Early Detection Of High-risk Patients Research Articles

Risk Factors Analysis of AKI in Patients with Primary Non-small Cell Lung Cancer Treated with PD-1/PD-L1 Inhibitor.

To investigate the risk factors of Programmed Cell Death Protein 1 (PD-1), Programmed Cell Death Ligand 1(PD-L1) inhibitor associated acute kidney injury (AKI) in patients with primary non-small cell lung cancer (NSCLC) and construct a predictive model. 120 NSCLC patients were selected as the research subjects and their clinical data were collected. Patients were divided into AKI and Non-AKI (N-AKI) group based on the development of AKI. Exploring the risk factors of PD-1P/D-L1 inhibitor related AKI in NSCLC patients using multivariate logistic regression analysis and visualized the logistic regression analysis to obtain a nomogram model. Meanwhile, evaluate the predictive value of the model. The results of multivariate analysis showed that the presence of extrarenal immune related adverse reactions (irAEs) is a risk factor for PD-1/PD-L1 inhibitor related AKI in NSCLC patients; At the same time, the risk of developing PD-1/PD-L1 inhibitor related AKI in NSCLC patients increases with increasing serum creatinine (SCr) and C-reactive protein (CRP) levels, decreasing baseline estimated glomerular filtration rate (eGFR) levels (P < .05). The analysis results of receiver operator characteristic curve (ROC), calibration curve, and decision curve show that the model has good discrimination and accuracy, and can achieve a high clinical benefit rate. Primary NSCLC patients with extrarenal irAEs, high levels of SCr and CRP, and low levels of eGFR have a higher risk of AKI after PD-1/PD-L1 inhibitor treatment. Establishing a predictive model with high accuracy is more conducive to early detection of high-risk patients. DOI: 10.52547/ijkd.7964.

Risk Factors Analysis of AKI in Patients with Primary Non-small Cell Lung Cancer Treated with PD-1/PD-L1 Inhibitor.

To investigate the risk factors of Programmed Cell Death Protein 1 (PD-1), Programmed Cell Death Ligand 1(PD-L1) inhibitor associated acute kidney injury (AKI) in patients with primary non-small cell lung cancer (NSCLC) and construct a predictive model. 120 NSCLC patients were selected as the research subjects and their clinical data were collected. Patients were divided into AKI and Non-AKI (N-AKI) group based on the development of AKI. Exploring the risk factors of PD-1P/D-L1 inhibitor related AKI in NSCLC patients using multivariate logistic regression analysis and visualized the logistic regression analysis to obtain a nomogram model. Meanwhile, evaluate the predictive value of the model. The results of multivariate analysis showed that the presence of extrarenal immune related adverse reactions (irAEs) is a risk factor for PD-1/PD-L1 inhibitor related AKI in NSCLC patients; At the same time, the risk of developing PD-1/PD-L1 inhibitor related AKI in NSCLC patients increases with increasing serum creatinine (SCr) and C-reactive protein (CRP) levels, decreasing baseline estimated glomerular filtration rate (eGFR) levels (P < .05). The analysis results of receiver operator characteristic curve (ROC), calibration curve, and decision curve show that the model has good discrimination and accuracy, and can achieve a high clinical benefit rate. Primary NSCLC patients with extrarenal irAEs, high levels of SCr and CRP, and low levels of eGFR have a higher risk of AKI after PD-1/PD-L1 inhibitor treatment. Establishing a predictive model with high accuracy is more conducive to early detection of high-risk patients. DOI: 10.52547/ijkd.7964.

Preoperative albumin-alkaline phosphatase ratio affects the prognosis of patients undergoing hepatocellular carcinoma surgery.

