First Day Of Admission Research Articles

Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2?

Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID‐19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID‐19 between March 15and April, 24, 2020. Mycophenolate and/or mammalian target of rapamycin inhibitors (mTORi) were discontinued in all patients. Two therapeutic strategies were compared: Group 1, minimization of calcineurin inhibitors (N = 6); and Group 2, cyclosporine‐based therapy (N = 23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after respiratory distress (20.6%). Five required mechanical ventilation (17.2%), and 3 could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3 of 6 patients died (50%) and 1 of 6 required invasive mechanical ventilation (16.7%). In group 2, 3 of 23 patients died (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID‐19.

Patterns and outcomes of abdominal trauma patients Admitted to Trauma Intensive Care Unit..

Abdomen is the third most common area of the body that is damaged because of trauma. The nurse must be aware of specific assessment findings associated with abdominal trauma and immediate recognition of problems, so this study aimed to assess patterns and outcomes of abdominal trauma patients admitted to trauma intensive care unit.A descriptive research design was used. Setting: This study was carried out in trauma intensive care unit at Assuit University Hospital. Sample: 60 adult critically ill patients with abdominal trauma. Tools: Patient profile characteristic's sheet and abdominal trauma severity scores and outcomes assessment sheet were used. Main results: There were 65% males and 35% females. Mean Age was 36.62±10.8. Blunt trauma accounted for 86.67% while penetrating was 13.33%. Motor car accidents was the main cause of trauma with 51.67%, liver and spleen the most affected organs. Mortality rate was 10%. Gastrointestinal and respiratory complications are the most occurred. Conclusion: Abdominal trauma patients need frequent assessment as majority of the studied patients at a high risk for developing complications. Recommendations: Training the nurses about how to use abdominal trauma scoring systems for frequent assessment of patients' heath statue from first day of admission.

Phosphate Disturbance in Critically Ill Children in Zagazig University Pediatric Intensive Care Unit

Background: Phosphorus is very important for normal cellular structure (cell membrane and nucleic acids). Phosphorus has an important role in the cell metabolism, ATP production, and homeostasis. Objectives: The aim of the work was to determine the prevalence and some of risk factors of hypophosphatemia in sick children, and to evaluate the prognostic effect of serum phosphorous level on the outcome in terms of morbidity and mortality in critically ill children during their stay in the pediatric intensive care unit. Patients and methods: This prospective cohort study included a total of 50 critically ill children, attending at Department of Biochemistry and Pediatric Intensive Care Unit (PICU), Department of Pediatrics, Zagazig University Hospitals. This study was conducted between April 2017 to August 2018. Patients age ranged from 2 months to 129 months and according to serum phosphorus level cases were classified into those with hypophosphatemia and others with normal phosphate level. The severity of illness was determined by using SOFA score. Results: Revealed that there was statistically significant decrease in phosphorus level at day 1 and day 3 between hypophosphatemia and normal phosphate level groups. The prevalence of hypophosphatemia was 46% at first day of admission and 70% at third day of admission. Significant increase of PTH and total bilirubin in hypophosphatemia group, and significant decrease of calcium in hypophosphatemia group compared to normophosphatemia group. The cases were followed and compared regarding; morbidity (need for mechanical ventilation, and length of PICU stay), degree of organ failure (SOFA score) and their outcome (discharge from PICU or death). Conclusion: It could be concluded that hypophosphatemia is considered a common co-morbidity in critically ill children in PICU. Hypophosphatemia more prevalent in those with respiratory problems, and higher SOFA score.

