Fatal Outcomes Research Articles

Crash Severity Analysis of Young Adult Motorcyclists: A Comparison of Urban and Rural Local Roadways

In developing nations, motorcycles are a ubiquitous mode of transportation on local road networks, contributing to a substantial frequency of traffic accidents and fatalities. These occurrences exhibit significant discrepancies between urban and rural road environments. Specifically, urban roads exhibit greater traffic density and more robust law enforcement presence compared to their rural counterparts, factors that invariably influence vehicular speeds. Consequently, these variations in speed are associated with the adoption of riskier behaviors by motorists, with a pronounced impact on Young Adult Motorcyclists (YAMs) who demonstrate a heightened propensity for engaging in perilous activities, such as operating a motorcycle while under the influence or executing excessively close maneuvers. This study seeks to examine the factors that influence injury severity among YAM on local roads by contrasting urban and rural roadways, taking into account the different roadway contexts. Data from motorcycle crashes on local roads in Thailand between 2018 and 2020 were analyzed using the Random Parameter Logit Models with Unobserved Heterogeneity in Means and Variances (RPLMV) approach to investigate the relationship between contributing factors and YAM injury severity. The findings revealed several critical insights into the factors influencing the severity of motorcycle accidents, particularly among YAM on local urban roads. It is evident that a confluence of factors, including the absence of a valid driver’s license, exceeding designated speed limits, and the involvement of male drivers, significantly elevates the probability of fatal outcomes in these accidents. Our analysis has also unveiled intriguing patterns in nighttime accidents involving motorcycles, where those with functioning vehicle lights and those occurring under the cover of darkness without proper illumination share notable similarities in terms of severity. Furthermore, our research has emphasized that accidents transpiring outside city confines during nighttime hours with adequate lighting exhibit a negligible impact on higher crash severity. The key findings advocate for the development and implementation of targeted policy recommendations and countermeasures to alleviate the severity of accidents involving YAM. This includes a proposition to bolster law enforcement efforts, particularly in regions beyond city borders, and to enforce strict adherence to regulations concerning driver’s license verifications. Our study offers a crucial foundation for future research and policy development aimed at improving road safety and reducing the severity of motorcycle accidents, with the ultimate goal of safeguarding the lives of YAM.

Endogenous bacteriophages in intensive care patients with bacteremia and sepsis

Aim. To study the effect of endogenous bacteriophages on the outcome of infectious and inflammatory diseases in intensive care patients.Materials and methods. 30 patients with positive hemoculture were examined for the presence of bacteriophages. The detection of endogenous bacteriophages in the blood of patients was made using traditional virological methods. Statistical analysis was performed using the Statistica 10 program.Results. The bacteriophages were found in the blood of 11 patients, 5 of them were examined in dynamics15 strains of microorganisms were isolated. The mortality rate of patients in the phagopositive group was 18.2 %. 19 patients had no endogenous bacteriophages. In this group, the mortality rate was 68.4 %, that is significantly higher than in patients with endogenous phages. K. pneumonia was are the main causative agent of bacteremia and sepsis (12 strains out of 36).Conclusions. Fatal outcomes were more often detected in patients whose endogenous bacteriophages were not detected in the blood. The most serious complications with frequent fatal outcomes were observed in patients with bacteremia caused by K. pneumonia.

Blocking of doublecortin-like kinase 1-regulated SARS-CoV-2 replication cycle restores cell signaling network.

Severe COVID-19 and post-acute sequelae often afflict patients with underlying co-morbidities. There is a pressing need for highly effective treatment, particularly in light of the emergence of SARS-CoV-2 variants. In a previous study, we demonstrated that DCLK1, a protein associated with cancer stem cells, is highly expressed in the lungs of COVID-19 patients and enhances viral production and hyperinflammatory responses. In this study, we report the pivotal role of DCLK1-regulated mechanisms in driving SARS-CoV-2 replication-transcription processes and pathogenic signaling. Notably, pharmacological inhibition of DCLK1 kinase during SARS-CoV-2 effectively impedes these processes and counteracts virus-induced alternations in global cell signaling. These findings hold significant potential for immediate application in treating COVID-19.

Macrophage RAGE deficiency prevents myocardial fibrosis by repressing autophagy-mediated macrophage alternative activation.