The correlation between the preoperative albuminalkaline phosphatase ratio (AAPR) and the prognosis of hepatocellular carcinoma (HCC) patients after radical resection is still not comprehensive. This study aims to observe the correlation between preoperative AAPR and the prognosis of HCC patients after radical resection. We constructed a retrospective cohort study and included 656 HCC patients who underwent radical resection. The patients were grouped after determining an optimum AAPR cut-off value. We used the Cox proportional regression model to assess the correlation between preoperative AAPR and the prognosis of HCC patients after radical resection. The optimal cut-off value of AAPR for assessing the prognosis of HCC patients after radical resection was 0.52 which was acquired by using X-tile software. Kaplan-Meier analysis curves showed that a low AAPR (⩽ 0.52) had a significantly lower rate of overall survival (OS) and recurrence-free survival (RFS) (P< 0.05). Multiple Cox proportional regression showed that an AAPR > 0.52 was a protective factor for OS (HR = 0.66, 95%CI 0.45-0.97, p= 0.036) and RFS (HR = 0.70, 95% CI 0.53-0.92, p= 0.011). The preoperative AAPR level was related to the prognosis of HCC patients after radical resection and can be used as a routine preoperative test, which is important for early detection of high-risk patients and taking personalized adjuvant treatment.

Modern risk scales in pediatrics and pediatric cardiac surgery as tools for assessing the quality of medical care

Introduction. The review presents the characteristics of modern risk scales in pediatrics. A comparative analysis of the advantages and disadvantages of risk scales in pediatric cardiac surgery has been carried out. Early detection of high-risk patients was shown to be the basis for the prevention of adverse outcomes after cardiac surgery. The capabilities of the Aristotle School (Aristotle Basic Complexity (ABC) Score have been established as a tool for assessing the quality of surgical treatment of children with congenital heart defects (CHD). Its determinants are mortality, the complexity of the postoperative period, and the technical complexity of the operation. The correlation between the values of the ABC scale and its determinants was evaluated. If the values of all three determinants exceeded the upper limit of the 95% confidence interval (CI), the patient was included in the high-risk group. The quality of treatment was assessed by the performance index (IP). A close correlation between ABC and its determinants has been revealed. For the ABC school, a high accuracy of the prognosis of death, complications, and technical complexity was established with an optimal threshold value of 6.5 points. Patients with ABC above the threshold were more likely to die. The IP was 0.56, similar indicators of foreign clinics ranged from 0.46 to 0.62 points. &#x0D; Conclusion. The basic Aristotle scale and new risk stratification scales after cardiac surgery in children are effective systems for evaluating the results of surgical treatment of CHD patients of different levels of complexity can be used to determine the quality of surgical treatment and identify high-risk groups.

Development and validation of a nomogram predictive model for colorectal adenoma with low-grade intraepithelial neoplasia using routine laboratory tests: A single-center case-control study in China

BackgroundColorectal cancer (CRC) is the third most common cancer in the world and has a high mortality rate. Colorectal adenoma (CRA) is precancerous lesions of CRC. The purpose of the present study was to construct a nomogram predictive model for CRA with low-grade intraepithelial neoplasia (LGIN) in order to identify high-risk individuals, facilitating early diagnosis and treatment, and ultimately reducing the incidence of CRC. MethodsWe conducted a single-center case-control study. Based on the results of colonoscopy and pathology, 320 participants were divided into the CRA group and the control group, the demographic and laboratory test data were collected. A development cohort (n = 223) was used for identifying the risk factors for CRA with LGIN and to develop a predictive model, followed by an internal validation. An independent validation cohort (n = 97) was used for external validation. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate discrimination ability, accuracy and clinical practicability of the model. ResultsFour predictors, namely sex, age, albumin and monocyte count, were included in the predictive model. In the development cohort, internal validation and external validation cohort, the area under the curve (AUC) of this risk predictive model were 0.946 (95%CI: 0.919–0.973), 0.909 (95 % CI: 0.869–0.940) and 0.928 (95%CI: 0.876–0.980), respectively, which demonstrated the model had a good discrimination ability. The calibration plots showed a good agreement and the decision curve analysis (DCA) suggested the predictive model had a high clinical net benefit. ConclusionThe nomogram model exhibited good performance in predicting CRA with LGIN, which can aid in the early detection of high-risk patients, improve early treatment, and ultimately reduce the incidence of CRC.