Prediction of Acute Kidney Injury in Critically-Ill Pediatric Patients Admitted to PICU: The Role of Serum Cystatin C And Serum Interleukin-18

Objectives: We conducted this study to assess the sensitivity and specificity of serum cystatin C (sCysC) and serum interleukin-18 (IL-18) in comparison with serum creatinine and serum urea for early detection of acute kidney injury (AKI) in critically-ill pediatric patients admitted to the pediatric intensive care unit (PICU). Methods: This was an observational case-control study enrolled 61 patients admitted in PICU divided into two groups (the case group 30 patients with proposed AKI and the control group 31 control individuals). After complete clinical evaluation, electrolyte profile, including Na and K besides the biomarkers assay of serum creatinine, urea, sCysC , and IL-18 were measured at the first day of admission and after three days. Results: Urea and creatinine were increased at admission in only three patients and two patients, respectively, while it dramatically increased in 25 patients in both urea and creatinine separately on the third day of admission. sCysC and sIL-18 showed a high diagnostic ability for detecting AKI at admission with AUCs of 0.877 and 0.819 respectively. Supportingnly, sCysC and IL-18 were significantly higher in AKI group compared to the control group. Conclusions: sCysC and serum IL-18 proved their accuracy in prediction of AKI in patients admitted to the PICU. Their diagnostic ability was superior to serum creatinine, serum urea, and even urinary IL-18 and CysC.

Novel Strategies for Predicting Healthcare-Associated Infections at Admission: Implications for Nursing Care.

Accurate, real-time models to predict hospital adverse events could facilitate timely and targeted interventions to improve patient outcomes. Advances in computing enable the use of supervised machine learning (SML) techniques to predict hospital-onset infections. The purpose of this study was to trial SML methods to predict urinary tract infections (UTIs) during inpatient hospitalization at the time of admission. In a large cohort of adult hospitalizations in three New York City acute care facilities (N = 897,344), we used two SML methods-neural networks and decision trees-to predict having a hospital-onset UTI using data available and accessible on the first day of admission at healthcare facilities in the United States. Performance for both neural network and decision tree models were superior compared to logistic regression methods. The decision tree model had a higher sensitivity compared to neural network, but a lower specificity. SML methods show potential for automated accurate UTI risk stratification using electronic data routinely available at admission; this could relieve nurses from the burden of having to complete and document additional risk assessment forms in the electronic medical record. Future studies should pilot and test interventions linked to the risk stratification results, such as short nursing educational modules or alerts triggered for high-risk patients.

A comparative study on outcome of conservative and surgical treatment of type III supracondylar fracture of humerus in children

<p class="abstract"><strong>Background:</strong> Supracondylar fracture of humerus is most common of all the fractures around the elbow in children. They occur most commonly in children more so in male child with the peak around 5-8 years. Objective of this study was to compare the outcome of 3 different modalities of treatment for supracondylar fracture of humerus.</p><p class="abstract"><strong>Methods:</strong> Children with type III supracondylar fracture of humerus were categorized into group A, group B, group C based on conservative, closed reduction and percutaneous K wire fixation and open reduction and K wire fixation modalities of treatment given. All the children were followed for 6 months and the outcome of treatment was evaluated using Flynn’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> 40 children were treated with 3 different modalities of treatment. The rate of complications was less in children who were operated on first day of admission (p=0.02). Group B and group C had 80% and 61.11% excellent results and group A had 47.05% poor results. The outcome was better with cross K wire pinning than lateral pinning (p=0.015).</p><p class="abstract"><strong>Conclusions:</strong> Supracondylar fracture of humerus should be operated as early as possible to reduce the rate of complications. The outcome of surgical treatment was better than conservative treatment evaluated in terms of Flynn’s criteria. Cross wire pinning was better than lateral pinning in terms of outcome, but the rate of neuropraxias was more with cross wire pinning.</p>

Neurologic prognostication after resuscitation from cardiac arrest.

Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

Validation of a Therapeutic Intervention Scoring System (TISS-28) in critically ill children