Myocardial fibrosis (MF) is the characteristic pathological feature of various cardiovascular diseases that lead to heart failure (HF) or even fatal outcomes. Alternatively, activated macrophages are involved in the development of fibrosis and tissue remodeling. Although the receptor for advanced glycation end products (RAGE) is involved in MF, its potential role in regulating macrophage function in cardiac fibrosis has not been fully investigated. We aimed to determine the role of macrophage RAGE in transverse aortic constriction (TAC)-induced MF. In this study, we found that RAGE expression was markedly increased in the infiltrated alternatively activated macrophages within mice hearts after TAC. RAGE knockout mice showed less infiltration of alternatively activated macrophages and attenuated cardiac hypertrophy and fibrosis compared to the wild-type mice. Our data suggest that mice with macrophage-specific genetic deletion of RAGE were protected from interstitial fibrosis and cardiac dysfunction when subjected to pressure overload, which led to a decreased proportion of alternatively activated macrophages in heart tissues. Our invitro experiments demonstrated that RAGE deficiency inhibited the differentiation into alternatively activated macrophages by suppressing autophagy activation. In the co-culture system, invitro polarization of RAW264.7 macrophages toward an alternatively activated phenotype stimulated the expression of α-smooth muscle actin and collagen in cardiac fibroblasts. However, the knockdown of RAGE and inhibition of autophagy in macrophages showed reduced fibroblast-to-myofibroblast transition (FMT). Collectively, our results suggest that RAGE plays an important role in the recruitment and activation of alternatively activated macrophages by regulating autophagy, which contributes to MF. Thus, blockage of RAGE signaling may be an attractive therapeutic target for the treatment of hypertensive heart disease.

Development of a Scoring Method Based on a Chest CT Scan to Determine the Outcomes of COVID-19 Patients.

Introduction As COVID-19 shifts from pandemic urgency to endemic management, healthcare systems are faced with the evolving challenge of providing optimized care and adept resource allocation in this evolving landscape of the disease. However, the timely management and accurate assessment of disease severity remains a cornerstone of effective treatment. This study presents a pioneering scoring system, based on the primary chest CT scan findings, to predict patient outcomes and to equip clinicians with a tool that can expedite decision-making. Method A retrospective cohort study was conducted involving 406 confirmed COVID-19 cases referred to two of our hospitals in Tehran, between February and April 2020. Radiographic and CT scan data were sourced from the imaging archive system and evaluated by a certified radiologist. We devised distinct severity scores for CT findings, demographic factors, and clinical indicators. These were synthesized into a comprehensive severity score to forecast critical patient outcomes, such as mortality, ICU admission, intubation, or extended hospitalization. Of the total cases, 161 (39.7%) were classified as severe, while 245 (60%) fell into the low or moderate severity category. Results The mean score of demographic, CT scan, and clinical characteristics was significantly higher for those in the severe COVID-19 than the non-severe group. The cutoff score for predicting the outcomes in COVID-19 patients for demographic, clinical, and chest CT scan factors was 2.5, 9.5, and 8.5, respectively. Multivariate analysis indicated that each unit increase in these scores elevated the odds of fatal outcomes by 24%, 2.8%, and 12%, respectively. Then, using the comprehensive severity score, which is the sum of the above scores, we further predicted the disease severity. Conclusion The findings suggest that our innovative scoring system, based on initial chest CT scan findings, serves as a robust predictor of COVID-19 outcomes.

A Pragmatic Approach for Managing Unexplained Neutropenia in a Brain Tumor Patient

Cancer patients experience a decrease in blood counts either due to the myelosuppressive effect of oncological treatment or bone marrow infiltration due to distant metastases. Oncological interventions, such as chemotherapy, immunotherapy or large-field irradiation, are common causes of neutropenia, thrombocytopenia, or pancytopenia in cancer patients. Non-oncological reasons for the decrease in blood counts can be attributed to drug-induced, autoimmune diseases, or viral infections. Recently, case reports have been published for neutropenia/thrombocytopenia due to the Coronavirus disease (Covid-19) pandemic too. Here, we discuss a case of phenytoin-induced neutropenia in a brain tumor patient and a pragmatic approach for managing unexplained neutropenia, that is, neutropenia unrelated to cancer or oncological intervention. Timely recognition and timely intervention can prevent fatal outcomes.