Cd8+ expression in oral potentially malignant disorders associated with risk factors in selected population of east Indonesia

Background: Oral potentially malignant disorder (OPMD) is a lesion with a high potential to turn into oral squamous cell carcinoma (OSCC). The discovery of OPMD lesions precedes most cases of OSCC. Sensitive and specific biomarkers can help in the early detection of high-risk patients, one of which is CD8+, part of the cytotoxic T lymphocytes, which have a role in eliminating cancer cells. Several studies use infiltration density and CD8+ T cells' activity as biomarkers in malignancy. This study aims to observe the expression of CD8+ in OPMD lesions and correlate with risk factors&#x0D; Method: Twelve paraffin blocks samples consist of OPMD lesions. One oral lichen planus (OLP) as the positive control. Samples were stained using HE to observe the degree of dysplasia and immunohistochemistry to observe the expression of CD8+ T cells. Observation of results using a microscope with 100x magnification to select the field of view and 400x magnification to count the number of positive CD8+ T cells with a cut-off point of 500 cells from a total of 5 fields of view and determined by weak intensity (

Novel nomogram for predicting pulmonary complications in patients with blunt chest trauma with rib fractures: a retrospective cohort study

The direct consequences of chest trauma may cause adverse outcomes. Therefore, the early detection of high-risk patients and appropriate interventions can improve patient outcomes. This study aimed to investigate the risk factor for overall pulmonary complications in patients with blunt traumatic rib fractures. Prospectively recorded data of patients with blunt chest trauma in a level 1 trauma center between January 2019 and October 2022 were retrospectively analyzed. The primary outcomes were one or more pulmonary complications. To minimize the overfitting of the prediction model, we used the least absolute shrinkage and selection operator (LASSO) logistic regression. We input selected features using LASSO regression into the multivariable logistic regression model (MLR). We also constructed a nomogram to calculate approximate individual probability. Altogether, 542 patients were included. The LASSO regression model identified age, injury severity score (ISS), and flail motion of the chest wall as significant risk factors. In the MLR analysis, age (adjusted OR [aOR] 1.06; 95% confidence interval [CI] 1.03–1.08; p < 0.001), ISS (aOR 1.10; 95% CI 1.05–1.16; p < 0.001), and flail motion (aOR 8.82; 95% CI 4.13–18.83; p < 0.001) were significant. An MLR-based nomogram predicted the individual risk, and the area under the receiver operating characteristic curve was 0.826. We suggest a novel nomogram with good performance for predicting adverse pulmonary outcomes. The flail motion of the chest wall may be the most significant risk factor for pulmonary complications.

Extracellular RNA profiles in non-small cell lung cancer plasma.

Non-small cell lung cancer (NSCLC) has a high mortality rate and poor prognosis. The early detection of high-risk patients is essential to improve patient prognosis. Thus, the identification of a non-invasive, non-radiative, convenient, and fast diagnostic approach should be a top priority in NSCLC research. Circulating extracellular RNAs (exRNAs) in the plasma are potential biomarkers for NSCLC. We used RNA-sequencing (RNA-seq) technology to explore the NSCLC-related RNAs, especially the circular RNAs (circRNAs). The circRNA-targeted micro RNAs (miRNAs) were predicted using 3 circRNA databases [i.e., the Cancer-Specific CircRNA Database (CSCD), circBank, and Circular RNA Interactome]. The circRNA-miRNA-messenger RNA (mRNA) network was constructed using Cytoscape V3.8.0 (Cytoscape Consortium, San Diego, CA, USA). The expression levels of some differentially expressed genes were validated by a quantitative real-time polymerase chain reaction (qRT-PCR) analysis. The results showed that the RNA biotypes of the mitochondrial ribosomal RNAs (mt-rRNAs) and mitochondrial transfer RNAs (mt-tRNAs) were upregulated in the NSCLC plasma. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) terms of the differentially expressed transcripts of NSCLC included oxidative phosphorylation, proton transmembrane transport, and the response to oxidative stress. Additionally, the qRT-PCR validation indicated that hsa_circ_0000722 had significantly higher expression in the NSCLC plasma than the control plasma, but hsa_circ_0006156 did not differ between the NSCLC plasma and the control plasma. The expression levels of miR-324-5p and miR-326 were higher in the NSCLC plasma than the control plasma. In this study, an exRNA-sequencing strategy was used to identify the expression of NSCLC-specific transcription factors in clinical plasma samples, and hsa_circ_0000722 and hsa-miR-324-5p were identified as potential biomarkers in NSCLC.