IntroductionThere are numerous scales in intensive care units that are used to quantify the severity of patients. Most of them are very useful, although sometimes laborious to complete, thus limiting their use in usual practice. One of these scales, the Therapeutic Intervention Scoring System (TISS-76), has been validated in adult and paediatric units. Its simplified and updated version, the Simplified Therapeutic Intervention Scoring System (TISS-28), has not yet been validated in paediatric units. The aim of this study is to validate TISS-28, in order to have a simple and rapid scale. Material and methodA prospective non-interventional observational study was conducted in a Paediatric Intensive Care Unit (PICU) of a university hospital. Data were collected from 935 consecutive patients admitted to the PICU over a 3-year period. These included the values of TISS-76 and TISS-28 during the first 4 days of admission and the subsequent outcome of the patients. ResultsThe mean values of TISS-76 and TISS-28 for the first day of admission were 18.27 and 18.02, respectively. Values were higher in patients who had sequelae or died (17.58 versus 27.23 and 37.44, respectively for TISS-76 (p<.01); and 17.51 versus 23.80 and 33.44, respectively for TISS-28 (p<.01).A very good correlation was found between TISS-76 and TISS-28, with Pearson correlation and intraclass correlation coefficients >0.9 (except for the 2nd day). The correlation equation for the overall 4 days was: TISS-76=−1.74+1.05×TISS-28. TISS-28 was able to explain 82.4% of variability of TISS-76. The area under the curve with a confidence interval (CI) of 95% for the first day was 0.80 (0.73–0.87) for TISS-76, and 0.76 (0.67–0.84) for TISS-28. ConclusionsOn observing the results obtained, TISS-28 can replace TISS-76 in our PICU, without worsening the information provided. Being a reliable scale and easier to apply, its practical application could be useful.

Children in Critical Care Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Experience in a Spanish Hospital.

Objectives:Spain has been one of the countries most severely affected by the coronavirus disease 2019. This study aims to describe a series of children admitted to a PICU due to coronavirus disease 2019 infection.Design:Prospective observational study.Setting:Tertiary hospital in Madrid, Spain.Patients:Children admitted to the PICU with severe acute respiratory syndrome coronavirus 2 (severe acute respiratory syndrome coronavirus 2) infection, from March 1, 2020, to April 15, 2020.Interventions:Observational study.Measurements and Main Results:Epidemiologic data, previous clinical characteristics, support therapy needed, imaging tests, laboratory observations on admission, and pharmacologic therapy. Eleven children were admitted to the PICU, with suspected coronavirus disease 2019; the polymerase chain reaction test was positive in seven. The median age was 100.7 months (range, 0.5–162). Five were admitted from the emergency department and two from the ward. The Pediatric Sequential Organ Failure Assessment score was 3 (range, 0–9), and Pediatric Risk of Mortality II score was 4 (range, 0–16). All children were previously healthy except one (allogeneic hematopoietic stem cell transplantation). Respiratory symptoms and fever were prevalent. A chest radiograph led to a pneumonia diagnosis. Not all patients presented with lymphopenia on admission. d-Dimer and ferritin were elevated. All patients needed oxygen therapy through a nasal cannula; five patients received high-flow nasal cannula therapy, which was later substituted with noninvasive ventilation in four. Mechanical ventilation was necessary in two patients on the first day of PICU admission. Two children required mechanical ventilation and inotropic support. Tocilizumab was applied in two intubated children. Also, four children received heparin. No patients died.Conclusions:On the whole, the children were previously healthy and are more than 1 year old. Respiratory symptoms were the leading cause of PICU admission, making respiratory support the principal therapy. Patients requiring mechanical ventilation showed deterioration on the first day of admission. These children seemed to require close monitoring, and multicenter studies are necessary.