An artificial intelligence approach for prognosis of COVID-19 course in hospitalized patients

Aim. To create algorithm and risk calculator for predicting the lethal outcome in patients with COVID-19.Materials and methods. Based on machine learning approach mortality risk calculator was developed in Almazov National Medical Research Centre using data of the hospitalised patients with an established diagnosis of COVID-19 (n=4071).Results. This mathematical model, which includes 11 significant features, has been proposed for estimation of fatal outcomes in the Clinical Infectious Hospital named after S.P. Botkin. Some key features were not assessed in most hospitals according to accepted standards of care for COVID-19. So systematic analysis of factors affecting the course of disease in patients (n=2876) were conducted and «urea» and «total protein» were replaced with «sex» and «BMI». Modified algorithm demonstrated high sensitivity and specificity. Conclusion. This calculator is able to predict hospitalisation outcome with high accuracy in patients infected with different strains of SARS-CoV-2. This decision support system may be used for risk stratification and following correct patients routing.

Effect of Graphene Oxide and Silver Nanoparticle Hybrid Composite on Acinetobacter baumannii Strains, Regarding Antibiotic Resistance and Prevalence of AMP-C Production.

Background and Objectives: Growing antibiotic resistance among bacteria is a global issue that is becoming harder and more expensive to solve. Traditional treatment options are becoming less effective, causing more fatal outcomes of nosocomial infections. Since the development of new antibiotics has stagnated in the last decade, a novel approach is needed. Materials and Methods: Graphene-based materials are being developed and tested for various applications, and the medical field is no exception. We tested 98 clinical A. baumannii strains for antibiotic resistance, AMP-C production and the effectiveness of a graphene oxide and silver nanoparticle hybrid nanocomposite. The disc diffusion method was used to determine antibiotic susceptibility results. Antibiotic discs containing cefotaxime, cloxacillin and clavulanate were used to detect AMP-C production. The effectiveness of the GO-Ag hybrid nanocomposite was determined by counting colony forming units (CFUs) after a suspension of A. baumannii and the GO-Ag hybrid nanocomposite was plated on MH agar and incubated overnight to grow colonies. Results: In our research, we found that A. baumannii strains are resistant to the majority of commonly used antibiotics. Antibiotic resistance levels and AMP-C production can be factors, indicating the better effectiveness of the graphene oxide and silver nanoparticle hybrid nanocomposite. Conclusions: In this study, a GO-Ag hybrid nanocomposite was shown to have the potential to fight even the most problematic bacteria like A. baumannii.

Peculiarities of Clinical Symptoms, Somatic Complications, Approaches to Therapy and Outcomes of Delirium Induced by Exposure to Synthetic Cannabinoids: Systematic Review

INTRODUCTION: The use of synthetic cannabinoids (SCs) is an urgent healthcare problem, due to, among other things, a high number of complications.
 AIM: To systematize the peculiarities of clinical presentation, somatic complications, effectiveness of empirical approaches to therapy, and probable outcomes of delirium induced by exposure to SCs.
 MATERIALS AND METHODS: The analysis of scientific publications selected by the keywords in eLibrary, СNKI, PubMed databases, was conducted. According to PRISMA recommendations, 20 articles were taken for analysis.
 RESULTS: Today, it is impossible to predict the period when SC-induced delirium may occur. It can start after one-time intake of even small dose, and can occur both due to intoxication and with the underlying withdrawal state on the 2nd4th days after the last use. Besides classic symptoms, the clinical picture of delirium is characterized by many symptoms of schizophrenic psychoses: hallucinations of threatening or drug-addicted content; secondary paranoid delusion, less expressed than hallucinations; aggressiveness and agitated behavior; some formal thinking disorders; rarely, KandinskiClerambault and oneiroid syndromes. There are reported cases of severe somatic complications in the form of depression of consciousness, rhabdomyolysis, acute renal failure, cardiomyopathy, myocardial infarction, epilepsy, infectious complications with the underlying weakened immunity. Therapy of SC-induced delirium includes detoxification and metabolic therapy, administration of antipsychotics and tranquilizers; use of resuscitation measures in case of depression of consciousness and development of life-threatening conditions. SC-induced delirium lasts from several hours to several days. In most cases, it terminates with complete recovery with amnesia of the period of confusion and asthenia, but in some cases fatal outcomes are reported caused not only by accidents such as road accidents or suicide, but also by somatic complications (most often of infectious character, or multi-organ failure).
 CONCLUSION: SСs remain relevant due to high frequency of their use and continuous emergence of new analogs to substances of this group. They have multidirectional effect, and so far it is difficult to predict at what period the delirium induced by them may occur.