Adverse muscle composition is a significant risk factor for all-cause mortality in NAFLD

Adverse muscle composition (MC) (i.e., low muscle volume and high muscle fat) has previously been linked to poor functional performance and comorbidities in non-alcoholic fatty liver disease (NAFLD). In this study we aimed to investigate associations of all-cause mortality with liver fat, NAFLD, and MC in the UK Biobank imaging study. Magnetic resonance images of 40,174 participants were analyzed for liver proton density fat fraction (PDFF), thigh fat-free muscle volume (FFMV) z-score, and muscle fat infiltration (MFI) using the AMRA® Researcher. Participants with NAFLD were sex-, age-, and BMI-matched to participants without NAFLD with low alcohol consumption. Adverse MC was identified using previously published cut-offs. All-cause mortality was investigated using Cox regression. Models within NAFLD were crude and subsequently adjusted for sex, age, BMI (M1), hand grip strength, physical activity, smoking, alcohol (M2), and previous cancer, coronary heart disease, type 2 diabetes (M3). A total of 5,069 participants had NAFLD. During a mean (±SD) follow-up of 3.9 (±1.4) years, 150 out of the 10,138 participants (53% men, age 64.4 [±7.6] years, BMI 29.7 [±4.4] kg/m2) died. In the matched dataset, neither NAFLD nor liver PDFF were associated with all-cause mortality, while all MC variables achieved significance. Within NAFLD, adverse MC, MFI and FFMV z-score were significantly associated with all-cause mortality and remained so in M1 and M2 (crude hazard ratios [HRs] 2.84, 95% CI 1.70-4.75, p <0.001; 1.15, 95% CI 1.07-1.24, p <0.001; 0.70, 95% CI 0.55-0.88, p <0.001). In M3, the relationship was attenuated for adverse MC and FFMV z-score (adjusted HRs 1.72, 95% CI 1.00-2.98, p=0.051; 0.77, 95% CI 0.58-1.02, p=0.069) but remained significant for MFI (adjusted HR 1.13, 95% CI 1.01-1.26, p=0.026). Neither NAFLD nor liver PDFF was predictive of all-cause mortality. Adverse MC was a strong predictor of all-cause mortality in individuals with NAFLD. Individuals with fatty liver disease and poor muscle health more often suffer from poor functional performance and comorbidities. This study shows that they are also at a higher risk of dying. The study results indicate that measuring muscle health (the patient's muscle volume and how much fat they have in their muscles) could help in the early detection of high-risk patients and enable targeted preventative care.

Screening for Obstructive Sleep Apnea using Epworth Sleepiness Score and Berlin Questionnaire: Which is Better?

Background: Obstructive sleep apnea (OSA) is a highly prevalent, but underdiagnosed and undertreated disorder. There is a need for simple but accurate tool for early detection of patients based on their clinical symptoms and physical findings into high- or low-risk group and give information for urgent polysomnography (PSG) and further treatment to prevent serious consequences. Epworth Sleepiness Score (ESS) and Berlin Questionnaire (BQ) are the most popular and widely acceptable instruments for identification of high-risk patients of OSA. The aim of our study was to compare these two established and well-known sleep questionnaires regarding their ability to find out the probable cases of OSA in Indian scenario. Methods: This cross-sectional study was conducted at a tertiary care center on 72 adult patients with symptoms of sleep-related breathing disorders. All patients were asked to fill both ESS and BQ questionnaires. Subsequently, all patients were subjected to level-1 PSG. For each patient, the Apnea–hypopnoea index was calculated to assess the diagnosis and severity of OSA and to further compare the ESS and BQ questionnaires for their sensitivity (SN) in OSA patients. Results: A total of 14 (19.4%) patients were diagnosed as OSA by ESS while by BQ, 32 (44.4%) patients were diagnosed as having OSA with SN of 31% and 71.11%, respectively (P = 0.00004). The positive predictive value was 82.3% and 88.8% for ESS and BQ, respectively, with a negative predictive value of 43.6% by ESS and 63.8% by BQ questionnaires. Conclusion: ESS is a less sensitive diagnostic tool for early detection of high-risk patients of OSA in general population. BQ is a valid, reliable, and more sensitive parameter to screen patients for OSA and may help in improving the quality of life in such patients with proper OSA management.

Immunogenomic correlates of immune-related adverse events for anti-programmed cell death 1 therapy.