SAT-339 Calcium Level in a Patient with Rhabdomyolysis. A Tale of Two Phases

Background: Calcium kinetics can be challenging during the different phases of rhabdomyolysis1. We herein report a case of sever hypercalcemia refractory to hemodialysis following a period of hypocalcaemia that developed in a patient with rhabdomyolysis. Case: A 27-year-old male patient was diagnosed with meningoencephalitis complicated with septic shock, continuous seizures, rhabdomyolysis, acute kidney injury and oliguria. His creatinine was 219 μmol/L (53–115), urea was 8 mmol/L (2.5–6.4). Creatine kinase (CK) was significantly high above assay range. Corrected serum calcium was 1.82 mmol/L (2.12- 2.52), phosphate was 0.48 mmol/L (0.81–1.58). He required intermittent sessions of hemodialysis and antibiotics therapy which both have been initiated since the first day of admission. Initially he had hypocalcaemia but as rhabdomyolysis improved, his calcium levels started to rise to reach normal levels by day 13 post admission. By day 16, he started to gradually develop hypercalcemia. Initially, it was 2.73 mmol/L and in another 10 days it was 3.39 mmol/L and reached maximum of 3.90 mmo/L despite the intermittent dialysis sessions. PTH was supressed at 0.62 Pmol/L. Over that time, his renal functions and urine output were gradually improving.The clinical impression was PTH independent hypercalcemia and the work up for that was initiated. CT chest, abdomen and pelvis did not reveal any suspicious masses, lytic bone lesions, or lymphadenopathies. His acid fast bacilli stain and culture were both negative. His chest imaging did not show any findings to suggest sarcoidosis. TSH was normal and random cortisol was 339.2 nmol/l with albumin 20g/L. HIV serology came back negative.He received Calcitonin 500 IU BID for three days and Denosumab 120 mg SC in order to control the hypercalcemia along with, cautious intravenous hydration. Within one week after Denosumab therapy, serum corrected calcium decreased to 3.07 mmol/L. After another week, corrected calcium reached 2.53 mmol/L. When his urine output improved further and his calcium levels dropped, hemodialysis was discontinued. His calcium level later normalised to 2.49 mmol/L.After ruling out the common differential of PTH independent hypercalcemia, and from the diuretic phase the patient went through with concomitant hypercalcemia following hypocalcaemia, it was concluded that the cause of hypercalcemia was rebound hypercalcemia following rhabdomyolysis recovery. Conclusion: hypercalcemia can complicate the recovery phase of rhabdomyolysis. Careful monitoring of calcium levels and management are warranted.

Epidemiological and initial clinical characteristics of patients with family aggregation of COVID-19

BackgroundSince December 2019, a new outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan (Hubei, China) and rapidly spread throughout China, however, confirmed cases are still increasing worldwide. ObjectivesTo investigate the epidemiological history and initial clinical characteristics of 10 patients with family aggregation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Western Chongqing, China. Study designTen patients positive for SARS-CoV-2 nucleic acid detection by real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR), were collected from The People's Hospital of Dazu District, Chongqing. Epidemiological data and laboratory and imaging results were collected on the first day of admission, and analyzed based on the Diagnosis and Treatment Guideline for COVID-19 (5th edition, China). ResultsOf the 10 cases, case A had a history of a temporary stay in Wuhan and transmitted the virus to the others through family gathering, living together, and sharing vehicles. The average age was 56.5 years (± 11.16), six patients were males, and the incubation period was 2–14 days. Dry cough was the main symptom, followed by fever and fatigue. Most patients were clinically classified as ordinary-type, with three cases being severe-type. Chest computed tomography results were nonspecific, mainly with ground-glass attenuation and/or shadow images. Extensive lesion distribution was seen in severe cases. CD4+ lymphocyte counts were 61, 180, and 348 cells/uL in severe-type patients, respectively. Notably, viral nucleic acid values in nasopharyngeal swabs were lower (19, 25, and 26) than those of ordinary-type patients, suggesting a higher viral load. Neutrophil-lymphocyte ratio (NLR) was also higher in severe-type patients ConclusionsInitial examination results of lower CD4+ lymphocyte counts and RT-PCR-CT values coupled with higher NLR may indicate the severity of COVID-19 infection for these family clusters.

Predictors for imaging progression on chest CT from coronavirus disease 2019 (COVID-19) patients.

Objective: This study aimed to investigate the potential parameters associated with imaging progression on chest CT from coronavirus disease 19 (COVID-19) patients.Results: The average age of 273 COVID-19 patients enrolled with imaging progression were older than those without imaging progression (p = 0.006). The white blood cells, platelets, neutrophils and acid glycoprotein were all decreased in imaging progression patients (all p < 0.05), and monocytes were increased (p = 0.025). The parameters including homocysteine, urea, creatinine and serum cystatin C were significantly higher in imaging progression patients (all p < 0.05), while eGFR decreased (p < 0.001). Monocyte-lymphocyte ratio (MLR) was significantly higher in imaging progression patients compared to that in imaging progression-free ones (p < 0.001). Logistic models revealed that age, MLR, homocysteine and period from onset to admission were factors for predicting imaging progression on chest CT at first week from COVID-19 patients (all p < 0.05).Conclusion: Age, MLR, homocysteine and period from onset to admission could predict imaging progression on chest CT from COVID-19 patients.Methods: The primary outcome was imaging progression on chest CT. Baseline parameters were collected at the first day of admission. Imaging manifestations on chest CT were followed-up at (6±1) days.

Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union? A case series

PurposeTibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner. MethodsTwenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated.1 All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software. ResultsMaximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = −0.554). ConclusionA staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

Cortisol and DHEAS Related to Metabolic Syndrome in Patients with Schizophrenia.

BackgroundBoth dehydroepiandrosterone (DHEAS) and cortisol are secreted by the adrenal glands and may modulate metabolic syndrome (MetS), which often affects the health of patients with schizophrenia. The relationship between the serum levels of these hormones and MetS has not been established.PurposeIn this pilot study, we investigated the serum levels in schizophrenia patients with and without MetS and compared them with those in healthy volunteers.Patients and MethodsAfter obtaining informed consent, 110 patients with acute paranoid schizophrenia were recruited directly after admission to the Mental Health Research Institute. The control group consisted of 51 persons reported on questioning to be mentally and somatically healthy. Blood samples to prepare serum were drawn after an 8-h overnight fast during one of the first days of admission. Serum cortisol and DHEAS concentrations were quantified by enzyme-linked immunosorbent assay.ResultsA total of 42 patients had MetS and 68 patients were without MetS. The cortisol blood level was significantly (p = 0.012) higher in schizophrenia patients without MetS in comparison to healthy controls, while patients with schizophrenia and a MetS have significantly (p = 0.014) lower DHEAS levels than healthy volunteers. These differences could, however, exclusively be attributed to female participants. Analysis of covariance adjusted for gender and age demonstrated a significant relationship between age and DHEAS levels (F = 9.512, р = 0.003).ConclusionLower DHEAS serum levels in relationship to MetS become evident in women, but not in men, and have age differences as a confounding factor.

Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction

Aim: Prior cocaine and methamphetamine use influence treatment strategies in subjects with acute myocardial infarction. Often patients may not self-report illicit drug use on admission but urine analysis may reveal etiology. This study aimed to investigate if routine screening of cocaine and methamphetamine use by urine analysis is reasonable in young myocardial infarction.Material and Methods: This study enrolled 50 consecutive young patients (≤50 years old) with acute myocardial infarction. Mean age was 41.3±7.8 (21-50) and 80% of patients were male. Patients were queried about the use of any illicit drug use on admission. Urine samples for cocaine and methamphetamine analysis were done using immunuassay tests within the first day of admission. Cocaine use was considered as positive if the level of benzoylecgonine was above 300 ng/mL. Methamphetamine use was considered as positive if the level was above 1000 ng/mL. All the patients underwent coronary angiography and percutaneous coronary revascularization if they had significant coronary artery stenosis.Results: ST elevated acute myocardial infarction was diagnosed in 38 patients (76%) and non-ST elevated acute myocardial infarction was diagnosed in 12 patients (24%). No patient self-reported cocaine or methamphetamine use. Urine analyses for cocaine were negative in all 50 patients. In urine analyses methamphetamine were found to be positive in 5 patients (10%). Classical risk factors for atherosclerosis were similar between the groups.Conclusion: As we found 10% incidence of methamphetamine use, it may be reasonable to screen methamphetamine use but not cocaine use by urine analysis in younger myocardial infarction patients

Hypertriglyceridemia with total parenteral nutrition versus enteral nutrition in patients with acute pancreatitis