Morbidity and mortality of newborn from preeclampsia mother with SARS-CoV-2 infection.

Preeclampsia is a major cause of maternal and infant mortality in Indonesia. Several studies have investigated the association between SARS-CoV-2 infection and adverse maternal, fetal, and neonatal outcomes. The studies found that SARS-CoV-2 infection during pregnancy is associated with an increased risk of maternal morbidity and mortality related to hypertensive disorders, including preeclampsia. However, the studies did not provide specific information on the morbidity and mortality of newborns from mothers diagnosed with preeclampsia with conjunction SARS-CoV-2 infection. This hospital-based case-control study was conducted on 28 mother-infant pairs using a systematic sampling method from February 2021 to December 2021. Data were analyzed using SPSS software (version 26), and statistical tests including chi-square analysis, Fisher's exact test, Mann-Whitney U-test and independent t-test were performed to identify factors associated with study variables in a 95% confidence interval (CI). We conducted a prospective study involving the enrollment of 28 pregnant women with confirmed SARS-CoV-2 infection through RT-PCR tests. Within this cohort, a subset of 4 mothers (14.8%) were diagnosed with preeclampsia. Four preeclamptic patients (100%) experienced fatal outcomes. Furthermore, among the infants born to preeclamptic mothers with SARS-CoV-2 infections, two (50%) newborns not survive. One infant passed away shortly after birth at 30 weeks of gestation, while the other had intrauterine demise at 28 weeks of gestation. SARS-CoV-2 infection during pregnancy is associated with an increased risk of maternal morbidity and mortality related preeclampsia.

Optimization and prospective evaluation of sensitive real-time PCR assays with an internal control for the diagnosis of melioidosis in Thailand.

Melioidosis is a severe infectious disease caused by Burkholderia pseudomallei. Effective treatment of melioidosis requires rapid detection of B. pseudomallei infection. Previous studies demonstrated that real-time PCR for the diagnosis of melioidosis in blood samples was insensitive. We optimized the DNA extraction method and evaluated real-time PCRs with an internal control for the detection of B. pseudomallei in plasma samples and compared the performance of real-time PCRs based on six target genes. The lower limit of detection (LOD) of TTS1-orf2, BPSS0745, BPSS1187, and BPSS1498 real-time PCRs was ≤10 genome equivalent (GE)/reaction, while the LOD of BPSS0087 and BPSS1492 was 100 GE/reaction. In the initial phase, we evaluated four targets (TTS1-orf2, BPSS0745, BPSS1187, BPSS1498) for the diagnosis of melioidosis using 87 plasma samples from 38 bacteremic-melioidosis patients and 49 other infection patients at a hospital in Northeast Thailand. Among these, BPSS1187 exhibited the highest sensitivity of 76.3% and specificity of 100%. A second evaluation phase was conducted at two hospitals in Northeast Thailand to compare two real-time PCRs between BPSS1187 and widely used TTS1-orf2 targets. A total of 705 clinical samples were collected from 421 suspected melioidosis cases; 77 of them were subsequently confirmed as melioidosis by culture using one or more specimens. The sensitivities of BPSS1187 and TTS1-orf2 were 89.6% and 79.2%, respectively (P = 0.004), and the specificities were 96% and 99%, respectively. The sensitivities of these two assays in plasma samples were 84.6% and 67.7%, respectively (P = 0.007). Therefore, the BPSS1187 real-time PCR was sensitive and specific for early diagnosis of melioidosis. IMPORTANCE Melioidosis is a serious infectious disease caused by Burkholderia pseudomallei, an environmental Gram-negative bacterium. Early detection of B. pseudomallei infection is crucial for successful antibiotic treatment and reducing mortality rates associated with melioidosis. Bacteria culture is currently used to identify B. pseudomallei in clinical samples, but the method is slow. Therefore, there is a need for more accurate and sensitive molecular-based diagnostic methods that can detect B. pseudomallei in all sample types, including samples from blood. We developed an optimal DNA extraction method for B. pseudomallei from plasma samples and used an internal control for real-time PCR. We evaluated six PCR target genes and identified the most effective target for the early detection of B. pseudomallei infection in patients. To prevent delays in the treatment of melioidosis that can lead to fatal outcomes, we recommend implementing this new approach for routine early detection of B. pseudomallei in clinical settings.