Despite impressive antitumor efficacy of programmed cell death 1 (PD-1) inhibitors, this inhibition can induce mild to severe autoimmune toxicities, termed immune-related adverse events (irAEs). Yet, predictive pretreatment biomarkers for irAEs development across cancer types remain elusive. We first assessed cellular and molecular factors. To determine factors predicting the risk of irAEs for anti-PD-1 immunotherapy across multiple cancer types, an integrative analysis of cellular and molecular factors from 9104 patients across 21 cancer types and 4865522 postmarketing adverse event reports retrieved from adverse event reporting system was then performed. Accuracy of predictions was quantified as Pearson correlation coefficient determined using leave-one-out cross-validation. Independent validation sets included small cell lung cancer and melanoma cohorts. Out of 4865522 eligible adverse events reports, 10412 cases received anti-PD-1 monotherapy, of which, 2997 (28.78%) exhibited at least one irAE. Among established immunogenomic factors, dendritic cells (DC) abundance showed the strongest correlation with irAEs risk, followed by tumor mutational burden (TMB). Further predictive accuracy was achieved by DC and TMB in combination with CD4+ naive T-cells abundance, and then validated in the small cell lung cancer cohort. Additionally, global screening of multiomics data identified 11 novel predictors of irAEs. Of these, IRF4 showed the highest correlation. Best predictive performance was observed in the IRF4 - TCL1A - SHC-pY317 trivariate model. Associations of IRF4 and TCL1A expression with irAEs development were verified in the melanoma cohort receiving immune checkpoint inhibitors. Collectively, pretreatment cellular and molecular irAEs-associated features as well as their combinations are identified regardless of cancer types. These findings may deepen our knowledge of irAEs pathogenesis and, ultimately, aid in early detection of high-risk patients and management of irAEs.

Exploration of prognostic factors for prediction of mortality in elderly CAP population using a nomogram model.

BackgroundThe incidence and mortality rate of community-acquired pneumonia (CAP) in elderly patients were higher than the younger population. The assessment tools including CURB-65 and qSOFA have been applied in early detection of high-risk patients with CAP. However, several disadvantages exist to limit the efficiency of these tools for accurate assessment in elderly CAP. Therefore, we aimed to explore a more comprehensive tool to predict mortality in elderly CAP population by establishing a nomogram model.MethodsWe retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University. The least absolute shrinkage and selection operator (LASSO) logistic regression combined with multivariate analyses were used to select independent predictive factors and established nomogram models via R software. Calibration plots, decision curve analysis (DCA) and receiver operating characteristic curve (ROC) were generated to assess predictive performance.ResultsLASSO and multiple logistic regression analyses showed the age, pulse, NLR, albumin, BUN, and D-dimer were independent risk predictors. A nomogram model (NB-DAPA model) was established for predicting mortality of CAP in elderly patients. In both training and validation set, the area under the curve (AUC) of the NB-DAPA model showed superiority than CURB-65 and qSOFA. Meanwhile, DCA revealed that the predictive model had significant net benefits for most threshold probabilities.ConclusionOur established NB-DAPA nomogram model is a simple and accurate tool for predicting in-hospital mortality of CAP, adapted for patients aged 65 years and above. The predictive performance of the NB-DAPA model was better than PSI, CURB-65 and qSOFA.

Pulmonary artery obstruction index, pulmonary artery diameter and right ventricle strain as prognostic CT findings in patient with acute pulmonary embolism

ObjectiveThis study was designed to determine predictors of pulmonary hypertension and signs of right heart dysfunction caused by pulmonary embolism (PE) that may lead to early detection of high-risk patients. So the predictive value of pulmonary artery obstruction index (PAOI), measured by pulmonary CT angiography (PCTA) in the acute setting, in predicting the patients susceptible to PE cardiac complications was evaluated. Also two other PCTA indices, pulmonary artery diameter (PAD), and right ventricle (RV) strain, in these patients were investigated and their predictive value for cardiac complications on follow up echocardiography were demonstrated. Materials and methodsIn the study 120 patients with a definite diagnosis of PE were included. The PAOI, PAD and RV strain were measured using PCTA at the time of the initial diagnosis. Transthoracic echocardiography was done 6 months after the diagnosis of PE and RV echocardiographic indices were measured. Pearson correlation was used to investigate correlation between PAOI, PAD, RV strain and signs of right heart dysfunction. ResultsPAOI was strongly correlated with systolic pulmonary artery pressure (SPAP) (r=0.83), RV systolic pressure (r=0.78) and RV wall thickness (r=0.61) in long-term follow up echocardiography. A higher rate of RV dysfunction and RV dilation was detected among the patients with higher PAOI (P<0.001). PAOI≥18 was strongly predictive for development of RV dysfunction. Also developments of pulmonary hypertension, RV systolic hypertension, RV dilation, RV dysfunction, and RV hypertrophy were significantly more common among patients with higher PAD and RV strain (P<0.001). ConclusionsPAOI, PAD and RV strain are sensitive and specific PCTA indices that can predict the development of long-term complications such as pulmonary hypertension and right heart dysfunction, at the time of initial PE diagnosis.

