adenocarcinoma with elevated serum alpha-fetoprotein and enteroblastic differentiation

Objective: To investigate the immunophenotypic and molecular biological characteristics of patients with elevated serum alpha-fetoprotein (AFP) and enteroblastic differentiated gastric adenocarcinoma (GAED). Methods: The clinicopathological data of 13 patients with elevated serum AFP and GAED admitted to Shanxi Cancer Hospital from 2018 to 2020 were collected. Immunohistochemistry (IHC) and next-generation sequencing (NGS) were used to analyze the immune markers and molecular biological characteristics of the pathological tissues of the patients. Kaplan-Meier method and log rank test were used for survival analysis. Results: Among the 13 patients with GAED, 12 were male and 1 was female, aged 41-70 years, with a median age of 64 years. The lesions were mainly located in the gastric antrum (5 cases) and gastric body (4 cases). IHC results showed that the tumor embryonic protein (AFP, SALL4, GPC3), intestinal epithelial differentiation protein (CDX-2, CD10), and some original intestinal epithelial phenotype markers (OCT3/4, Claudin6) were expressed in the tumor tissues. Combined application of multiple markers can reduce the rate of missed diagnosis. Among the 13 patients, 12 had at least one mutation (1 mutation: 1 case, 2-5 mutations: 3 cases, 6-15 mutations: 8 cases), and 1 case was not detected. The gene with the highest mutation frequency was TP53 (10 cases), and other mutant genes included EPHB1 (3 cases), ATRX (2 cases), EPHA5 (2 cases), GATA3 (2 cases), LRP1B (2 cases) and MAP2K4 (2 cases) were also detected. Three of the 13 patients had structural variations, which were C14orf177-GNAS, AIM1-FGFR3, and EPHA6-ROS1 gene rearrangements. All 13 patients had copy number variation, and 11 patients had copy number variation of more than 2 genes. The common amplification genes were IRS2 (5 cases), PTEN (5 cases), GNAS (4 cases), CCNE1 (3 cases), CEBPA (3 cases), PCK1 (3 cases) and ERBB2 (2 cases). The common deletion genes were SOX2 (5 cases) and MYC (5 cases). Among the 13 patients, 4 died, and 2 of the dead patients had liver metastasis. There were 4 patients with disease-free survival and 5 patients with disease progression, including 3 cases of abdominal metastasis and 2 cases of liver metastasis. The 3-year survival rate of patients was 65.9 %, and the 3-year progression-free survival rate was 30.7 %. Gene LRP1B point mutation was associated with poor prognosis (P＜0.001). There was no significant improvement in the prognosis of patients treated with immunotherapy compared with those treated with chemotherapy alone (P=0.595), but the prognosis of patients treated with postoperative chemotherapy or postoperative chemotherapy plus immunotherapy was better than that of patients treated with surgery alone (P＜0.05). Conclusions: Elevated serum AFP with GAED is a highly invasive tumor with unique molecular characteristics, often accompanied by multiple molecular events. TP53 mutation is the most common type of gene mutation. In addition, some cases are accompanied by HER2 amplification and gene rearrangement.

Mephedrone concentrations in clinical intoxications and fatal cases: a systematic review.

Mephedrone, a ring-substituted synthetic cathinone derivative, gained popularity as a recreational drug in the late 2000s. Reports of fatalities related to mephedrone use have emerged with varying concentrations of blood mephedrone upon forensic investigations. This study aims to evaluate the existing literature on mephedrone concentrations in instances of clinical intoxication and fatal cases. We comprehensively searched electronic databases, including Web of Science, PubMed, Embase, and the Cochrane Library, from inception to July 26, 2023. We selected case reports or case series of mephedrone intoxication presented with individual blood mephedrone concentration. Patient demographics, clinical characteristics, blood mephedrone concentrations, and outcomes were extracted for analysis. 77 cases from 14 case reports and 6 case series were identified for review. There were 34 deaths and 43 non-fatal intoxication cases. The median patient's age was 24years (IQR: 10), and 91.4% were male. Forty-five of the 63 cases (71.4%) were reported with alcohol or other illicit drugs detected. The median blood mephedrone concentration was 0.37mg/L (IQR: 1.09mg/L). Death cases were older than non-fatal cases (median = 30 vs. 22years, p = 0.029). The median blood mephedrone concentration was higher in death cases (1.30mg/L vs. 0.12mg/L, p < 0.0001). Blood mephedrone concentration in dead patients is approximately 11 times higher than in non-fatal cases. This finding could serve as a stepping stone to the diagnosis of concentrations in clinical poisoning cases and deaths, especially in the treatment of poisoning patients. In more extensive prospective studies, further research is necessary to establish a standardized, real-time available methodology and validate the predictive value of mephedrone concentrations in the prognostic value of mephedrone concentrations.