Atrial fibrillation in patients with dilated cardiomyopathy: prevalence, risk factors and prognostic significance

Aim. To study the epidemiological profile and long-term prognostic significance of atrial fibrillation (AF) as a risk factor for adverse clinical outcomes in patients with dilated cardiomyopathy (DCM).Material and methods. The study included 270 patients with DCM (206/76,3% men, age 47 [37; 56] years, left ventricular (LV) ejection fraction 29 [21; 35]%). The observation period was 6 years (Me 76 [57; 119] months). To assess the effect of AF on DCM prognosis, Kaplan-Meier curves and Cox regression of clinical outcomes, including cardiovascular death, heart transplantation, and ventricular assist device implantation, were analyzed.Results. Of 270 patients with DCM, paroxysmal AF was detected in 10 (3,7%) patients (initial, 5/1,85%; during the first follow-up year, 5/1,85%). After 5 years, another 65 (24,1%) individuals had AF (paroxysmal, persistent or permanent). Ventricular tachyarrhythmias were registered in 163 (60,4%) patients. Compared with patients maintaining sinus rhythm, patients with AF were older (51,4±10 vs 43,6±13 years, p=0,001) and had lower exercise tolerance (6-minute walk test: 379±45 vs 445±43 meters; p=0,0002) and a higher heart failure functional class (NYHA class III-IV: 38/50,7% vs 52/26,7%; χ2=13,6; p=0 ,0003). In patients with AF, initially more pronounced manifestations of right ventricular contractile dysfunction (TAPSE: 13,1±3,4 vs 15,5±4,6 mm; p=0,0001) and LV diastolic dysfunction (E/A: 2,9±1,5 vs 2,1±1,3; p=0,006; E/e' 15,6±6,9 vs 11,8±7,2; p=0,019), more dilated left atrium (left atrial volume index: 63,3±19 vs 50±18,7 ml/m2; p=0,006). During the 6-year median follow-up, AF was observed in 75 patients (0,46 new cases/100 patients/year). As a result of Cox regression analysis, AF as a time-dependent factor was identified as an independent predictor of cardiovascular death (hazard ratio 3,99; 95% confidence interval, 1,67-8,59; p=0,0001).Conclusion. AF, as one of the most common sustained atrial tachyarrhythmias in the population, demonstrated a lower prevalence (27,8%) in the DCM cohort compared to ventricular tachyarrhythmias (60,4%), but a high prognostic significance of the negative impact on the risk of fatal outcomes. The development of AF in patients with DCM is associated with a 4-fold increase in cardiovascular death risk over a 6-year period.

FRI263 Challenges In Management Of Biochemically Silent Pheochromocytoma

Abstract Disclosure: G. Gannamani: None. T. Gourdin: None. J.K. Fernandes: None. Background: Incidental adrenal tumors are a common radiological finding. Biochemical work up is important as functioning adrenal tumors increase mortality and morbidity. Missing diagnosis of Pheochromocytoma can result in fatal outcomes. There have been case reports with asymptomatic and mildly elevated biochemical markers or symptomatic but no biochemical evidence which pose challenges in diagnosis. Here we describe a case of Metastatic Pheochromocytoma which was biochemically silent. Case Description: 61-year-old female with incidental finding of left adrenal mass measuring 8.7 x 5.6 x 5.7 cm on CT (Computed Tomography) scan for back pain 10 years prior to presentation. She was told no further testing was needed then as she was asymptomatic. She now has uncontrolled hypertension requiring multiple anti-hypertensives that prompted further work up. Biochemical work up at outside facility reported as normal aldosterone, renin activity, AM cortisol, ACTH, DHEA-S, plasma metanephrine and normetanephrine, epinephrine, norepinephrine, and dopamine. Elevated Chromogranin A of 5608 (normal < 93 ng/mL). Repeat CT Abdomen showed multiple enhancing lesions in liver, large lobulated adrenal mass measuring 15 x 10 x 14 cm (previously 8.7 x 5.6 x 5.7 cm) with central necrosis, absolute washout is 63%. This mass extended into gastro-hepatic space, obliterating fat space between the left adrenal mass and tail of pancreas was also reported. Imaging was concerning adrenal malignancy vs Pheochromocytoma. Further work up with MRI (Magnetic Resonance Imaging) Abdomen showed 14 cm centrally necrotic mass suggestive of adrenal neoplasm with loco-regional involvement. CT chest with bilateral pulmonary nodules and diffuse sclerotic and lucent bone lesions concerning osseous metastatic disease. Liver biopsy positive for metastatic neuroendocrine neoplasm consistent with Pheochromocytoma, immunohistochemical stains positive for Synaptophysin, Chromogranin, S100, GATA3, Inhibin. Dotatate PET CT with large centrally necrotic left adrenal mass. Abnormal radiotracer uptake in left kidney, stomach, gastrohepatic lymph nodes, widespread osseous lesions suggesting metastatic disease. She was not a surgical candidate given extension of mass and metastasis to multiple organs. Treatment started with Sunitinib (Tyrosine kinase inhibitor), plan to repeat imaging in 4-6 months hoping for tumor shrinkage.