Study of COVID-19 laboratory findings and chest CT findings in assessing disease severity in patients in western Maharashtra

Coronavirus disease-19 (COVID-19) has become a world health threat. Early detection of high-risk patients with laboratory and radiological parameters can aid in reducing mortality. Aims and objectives: To assess the clinical, laboratory, radiological parameters in patients with COVID-19 and to compare them with the outcome. The study was conducted in 200 patients presenting with COVID-19 infection in a tertiary care hospital over one month during month of October 2021. Enrolled patients underwent inflammatory markers, haematological markers and CT scan of the thorax on admission. Statistical analysis: Appropriate statistical tests were applied using SPSS software v21 for analysis; p-value&lt;0.05 was considered statistically significant. Mean age of the study population was 51.84(SD±16.02). D-dimer, CRP, ferritin, TLC, NLR, CTSS has shown significant correlation with mortality. Mean CTSS was 9.75 (SD±5.32), mean D-dimer was 0.79 (SD±1.69), mean sr. ferritin was 320.68 (SD±328.04), the mean CRP level was 2.08 (SD±5.86) and mean neutrophil-lymphocyte ratio (NLR) was 5.01 (SD±5.53). The PaO2/FiO2 ratio was identified as an independent risk factor (odd ratio [OR] = 0.992, 95% confidence interval [CI]: 0.986–0.998, p = 0.006). The area under curve of the receiver operator characteristic (AUROC) of PaO2/FiO2 with mortality as outcome was 0.795 (95% CI: 0.684–0.906, p &lt; 0.0001).

Nutritional status associated with clinical outcomes among patients hospitalized with COVID-19: A multicenter prospective study in Egypt.

Few studies have addressed the relationship between the nutritional status of patients with COVID-19 and their disease course. This multicenter prospective study aimed to evaluate the nutritional status of patients hospitalized with COVID-19 and its association with their clinical outcomes. Sociodemographic, physical, clinical, and nutritional data of 121 patients with confirmed COVID-19 were collected upon admission and at discharge from three COVID-19 quarantine hospitals in Egypt via a questionnaire and a standardized scale. The majority (73.6%) of the patients had a reduced dietary intake over the last week before admission, and 57% were severely ill. Overall, 14% had a high risk of malnutrition on admission, increasing to 26.3% at discharge. Malnutrition was present in most (85.7%) of the intensive care unit patients and deaths, compared with recovered patients (14%). We concluded that malnutrition might worsen the clinical outcomes and increase the morbidity and mortality of COVID-19 patients. A multidisciplinary approach is recommended to manage patients with COVID-19, considering their nutritional status before and during infection, with early detection of high-risk patients in order to design and provide the appropriate nutritional support.

The Utility of Metabolic Parameters on Baseline F-18 FDG PET/CT in Predicting Treatment Response and Survival in Paediatric and Adolescent Hodgkin Lymphoma.