Abstract Background Acute pancreatitis (AP) is an inflammatory condition of the pancreas that can cause local injury, systemic inflammatory response syndrome, and organ failure. Worldwide, AP is a common gastrointestinal condition and there is evidence that the incidence has been rising in recent years. AP is associated with substantial suffering, morbidity, and cost to the health care system. Objective Our study aims to compare between the effect of enteral (EN) and parenteral nutrition on serum triglycerides in patient with acute pancreatitis in intensive care unit of Ain Shams University (ICU). We found that enteral route is more safe than parenteral nutrition regarding serum triglycerides. Patients and Methods An informed written consent was obtained from patients and /or relatives who were included in this study. All patients were adults, more than 18 years old, admitted to ICU of Ain Shams University Hospital, either have acute pancreatitis on admission or acquired acute pancreatitis in ICU due to different causes in period of six months of approval of the protocol. Patients were divided into two groups: 30 patients started total parenteral nutrition TPN ) one day after admission consisting of 70% carbohydrate (in the form of dextrose 25%) and 30% fat (smoflipid 250 ml, 2 gm per ml). The other 30 patients started enteral nutrition rich in carbohydrates with low fat content one day after admission (peptamen) 6 scoops in 200 ml water every 2 hours, stopped from 12 am to 8 am. Serum triglyceride level was measured at first day of admission, then 3 days after admission, then one week after admission. Results Our study showed that TPN was associated with more increase of serum triglycerides level from first day of admission to 3 days after admission when compared with enteral nutrition, there is also increase in serum triglycerides from 3days to one week after admission, comparing the three periods together, there is increase in serum triglycerides with TPN group more than in enteral group. Conclusion The study showed that TPN was associated with higher mortality rate than EN, also there was an increase in serum triglycerides with TPN more than EN; suggesting that, enteral nutrition is a safer mode of nutrition in patients with acute pancreatitis.

A clinical study on the association of clinical outcome and acute systolic blood pressure incerebral hemorrhage patients .

To investigate the outcome of the rapid lowering of elevated blood pressure in patients with intracerebral hemorrhage and to understand its association with clinical outcome. Between July 2014 and June 2018, a total of 1,500 patients diagnosed with cerebral hemorrhage were randomized and assessed for their neurological symptoms and diagnosed with CT scan. 1,500 (42%) patients received intensive treatment, while 1,645 (58%) patients were assigned the guideline-recommended therapy. The systolic blood pressure of these patients was measured every half hour during the first day of admission. The intensive-treatment group was further categorized into five different subgroups in 10-mmHg intervals. On the other hand, the clinical outcome, as represented by the volume of hematoma, adverse events, modified Rankin scale etc., was measured and analyzed. The volume of hematoma varied with a p-value of 0.014 among the investigated groups. There was no direct correlation among the five groups based on the systolic blood pressure groups and modified Rankin scale 4 - 6. The 140-150 mmHg group observed an elevated risk compared to the 120-130 mmHg group in the modified Rankin scale ((OR=1.59; 95% CI (0.98-2.61)). The hematoma enlargement increased significantly with a p-value of 0.012. There was no direct association or statistical significance between the occurrence of the clinical outcome and the multivariate relationship between the five groups based on the multivariates (p=0.513). Systolic blood pressure ranging between 120and130 mmHg serves as an optimal goal for acute intracerebral hemorrhage by reducing the hematoma enlargement. It is also evident that the lowering of high mean systolic blood pressure after blood pressure-lowering therapy usually leads to cardiorenal injury.

&lt;p&gt;Identifying Suicidal Ideation Among Chinese Patients with Major Depressive Disorder: Evidence from a Real-World Hospital-Based Study in China&lt;/p&gt;

BackgroundA growing body of research suggests that major depressive disorder (MDD) is one of the most common psychiatric conditions associated with suicide ideation (SI). However, how a combination of easily accessible variables built a utility clinically model to estimate the probability of an individual patient with SI via machine learning is limited.MethodsWe used the electronic medical record database from a hospital located in western China. A total of 1916 Chinese patients with MDD were included. Easily accessible data (demographic, clinical, and biological variables) were collected at admission (on the first day of admission) and were used to distinguish SI with MDD from non-SI using a machine learning algorithm (neural network).ResultsThe neural network algorithm distinguished 1356 out of 1916 patients translating into 70.08% accuracy (70.68% sensitivity and 67.09% specificity) and an area under the curve (AUC) of 0.76. The most relevant predictor variables in identifying SI from non-SI included free thyroxine (FT4), the total scores of Hamilton Depression Scale (HAMD), vocational status, and free triiodothyronine (FT3).ConclusionRisk for SI among patients with MDD can be identified at an individual subject level by integrating demographic, clinical, and biological variables as possible as early during hospitalization (at admission).