FRI253 Concurrent Adrenal Insufficiency And Hyperthyroidism In A Breast Cancer Patient Treated With Pembrolizumab Therapy

Abstract Disclosure: A.U. Kulkarni: None. D.T. Patel: None. E.B. Ruby: None. Anti-programmed cell death-1 (Anti-PD1) antibodies (e.g., Pembrolizumab) are immune checkpoint inhibitors that are widely in use for the treatment of many advanced malignancies. This has resulted in various side effects known as irAEs (immune-related adverse events). Endocrine irAEs include hypophysitis, adrenal insufficiency (AI), hypothyroidism, and hyperthyroidism. A 40-yo female with a history of recently diagnosed triple-negative breast cancer, status post chemotherapy, and immunotherapy with Pembrolizumab (last treatment a month prior to presentation) came in with fatigue, weight loss, and persistent vomiting for two weeks. Her initial BP was noted to be 80/50 mmHg, with HR 108bpm. She appeared weak and tired with no other abnormalities on physical exam. The thyroid was normal with no enlargement. Significant labs were creatinine 1.4mg/dL (0.4-1.3mg/dL), corrected calcium 12.8mg/dL, TSH of <0.01mUI/L and fT4 of 4.47ng/dL (0.61-1.12ng/dL) (thyroid tests were previously normal). The patient was admitted to the ICU for hypovolemic shock refractory to IV fluids and endocrinology was consulted for multiple hormonal abnormalities. AKI and hypercalcemia were likely from dehydration as they subsequently resolved with IV fluids. AM cortisol level was low at 0.7ug/dL(3-16ug/dL). The cosyntropin test was positive, confirming AI. ACTH level was <5pg/mL (normal<46pg/mL) indicating a diagnosis of secondary AI, likely from immunotherapy. She was initiated on IV hydrocortisone. MRI brain was obtained to evaluate for hypophysitis which was unremarkable. Further thyroid testing was pursued which showed negative Thyroid peroxidase and anti-thyroglobulin antibodies. Thyroid scan showed a focal hot nodule in the left lobe suspicious for an autonomous nodule. She was started on beta blockers and methimazole with the goal of optimizing her thyroid function prior to her elective mastectomy. Pembrolizumab was discontinued with the plan to re-challenge after surgery. BP stabilized and she was discharged home on hydrocortisone with close outpatient follow-up with Endocrinology and Oncology. The clinical manifestations of Anti-PD1-associated AI are very non-specific and difficult to diagnose as they can be confused with the cancer-related illness itself or chemotherapy. Multiple endocrine abnormalities on initial labs with recent Pembrolizumab therapy in our patient raised suspicion for irAEs. Even though the occurrence of AI from anti-PD1 drugs is extremely rare, being <1%, it can be life-threatening. Very few cases of Anti-PD1-induced thyroid dysfunction have been reported, however further testing in our patient confirmed hyperthyroidism from a toxic thyroid nodule. With the increasing popularity of these drugs, endocrinological complications are on the rise, and we as clinicians need to be vigilant and intervene at an early stage to prevent irreversible and fatal outcomes. Presentation: Friday, June 16, 2023

Establishing and Validating a Morphological Prediction Model Based on CTA to Evaluate the Incidence of Type-B Dissection.