Lymphoma is the third most common paediatric cancer. Early detection of high-risk patients is necessary to anticipate those who require intensive therapy and follow-up. Current literature shows that residual tumor avidity on PET (Positron Emission Tomography) following chemotherapy corresponds with decreased survival. However, the value of metabolic parameters has not been adequately investigated. In this retrospective study, we aimed to evaluate the prognostic value of metabolic and other parameters in paediatric and adolescent Hodgkin lymphoma. We recorded tMTV (total Metabolic Tumor Volume), TLG (Total Lesion Glycolysis), and SUVmax (maximum Standard Uptake Value) on baseline PET, as well the presence of bone marrow or visceral involvement. HIV (human immunodeficiency virus) status and baseline biochemistry from clinical records were noted. All patients received stage-specific standard of care therapy. Response assessment on end-of-treatment PET was evaluated according to the Deauville criteria. We found that bone marrow involvement (p = 0.028), effusion (p < 0.001), and treatment response (p < 0.001) on baseline PET, as well as HIV status (p = 0.036) and baseline haemoglobin (p = 0.039), were significantly related to progression-free survival (PFS), whereas only effusion (p = 0.017) and treatment response (p = 0.050) were predictive of overall survival (OS). Only baseline tMTV predicted treatment response (p = 0.017). This confirms the value of F-18 FDG PET/CT (Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography) in prognostication in paediatric and adolescent Hodgkin lymphoma; however, further studies are required to define the significance of metabolic parameters.

Effect of Serum SAAG Ratio on the Outcome of Diagnosed Patients with (SBP) Spontaneous Bacterial Peritonitis in Comparison to their CTP &amp; Meld Classification

Objective: To investigate the serum albumin levels among hospitalized patients of chronic Liver disease (CLD) having SBP in Asian Institute of Medical Sciences Hospital Hyderabad, detecting early can potentially reduce its outcome of In-Hospital Mortality. Methodology: The descriptive case series study was conducted from January 2019 to June 2019 at Gastroenterology ward of Asian Institute of Medical Sciences, Hyderabad. All cases of CLD having spontaneous bacterial peritonitis and either of gender were enrolled in the study. Cirrhosis stages were assessed by CTP (Child-Turcot-Pugh) score and MELD (Model for End-stage Liver Disease) score. Serum levels of albumin were taken under the supervision of well-trained staff nurse(s) by following all guideline protocols and taking care of every risk factor and error for minimizing the bias results. The data was analyzed using SPSS version 20. Results: Mean age of the patients was 47.56±13.069 years. sampled serum albumin levels were found less than 2.0mg/dl have much higher in-hospital mortality rate compared to those having serum albumin levels more than 3.0mg/dl. There were also significant differences in outcome (in-hospital mortality) seen among the gender groups: Male vs. female; in-hospital death 42/165 vs. 19/58 (p-0.283). Hospital mortality was significantly high in CTP-C patients compared to CTP-B patients (59/185 vs. 02/38, (p-0.001). Early detection of high-risk patients is critical for better prognosis. Conclusion: It was observed that, there is a high prevalence of cirrhosis and its complications and a significant relationship of in-hospital mortality among patients of SBP and their SAAG (serum Albumin ratios), which clearly signifies that those patients who have serum Albumin ratio lesser than 2.0mg/dl have higher in-hospital mortality as compared to those have serum Albumin ratio lesser than 2.1-3.1mg/dl and more than 3.0mg/dl. Keywords: Cirrhosis, Albumin, Mortality

Прогнозування ризику розвитку хронічного бронхіту у підлітків-курців

Мета дослідження — побудова зручної для застосування в практичній медицині прогностичної моделі ризику розвитку хронічної патології органів дихання у підлітків-курців. Матеріали та методи. Проведено обстеження 73 підлітків-курців віком від 14 до 18 років (середній вік — 16,4 ± 0,2 року). Усі обстежені були розподілені на 2 групи: групу 1 становили 36 підлітків-курців із хронічним бронхітом (середній вік — 16,8 ± 0,2 року) та групу порівняння — 37 умовно здорових підлітків-курців (середній вік — 15,9 ± 0,2 року). Нами були вивчені клініко-анамнестичні, функціонально-інструментальні дані (показники спірометрії, рентгенографії органів грудної клітки, рівня оксиду азоту в конденсаті повітря, що видихається, сили дихальних м’язів) та молекулярно-генетичні фактори ризику розвитку хронічної патології органів дихання у підлітків-курців — усього 103 ознаки. Для створення прогностичної моделі ризику розвитку хронічного бронхіту було застосовано метод послідовного (секвенціального) аналізу Вальда та стратегію Байєса. Результати. Принцип роботи з математичною моделлю прогнозу ризику розвитку хронічної патології органів дихання у підлітків-курців полягає у підсумуванні діагностичних коефіцієнтів (ДК), що відповідають виявленим у пацієнта ознакам. При сумі ДК +13 діагностують розвиток хронічного бронхіту у підлітків-курців із вірогідністю помилки ≤ 5 % (р &lt; 0,05); при сумі +20 вірогідність прогнозу становить 99 % (р &lt; 0,01). Висновки. Розроблений нами алгоритм прогнозування ризику розвитку хронічного бронхіту у підлітків-курців буде сприяти ранньому виявленню груп пацієнтів високого ризику з формування даної патології для проведення персоніфікованих профілактичних заходів, що дозволить практичним лікарям запобігати хронізації патологічного процесу та покращувати якість життя.