Analysis of clinical characteristics and causes of death in 38 patients with pneumoconiosis

Objective: To analyze the clinical characteristics and causes of death of patients with pneumoconiosis, and to provide evidence for the prevention and management of pneumoconiosis. Methods: From June 2022 to July 2023, 38 dead patients with pneumoconiosis confirmed by Shandong Academy of Occupational Health and Occupational Medicine were selected as the research objects. The clinical data of patients were collected through hospital information system (HIS) and laboratory information management system (LIS) to analyze the basic situation of patients with pneumoconiosis who died, the distribution of industry types, the course of disease, the nature of work, the type of reimbursement, complications/comorbidities, and the direct causes of death. Univariate analysis of variance was used to compare the course of pneumoconiosis death in patients with different age of exposure to dust. Results: Among the 38 patients with pneumoconiosis, there were 37 males and 1 female. The age of exposure to dust was 5-37 (19.29±8.17) years, the duration of disease was 5-41 (20.26±8.53) years, and the age of death was 27-86 (70.42±12.26) years old. There were 10 cases of stage Ⅰ pneumoconiosis, 18 cases of stage Ⅱ, 10 cases of stage Ⅲ pneumoconiosis and 32 cases (84.21%) of silicosis. There were 30 (78.95%) people aged ≥65 years and 8 (21.05%) people aged <65 years. The industry was mainly metal products (18 workers, 47.37%), and the distribution of work was mainly excavation workers (11 workers, 28.95%). The death course of pneumoconiosis patients with 10-<30 years of exposure to dust accounted for 76.32% (29/38). The average course of pneumoconiosis patients with 20-<30 years of exposure to dust was the longest[ (24.00±9.39) years], and there was no statistically significant difference in the average course of disease among different age of exposure to dust groups (F=1.81, P=0.165). The working units of the deceased patients were private enterprises or factories, and the hospitalization expenses were borne by individuals for 21 people (55.26%). The working unit was a state-owned enterprise, and 17 people (44.74%) were reimbursed for hospitalization expenses and work-related injuries. The main comorbidities/complications of pneumoconiosis patients were respiratory infection in 18 cases (47.37%) and chronic pulmonary heart disease (47.37%). The top 3 direct causes of death were pneumoconiosis in 13 cases (34.21%), pulmonary infection in 10 cases (26.32%) and lung cancer in 7 cases (18.42%) . Conclusion: Most of 38 cases of pneumoconiosis patients death diseases such as multiple combination of respiratory system, cardiovascular system, respiratory system disease is a major cause of death in pneumoconiosis patients.

Study of Mortality Rate and its Causes among Egyptian Children and Adolescents with Cancer

Abstract Background There is little evidence about the burden of childhood cancers in Egypt. Knowledge about the current disease burden of childhood cancers is crucial to priorities cancer control plans and improve survival. Objective To describe the frequency of deaths among children diagnosed with cancer in the last 10 years. Patients and Methods This retrospective descriptive study was conducted in Pediatric Hematology /Oncology Unit, Children's Hospital, Ain Shams University. The data of 500 patients was collected from the database in the period from 1st September 2011 to 30th September 2021. The study included 500 Children less than 18 years diagnosed as solid and hematological malignancies. Results The median age of the included patients was 4.25 years, males represented 54.4%. The most common etiology of malignancies among the included patients were: acute lymphoblastic leukemia (31.8%) and acute myeloid leukemia (714.6%). Death was evident in 71.4% of the included patients. Among the dead cases 106 (74.12%) had late death; that occurred 5 years or more after diagnosis and 37(25.4%) had early death; that occurred within 30 days after diagnosis of the first neoplasm. The higher mortality was reported among acute lymphoblastic leukemia (52; 36.4%), acute myeloid leukemia (28; 19.6%), neuroblastoma (13; 9.1%) and brain tumors (10; 7.0%). Comparison between living and dead childhood cancer patients as regards the demographic and clinical data showed no significant difference regarding; age, gender, and residence (P-value= 0.591, 0.122 &amp; 0.077, respectively). Relapse was significantly increased among dead cases representing 32.9% (P-value= 0.000). Conclusion In our institute, childhood cancer patients’ mortality rate was 28.5% in the last 10 years. Early death occurred in (25.8%) among them; infection was the leading cause of death, while primary malignancy was the main cause of death among those who died late, which is almost comparable with international studies. Furthermore, the overall survival of our childhood with cancer was (67.30%) at 5 years from diagnosis. This is relatively better than the previous published Egyptian data and reaching international figures.