Background: Many patients with Type B aortic dissection (TBAD) may not show noticeable symptoms until they become intervention and help prevent critically ill, which can result in fatal outcomes. Thus, it is crucial to screen people at high risk of TBAD and initiate the necessary preventive and therapeutic measures before irreversible harm occurs. By developing a prediction model for aortic arch morphology, it is possible to accurately identify those at high risk and take prompt action to prevent the adverse consequences of TBAD. This approach can facilitate timely the development of serious illnesses. Method: The predictive model was established in a primary population consisting of 173 patients diagnosed with acute Stanford TBAD, with data collected from January 2017 and December 2018, as well as 534 patients with healthy aortas, with data collected from April 2018 and December 2018. Explicitly, the data were randomly separated into the derivation set and validation set in a 7:3 ratio. Geometric and anatomical features were extracted from a three-dimensional multiplanar reconstruction of the aortic arch. The LASSO regression model was utilized to minimize the data dimension and choose relevant features. Multivariable logistic regression analysis and backward stepwise selection were employed for predictive model generation, combining demographic and clinical features as well as geometric and anatomical features. The predictive model's performance was evaluated by examining its calibration, discrimination, and clinical benefit. Finally, we also conducted internal verification. Results: After applying LASSO logistic regression and backward stepwise selection, 12 features were entered into the prediction model. Age, aortic arch angle, total thoracic aorta distance, ascending aorta tortuosity, aortic arch tortuosity, distal descending aorta tortuosity, and type III arch were protective factors, while male sex, hypertension, aortic arch height, and aortic arch distance were risk factors. The model exhibited satisfactory discrimination (AUC, 0.917 [95% CI, 0.890-0.945]) and good calibration in the derivation set. Applying the predictive model to the validation set also provided satisfactory discrimination (AUC, 0.909 [95% CI, 0.864-0.953]) and good calibration. The TBAD nomogram for clinical use was established. Conclusions: This study demonstrates that a multivariable logistic regression model can be used to predict TBAD patients.

FRI501 A Rare Case Of Acute Suppurative Thyroiditis

Abstract Disclosure: V. Gupta: None. Acute Suppurative thyroiditis is an uncommon however potentially life threatening condition. It is often diagnosed in children due to a congenital association with pyriform sinus fistula. About 8% of cases have been reported in adults primarily in the immunocompromised population. Herein, we report a case of a 35-year-old African American male who presented with a two day history of sore throat, neck pain and swelling with odynophagia. Initial workup revealed a suppressed TSH and elevated free T4. CT imaging of the neck was concerning for a retropharyngeal fluid collection and thyroiditis. Blood cultures grew Methicillin Sensitive Staphylococcus Aureus. He was treated with atenolol, methimazole, broad spectrum empiric IV antibiotics and IV steroids however he remained febrile, tachycardic and tachypneic. Repeat imaging identified the interval development of a possible thyroid abscess. Multiple attempts were made to drain the abscess with fluid cultures confirming MSSA and the diagnosis of acute suppurative thyroiditis. Early diagnosis of acute suppurative thyroiditis is essential as delayed recognition can increase the risk for adverse events including morbidity and mortality. This unique case highlights the importance of the clinician thoroughly evaluating the patient and recognizing an uncommon presentation of thyroiditis. This leads to prompt treatment for a condition that without timely intervention, can lead to fatal outcomes.

Acute Cerebral Vascular Events after Carotid Endarterectomy

Introduction. Acute cerebrovascular accident is recognized as the leading pathology in the structure of cerebrovascular diseases (CVD). Annually 6 million cases of CVD are registered in the world. Fatal outcomes from this pathology in Russia occur 1.5–2 times more often than in developed countries. According to the All-Russian Center for Preventive Medicine, 25% of males and 39% of females die from CVD. The incidence of CVD in Russia ranges from 460 to 560 cases per 100 thousand people. This pathology may be caused by carotid artery stenosis resulting from atherosclerotic vascular lesions and plaque formation which lead to embolism and stroke.Materials and methods. The study analyzed 341 medical histories of patients hospitalized at the Bashkir State Medical University Clinic (BSMU Clinic) in 2022, who underwent carotid endarterectomy (CEE) (288 of them had a history of chronic cerebrovascular accident) and 278 medical histories of patients with acute cerebrovascular accident, hospitalized at the Neurologic Clinic of the Avicenna Tajik State Medical University in 2022.Results and discussion. Perioperative complications that occurred during CEE at BSMU Clinic in 2022 included 12 cases of acute cerebrovascular accident of ischemic type (3.52%) and 2 cases of transient ischemic attack (0.6%), which is lower than the same rates in previously published observations at the same clinic.Conclusion. The number of complications resulting from the CEE does not exceed the global rates. Quantitative and qualitative indicators of carotid reconstructions demonstrate positive trends. Acute cerebrovascular accident requires clarifying the cause of its occurrence and taking measures to prevent ischemic strokes, including angiosurgical interventions.