Long term outcomes in patients with RF/RHD: Eight-year follow-up of HP-RF/RHD (Himachal Pradesh Rheumatic Fever/Rheumatic Heart Disease) registry in a Northern Indian state

BackgroundThe long-term outcome data in patients with rheumatic fever/rheumatic heart disease (RF/RHD) is limited. We report the cumulative incidence of adverse outcomes in a cohort of RHD patients from a northern state of India at a median follow-up of 5.4 years. Methods1714 patients with RF/RHD diagnosed using clinical and echocardiographic criteria were registered from 2011 to 2018, and their baseline clinical characteristics and treatment practices were recorded. Patients were followed up annually for a median of 5.4 years (range 1–8 years) for incident adverse outcomes. The cumulative incidence of adverse composite outcomes, all-cause mortality, hospitalization for heart failure, stroke, and/or peripheral embolism was estimated. The baseline clinical characteristics were explored to identify the potential risk predictors using a multivariate cox proportional hazard model. ResultsThe cumulative incidence of adverse composite outcomes was 17.1% (15.3%–19.0%) at a median follow-up of 5.4 years. The predictors for the adverse composite outcomes (hazard ratio, 95% confidence interval) were age (1.03, 1.02–1.04), education status below primary level (1.60, 1.23–2.05), severe valvular heart disease (1.74, 1.36–2.23), NYHA class III/IV at enrollment (1.56, 1.18–2.07), right heart failure (4.48, 2.85–6.95), history of stroke and/or peripheral embolism (3.7, 1.5–9.2) and mitral balloon valvuloplasty (0.62, 0.40–0.96). ConclusionsThe incidence of adverse outcomes is substantial in patients with RF/RHD. Thus, early detection of high-risk patients and their risk management is needed to improve outcomes.

Risk Factors and Prognosis of Carbapenem-Resistant Klebsiella pneumoniae Infections in Respiratory Intensive Care Unit: A Retrospective Study.

PurposeCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections have become a serious threat with high morbidity and mortality. Early identification of risk factors for CRKP infections is important, but these factors are still controversial. Therefore, we aimed to identify the risk factors and clinical outcomes of CRKP infections.Patients and MethodsThe retrospective, single-center study was carried out in the respiratory intensive care unit of the Chinese People’s Liberation Army General Hospital from 2017 to 2020. Patients infected with K. pneumoniae were included and categorized into the CRKP group and carbapenem-sensitive K. pneumoniae (CSKP) group based on the susceptibility to carbapenems. The independent risk factors were investigated by univariate analysis and multivariate logistic regression analysis. The clinical outcomes were also evaluated between the two groups.ResultsA total of 138 eligible patients were included in our study, with a median age of 80.5 years (interquartile range: 62.0–86.3), and 78.3% of them were males. Of the 138 patients, there were 97 patients in the CRKP group, and the other 41 were assigned into the CSKP group. Multivariate analysis showed that exposure to ≥three types of comorbidities (OR = 5.465, P = 0.003), previous hospitalization (OR = 4.279, P = 0.006), use of quinolones (OR = 5.872, P = 0.012), and indwelling urinary catheter (OR = 5.035, P = 0.000) were independent risk factors for CRKP infections. The in-hospital mortality rate of the CRKP group was 42.1%, which was higher compared with the CSKP group (17.5%, P = 0.006).ConclusionExposure to ≥three types of comorbidities, previous hospitalization, use of quinolones, and indwelling urinary catheter were independent risk factors for CRKP infections, which had higher mortality compared with CSKP infections. Early detection of high-risk patients and timely control measures should be implemented to prevent the emergence of CRKP infections and thereby improve the clinical outcomes.