Relationship between the ABO/Rh Blood Group Factors with Coronavirus Disease 2019 Severity and Mortality among Hospitalized Patients in Algeria: A Single-center Study

Introduction: The novel coronavirus causes the deadly disease, severe acute respiratory syndrome (SARS). Therefore, it is necessary to identify prognostic factors for patients hospitalized with SARS-coronavirus-2 infection to identify patients with increased mortality risk. Several studies have shown that polymorphisms within the ABO gene are associated with different traits, including risk factors for coronavirus disease 2019 (COVID-19) mortality. Methods: We conducted a prospective, single-center study at the Pulmonologist Department of Rouiba Hospital, Algiers. The medical records of 498 COVID-19 patients enrolled in this cohort study were hospitalized between March 2020 and March 2022. The patient reported the blood group (grouping card) or was carried out on site. The patients were divided into 10 groups: A+, A−, B+, B−, O+, O−, AB+, AB−, (Rhesus+ABO/Rh blood groups), and Rhesus-groups, according to the distribution of ABO blood group. The different ABO blood group of the 498 patients was analyzed and compared according to their prognosis, death, or transfer to an intensive care unit. Results: Four hundred and ninety-eight patients were evaluated, 213 (42.8%) were male, and the mean age was 55.2 years (standard deviation: 15.3). A total of 473 (94.98%) patients were discharged, and 25 (5.02%) died during hospitalization. The number of patients with ARh negative was significantly higher in the dead patients 30% among 10 patients (P = 0.0002) versus 5.6% for A+, compared to improved individuals and more computed tomography scan lesion extension 40% (P = 0.021) between 50% and 75% vs. 13.2% ± 34.0% (P = 0.034) for the A(+) group, and hypernatremia 141.2 ± 2.7 (P = 0.056) versus 137.4 ± 4.36 for A(+) group. The distribution of ABO blood groups was statistically different between the two groups. The dead patients had the blood groups A(−), (30%), A+ (5.6%), B− (0%), B+ (1.5%), AB− (0%), AB+ (0%), O− (20%), and O+ (4.3%), respectively. Conclusion: The protective nature of all blood groups (AB, B, and O+) was observed in patients presenting with COVID-19 symptoms of varying severities. Blood grouping A and especially A− and O− are marked by a high risk of COVID-19 infection, serious form, and mortality and therefore deserve particular attention in their management.

Clinical characteristics, survival analysis and influencing factors of distant metastasis in patients with acromelanomas: A retrospective study.