Bayesian optimization-based CNN framework for automated detection of brain tumors

Brain tumors, capable of yielding fatal outcomes, can now be identified through MRI images. However, their heterogeneous nature introduces challenges and time-consuming aspects to manual detection. This study aims to design the optimal architecture, leveraging Convolutional Neural Networks (CNNs), for the automatic identification of brain tumor types within medical images. CNN architectures frequently face challenges of overfitting during the training phase, mainly attributed to the dual complexities of limited labeled datasets and complex models within the medical domain. The depth and width hyperparameters in these architectures play a crucial role, in determining the extent of learning parameters engaged in the learning process. These parameters, encompassing filter weights, fundamentally shape the performance of the model. In this context, it is quite difficult to manually determine the optimum depth and width hyperparameters due to many combinations. With Bayesian optimization and Gaussian process, we identified models with optimum architecture from hyperparameter combinations. We performed the training process with two different datasets. With the test data of dataset 1, we reached 98.01% accuracy and 98% F1 score values. With the test data of dataset 2, which has more data, 99.62% accuracy and F1 score values were obtained. The models we have derived will prove valuable to clinicians for the purpose of brain tumor detection.

Neuroimmunology of rabies: New insights into an ancient disease.

Rabies is an ancient neuroinvasive viral (genus Lyssavirus, family Rhabdoviridae) disease affecting approximately 59,000 people worldwide. The central nervous system (CNS) is targeted, and rabies has a case fatality rate of almost 100% in humans and animals. Rabies is entirely preventable through proper vaccination, and thus, the highest incidence is typically observed in developing countries, mainly in Africa and Asia. However, there are still cases in European countries and the United States. Recently, demographic, increasing income levels, and the coronavirus disease 2019 (COVID-19) pandemic have caused a massive raising in the animal population, enhancing the need for preventive measures (e.g., vaccination, surveillance, and animal control programs), postexposure prophylaxis, and a better understanding of rabies pathophysiology to identify therapeutic targets, since there is no effective treatment after the onset of clinical manifestations. Here, we review the neuroimmune biology and mechanisms of rabies. Its pathogenesis involves a complex and poorly understood modulation of immune and brain functions associated with metabolic, synaptic, and neuronal impairments, resulting in fatal outcomes without significant histopathological lesions in the CNS. In this context, the neuroimmunological and neurochemical aspects of excitatory/inhibitory signaling (e.g., GABA/glutamate crosstalk) are likely related to the clinical manifestations of rabies infection. Uncovering new links between immunopathological mechanisms and neurochemical imbalance will be essential to identify novel potential therapeutic targets to reduce rabies morbidity and mortality.

Multidetector computed tomography findings in patients with abdominal crush trauma due to Kahramanmaraş centered earthquakes

Purpose: This study aimed to investigate the characteristics of abdominal crush injuries using multidetector computed tomography (MDCT) in survivors of earthquakes centered in Kahramanmaraş.
 Materials and Methods: Retrospective evaluation was conducted on 255 patients who sustained injuries due to an earthquake centered in Kahramanmaraş and were treated at our hospital. Patients clinically suspected of having abdominal crush trauma underwent MDCT examinations. The presence of abdominal wall injuries, solid organ injuries, free fluid in the abdomen, pneumoperitoneum, and subcutaneous emphysema findings were examined.
 Results: The median time between injury and MDCT examination was 3 days, ranging from 4 hours to 8 days. Among pediatric and adult age groups, males constituted 42.6% (52/122) and 47.4% (63/133), while females were 57.4% (70/122) and 52.6% (70/133), respectively. The mortality rates for pediatric and adult age groups were 0.4% (1/122) and 4.3% (11/133), respectively. Among patients with fatal outcomes, rates of acute kidney injury, subcutaneous emphysema, spleen injuries, and renal/perirenal injuries were 8.3% (1/12), liver and abdominal wall injuries were 16.7% (2/12), and free fluid in the abdomen was observed at a rate of 33.3% (4/12).
 Conclusion: Abdominal wall injuries were the most frequently observed manifestations of crush injuries, with renal/perirenal injuries being the most common among solid organs, and liver injuries being commonly seen among intraperitoneal organs. These findings underscore important characteristics of abdominal crush trauma related to earthquakes.