High Fatality Research Articles

Associations between high temperature exposure and overdose fatalities (amphetamine, cocaine, and opioid use) in Quebec from 2015 to 2022

Associations between high temperature exposure and overdose fatalities (amphetamine, cocaine, and opioid use) in Quebec from 2015 to 2022

In Reply: High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

In Reply: High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

Application and development of TCR-T in tumor therapy

As cancer has gradually become the world's deadliest long-term disease, the impact on the public health has been devastating. Especially the Melanoma which is a cancer with a very high malignant and a high fatality rate. With the emergence of adoptive cell therapy(ACT) based on T Cell Receptor-Gene Engineered T Cells (TCR-T), good results have been obtained in scientific research and clinical fields for a variety of malignant tumors. As TCR-T continues to enter the clinic, the FDA also has approved the first case of TCR-T in 2022, and more and more basic researches and clinical trial projects based on TCR-T are gradually being carried out. However, TCR-T therapy still has some defects, such as non-tumor tissue damage caused by off-target effect and insufficient affinity with tumor tissue. Therefore, the affinity and anti-tumor effectiveness of TCR-T should be improved in multiple aspects, and multi-field cooperation should be carried out to promote the development of basic research, a number of products should be introduced into the clinic, and the intervention of economic means to improve the accessibility of TCR-T. Not only brings the Gospel of cure to patients in the field of solid tumors, but also produces innovation in the field of non-solid tumors.

A quantitative LC-MS/MS method for investigation of polysubstance use involving heroin and cocaine

Concurrent use of heroin and cocaine (known as the “speedball”) prevails among substance use disorder populations, especially in opioid-dependent individuals, with severe consequences and a high fatality rate. Little is known about the patterns and correlations of the concurrent use of heroin and cocaine. It is vital to investigate such a polydrug use in both humans and animals to uncover concomitant toxicity and the cause of fatal overdose (death). In this study, we aimed to shed some light on the role of cocaine in the etiology of heroin-related deaths in the context of molecular pharmacokinetics (PK). For the purpose, a high-performance liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method for simultaneous determination of heroin, cocaine, and their metabolites in whole blood was developed and fully validated in accordance with the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines. Then, this method was used to analyze heroin, cocaine, and their metabolites in blood from the rats intraperitoneally administered non-lethal 10 mg/kg heroin or 20 mg/kg cocaine alone, or their combination that is lethal with a proximal mortality of 33 %. The obtained results from the rats that experienced the lethal toxicity revealed that the concurrent use of heroin and cocaine significantly increased the risk of fatality from overdose. Heroin significantly slowed down the elimination of cocaine and its main metabolites in blood, while cocaine significantly enhanced heroin metabolism from 6-monoacetylmorphine (6-MAM) to morphine. Similar elimination half-lives for other heroin metabolites were observed. These findings are reported for the first time in this study, facilitating our understanding of the polysubstance metabolism and severe consequences produced by the polydrug use.

Synthesis and Biological Evaluation of Cyanoacrylamides and 5-Iminopyrrol-2-Ones Against Naegleria fowleri.

Primary amoebic meningoencephalitis is caused by the free-living amoeba Naegleria fowleri. The lack of standardized treatment has significantly contributed to the high fatality rates observed in reported cases. Therefore, this study aims to explore the anti-Naegleria activity of eight synthesized cyanoacrylamides and 5-iminopyrrol-2-ones. Notably, QOET-109, QOET-111, QOET-112, and QOET-114 exhibited a higher selectivity index against Naegleria compared to those of the rest of the compounds. Subsequently, these chemicals were assessed against the resistant stage of N. fowleri, demonstrating activity similar to that observed in the vegetative stage. Moreover, characteristic events of programmed cell death were evidenced, including chromatin condensation, increased plasma membrane permeability, mitochondrial damage, and heightened oxidative stress, among others. Finally, this research demonstrated the in vitro activity of the cyanoacrylamide and 5-iminopyrrol-2-one molecules, as well as the induction of metabolic event characteristics of regulated cell death in Naegleria fowleri.

Identification of oxidative stress-related diagnostic markers and immune infiltration features for idiopathic pulmonary fibrosis by bibliometrics and bioinformatics.