The prognosis of acromelanomas (AM) is worse. The objective of this study was to investigate the clinical features of distant metastasis of AM and the factors affecting the survival and prognosis of patients. In this study, a retrospective study was conducted to select 154 AM patients admitted to Nanjing Pukou People's Hospital from January 2018 to April 2021 for clinical research. The clinical characteristics of distant metastasis were statistically analyzed, and the survival curve was drawn with 5-year follow-up outcomes. The median survival time of the patients was calculated, and the clinicopathological features and peripheral blood laboratory indexes of the surviving and dead patients were analyzed. Logistic regression model was used to analyze the risk factors affecting the prognosis of AM patients. In this study, 154 patients with AM were treated, including 88 males and 76 females, aged from 27 to 79 years old, with an average age of (59.3 ± 11.7) years old. Among them, 90 cases had distant metastasis. The main metastatic sites were lung (47.78%) and lymph nodes (42.22%). Among them, single site metastasis accounted for 41.11% and multiple site metastasis 58.89%. 89 cases survived and 65 cases died. The survival time was 22 months to 60 months, and the median survival time was 48.0 months. The Breslow thickness, stage at diagnosis, distant metastasis, site of metastasis and ulceration were compared between the survival group and the death group (P < .05). serum lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) were compared between the survival group and the death group (P < .05). The results of Logistic regression model showed that LDH ≥ 281 U/L, NLR ≥ 2.96, LMR ≤ 3.57, newly diagnosed stage > stage II, distant metastasis, multiple site metastasis and tumor ulcer were independent risk factors for poor prognosis of AM patients (P < .05). Patients with AM had a higher proportion of distant metastasis, mainly lung and lymph node metastasis. Increased LDH, increased NLR, decreased LMR, higher initial stage, distant metastasis, multiple site metastasis, and combined tumor ulcer were closely related to the poor prognosis of patients after surgery.

IL-6 significantly correlated with the prognosis in low-grade glioma and the mediating effect of immune microenvironment.

To screen immune-related prognostic biomarkers in low-grade glioma (LGG), and reveal the potential regulatory mechanism. The differential expressed genes (DEGs) between alive and dead patients were initially identified, then the key common genes between DEGs and immune-related genes were obtained. Regarding the key DEGs associated with the overall survival (OS), their clinical value was assessed by Kaplan-Meier, RCS, logistic regression, ROC, and decision curve analysis methods. We also assessed the role of immune infiltration on the association between key DEGs and OS. All the analyses were based on the TGCA-LGG data. Finally, we conducted the molecular docking analysis to explore the targeting binding of key DEGs with the therapeutic agents in LGG. Among 146 DEGs, only interleukin-6 (IL-6) was finally screened as an immune-related biomarker. High expression of IL-6 significantly correlated with poor OS time (all P < .05), showing a linear relationship. The combination of IL-6 with IDH1 mutation had the most favorable prediction performance on survival status and they achieved a good clinical net benefit. Next, we found a significant relationship between IL-6 and immune microenvironment score, and the immune microenvironment played a mediating effect on the association of IL-6 with survival (all P < .05). Detailly, IL-6 was positively related to M1 macrophage infiltration abundance and its biomarkers (all P < .05). Finally, we obtained 4 therapeutic agents in LGG targeting IL-6, and their targeting binding relationships were all verified. IL6, as an immune-related biomarker, was associated with the prognosis in LGG, and it can be a therapeutic target in LGG.

Collective neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio symbolizes a new prognostic factor in the survival of gastric cancer patients

Background and aims: Due to the high prevalence of gastric cancer and the lack of appropriate prognostic factors, most patients are diagnosed at advanced stages of the disease. Therefore, this study aimed to investigate the relationship between two prognostic factors: neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to patient survival in gastric cancer patients diagnosed before surgery. Methods: This retrospective study was performed on all gastric cancer patients referred to Kashani Hospital in Shahrekord during 2011-2016. Demographic and biological variables such as NLR and PLR were evaluated. Patient survival was calculated by subtracting the date of disease diagnosis (using endoscopy) from the date of death, and data were analyzed by SPSS version 16. Results: In 100 studied patients, the mean age of patients was 63.79±15.03 (range: 10-92) years. 76% of patients were male and the rest were female. The duration of chronic gastrointestinal disease before cancer diagnosis ranged from one year to 12 years (mean: 3.3±2.06 years). The mean values of inflammatory markers for NLR were 3.37±2.78, and the mean PLR was 147.13±78.93. Patient survival after surgery until death or last follow-up ranged from 0.47 to 63.1 months (mean: 18.29±13.53 months). The mean survival in the survived and dead patients was 16.89±11.44 months and 18.66±14.07 months, respectively. Only NLR had a significant effect on survival (P&lt;0.001) and PLR had no significant effect on survival (P=0.646). Conclusion: With the increase of NLR by one point, the hazard rate of gastric cancer patients after surgery increased by 19%. In fact, the survival rate of gastric cancer patients after surgery decreased significantly with increasing NLR.