Abstract TP215: Machine Learning Analysis of Gene Expression Data and Predictive Stroke Outcomes in Acute Ischemic Stroke

Background and Purpose: The ability to predict ischemic stroke outcomes in the first day of admission could be vital for patient counseling, rehabilitation, and care planning. The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC; clinicaltrials.gov NCT03153683) collects blood samples distal and proximal to the intracranial thrombus during mechanical thrombectomy. These samples are a novel resource in evaluating acute gene expression changes at the time of ischemic stroke. The purpose of this study was to identify inflammatory genes and patient demographics that are predictive of stroke outcomes (infarct and/or edema volume) in acute ischemic stroke patients. Methods: The BACTRAC study is a non-probability, convenience sampling of subjects (≥ 18 year olds) treated with mechanical thrombectomy for emergent large vessel occlusion. We evaluated relative concentrations of mRNA for gene expression in 84 inflammatory molecules in static blood distal and proximal to the intracranial thrombus from adults who underwent thrombectomy. We employed a machine learning method, Random Forest, utilizing the first set of enrolled subjects, to predict which inflammatory genes and patient demographics were important features for infarct and edema volumes. Results: We analyzed the first 28 subjects (age = 66 ± 15.48, 11 males) in the BACTRAC registry. Results from machine learning analyses demonstrate that the genes CCR4, IFNA2, IL9, CXCL3, Age, DM, IL7, CCL4, BMI, IL5, CCR3, TNF, and IL27 predict infarct volume. The genes IFNA2, IL5, CCL11, IL17C, CCR4, IL9, IL7, CCR3, IL27, DM, and CSF2 predict edema volume. There is an intersection of genes CCR4, IFNA2, IL9, IL7, IL5, CCR3 to both infarct and edema volumes. Overall, these genes depicts a microenvironment for chemoattraction and proliferation of autoimmune cells, particularly Th2 cells and neutrophils. Conclusions: Machine learning algorithms can be employed to develop predictive biomarker signatures for stroke outcomes in ischemic stroke patients, particularly in regard to identifying acute gene expression changes that occur during stroke.

CORRELATION BETWEEN NEUTROPHIL-TO-LYMPHOCYTE RATIO AND HIGH SENSITIVITY C REACTIVE PROTEIN WITH SEVERITY AND OUTCOME IN ACUTE ISCHEMIC STROKE PATIENT

Background: Inflammation plays a role in the pathophysiology of cerebral ischemic and also an initial response to brain injury. Inflammation involving Blood and Brain Barrier disturbance, leukocyte infiltration, endothelial cells activation, oxidant and inflammatory mediator buildups which can develop rapidly within hours and can cause secondary injury to brain tissues Objectives: To determine the correlation between Neutrophil-to-Lymphocyte Ratio (NLR) and High Sensitivity C Reactive Protein (hsCRP) with severity and outcome in acute ischemic stroke patients Methods: This study used a cross-sectional design approach. Sampling was done at H. Adam Malik General Hospital Medan and taken as many as 38 subjects. NLR and hsCRP were examined on the first day of admission. Severity was assessed by using the National Institutes of Health Stroke Scale and the outcome was assessed by using the Modified Ranking Scale on the first and fourteenth day of admission. The data analysis used the contingency coefficient correlation test and gamma test. Results: Demographic characteristics of the subjects are; the average age is 62 years old, the highest educational level is high school graduate, and the most occupation is unemployed. There is a positive, moderate, and significant correlation between NLR and severity of acute ischemic stroke (r=0.511; p=0.001). There is a positive, moderate, and significant correlation between NLR and the outcome of acute ischemic stroke (r=0.463; p=0.001). There is a positive, very strong, and significant correlation between hsCRP and severity of acute ischemic stroke (r=0.896; p=0.001). There is a positive, strong, and significant correlation between hsCRP and outcome of acute ischemic stroke (r=0.624; p=0.001) Conclusions: There is a positive and significant correlation between NLR and hsCRP with severity and outcome in acute ischemic stroke patients.