Idiopathic pulmonary fibrosis (IPF) garners considerable attention due to its high fatality rate and profound impact on quality of life. Our study conducts a comprehensive literature review on IPF using bibliometric analysis to explore existing hot research topics, and identifies novel diagnostic and therapeutic targets for IPF using bioinformatics analysis. Publications related to IPF from 2013 to 2023 were searched on the Web of Science Core Collection (WoSCC) database. Data analysis and visualization were conducted using CiteSpace and VOSviewer software primarily. The gene expression profiles GSE24206 and GSE53845 were employed as the training dataset. The GSE110147 dataset was employed as the validation dataset. We identified differentially expressed genes (DEGs) and differentially expressed genes related to oxidative stress (DEOSGs) between IPF and normal samples. Then, we conducted Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. The hub genes were screened by protein-protein interaction (PPI) networks and machine learning algorithms. The CIBERSORT was used to analyze the immune infiltration of 22 kinds of immune cells. Finally, we conducted the expression and validation of hub genes. The diagnostic efficacy of hub genes was evaluated by employing Receiver Operating Characteristic (ROC) curves and the associations between hub genes and immune cells were analyzed. A total of 6,500 articles were identified, and the annual number of articles exhibited an upward trend. The United States emerged as the leading contributor in terms of publication count, institutional affiliations, highly cited articles, and prolific authorship. According to co-occurrence analysis, oxidative stress and inflammation are hot topics in IPF research. A total of 1,140 DEGs were identified, and 72 genes were classified as DEOSGs. By employing PPI network analysis and machine learning algorithms, PON2 and TLR4 were identified as hub genes. A total of 10 immune cells exhibited significant differences between IPF and normal samples. PON2 and TLR4, as oxidative stress-related genes, not only exhibit high diagnostic efficacy but also show close associations with immune cells. In summary, our study highlights oxidative stress and inflammation are hot topics in IPF research. Oxidative stress and immune cells play a vital role in the pathogenesis of IPF. Our findings suggest the potential of PON2 and TLR4 as novel diagnostic and therapeutic targets for IPF.

Disease modifiers and novel markers in HBV-related HCC.

Chronic hepatitis B (CHB) infection is responsible for 40% of the global burden of hepatocellular carcinoma (HCC) with a high case fatality rate. The risk of HCC differs among CHB subjects owing to differences in host and viral factors. Modifiable risk factors include viral load, use of antiviral therapy, co-infection with other hepatotropic viruses, concomitant metabolic dysfunction-associated steatotic liver disease or diabetes mellitus, environmental exposure, and medication use. Detecting HCC at early stage improves survival, and current practice recommends HCC surveillance among individuals with cirrhosis, family history of HCC, or above an age cut-off. Ultrasonography with or without serum alpha feto-protein every 6 months is widely accepted strategy for HCC surveillance. Novel tumor-specific markers, when combined with AFP, improve diagnostic accuracy than AFP alone to detect HCC at an early stage. To predict the risk of HCC, a number of clinical risk scores have been developed but none of them are clinically implemented nor endorsed by clinical practice guidelines. Biomarkers that reflect viral transcriptional activity and degree of liver fibrosis can potentially stratify the risk of HCC, especially among subjects who are already on antiviral therapy. Ongoing exploration of these novel biomarkers is required to confirm their performance characteristics, replicability and practicability.

Vaccine Platform Comparison: Protective Efficacy against Lethal Marburg Virus Challenge in the Hamster Model.

Marburg virus (MARV), a filovirus, was first identified in 1967 in Marburg, Germany, and Belgrade, former Yugoslavia. Since then, MARV has caused sporadic outbreaks of human disease with high case fatality rates in parts of Africa, with the largest outbreak occurring in 2004/05 in Angola. From 2021 to 2023, MARV outbreaks occurred in Guinea, Ghana, New Guinea, and Tanzania, emphasizing the expansion of its endemic area into new geographical regions. There are currently no approved vaccines or therapeutics targeting MARV, but several vaccine candidates have shown promise in preclinical studies. We compared three vaccine platforms simultaneously by vaccinating hamsters with either a single dose of an adenovirus-based (ChAdOx-1 MARV) vaccine, an alphavirus replicon-based RNA (LION-MARV) vaccine, or a recombinant vesicular stomatitis virus-based (VSV-MARV) vaccine, all expressing the MARV glycoprotein as the antigen. Lethal challenge with hamster-adapted MARV 4 weeks after vaccination resulted in uniform protection of the VSV-MARV and LION-MARV groups and 83% of the ChAdOx-1 MARV group. Assessment of the antigen-specific humoral response and its functionality revealed vaccine-platform-dependent differences, particularly in the Fc effector functions.

Patient socio-demographics and clinical factors associated with malaria mortality: a case control study in the northern region of Ghana

BackgroundGhana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures.MethodsAn unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant.ResultsIn all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9–24.6)], severe pallor [aOR: 2.3, 95% CI (1.1–4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4–5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2–0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8–9.5)].ConclusionPredictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced.

Synthesis and molecular docking of novel biguanide-NSAIDs hybrid with dual anti-diabetic and anti-inflammatory activity

Herein, we report the synthesis, characterization, anti-diabetic and anti-inflammatory activities of biguanide hybridized with NSAIDS drugs linked via hydrazide. Diabetes Mellitus is a chronic metabolic condition that can lead to significant complications and a high fatality rate worldwide. Efforts are ramping up to find and develop novel α-glucosidase and α-amylase inhibitors that are both effective and potentially safe. Docking studies have also been done for antidiabetic target. The molecular docking results displayed that the constituents strongly bind α-amylase and α-glucosidase while achieving better binding affinities. IBU (182.64 μg/mL and 65.41 μg/mL), NAP (195.25 μg/mL and 78.53 μg/mL) and DIC (185.94 μg/mL and 91.26 μg/mL) showed a better antidiabetic activity with α-glucosidase and α-amylase respectively. Also, IBU and KET showed a better reduction in paw volume 0.710 mL and 0.718 mL at 240 min indicating better anti-inflammatory effect. ADMET study states, lipophilicity of the compounds, reflected in their log Po/w values, varies significantly. ASP (3c) is quite hydrophilic, while DIC (3e) and FLU (3 g) are more lipophilic. Among the all-synthesized biguanide compounds ASP and KET exhibits low gastrointestinal absorption. MEF showed high skin permeation and ASP showed low skin permeation. From all the studies it concludes that the synthesised biguanide derivatives could be a potential in treatment of various inflammatory conditions associated with Diabetes Mellitus.

Deciphering the impact of Acinetobacter baumannii on human health, and exploration of natural compounds as efflux pump inhibitors to treat multidrug resistance.

Acinetobacter baumannii is an ESKAPE pathogen and threatens human health by generating infections with high fatality rates. A. baumannii leads to a spectrum of infections such as skin and wound infections, endocarditis, meningitis pneumonia, septicaemia and urinary tract infections. Recently, strains of A. baumannii have emerged as multidrug-resistant (MDR), meaning they are resistant to at least three different classes of antibiotics. MDR development is primarily intensified by widespread antibiotic misuse and inadequate stewardship. The World Health Organization (WHO) declared A. baumannii a precarious MDR species. A. baumannii maintains the MDR phenotype via a diverse array of antimicrobial metabolite-hydrolysing enzymes, efflux of antibiotics, impermeability and antibiotic target modification, thereby complicating treatment. Hence, a deeper understanding of the resistance mechanisms employed by MDR A. baumannii can give possible approaches to treat antimicrobial resistance. Resistance-nodulation-cell division (RND) efflux pumps have been identified as the key contributors to MDR determinants, owing to their capacity to force a broad spectrum of chemical substances out of the bacterial cell. Though synthetic inhibitors have been reported previously, their efficacy and safety are of debate. As resistance-modifying agents, phytochemicals are ideal choices. These natural compounds could eliminate the bacteria or interact with pathogenicity events and reduce the bacteria's ability to evolve resistance. This review aims to highlight the mechanism behind the multidrug resistance in A. baumannii and elucidate the utility of natural compounds as efflux pump inhibitors to deal with the infections caused by A. baumannii.

The potential inhibition effect of ellagic acid on liver cells in the treatment of hepatocellular carcinoma

Hepatocellular Carcinoma (HCC) is the most common kind of liver cancer, which has a relatively high fatality rate. The main cause of this type of cancer is liver inflammation, which leads to disorder in the tumor microenvironment. There are some current treatments, including liver transplants, radiofrequency, microwave ablation, and transarterial chemoembolization. However, the treatments still have limited disadvantages, which cannot be ignored. Recently, a traditional Chinese medicine - Chebulae Fructus, has been proven to have an inhibition ability on HCC cells. One of the main constituents, ellipticine, is found to have therapeutic targets that can treat HCC: PTGS2, CYP1A2, CCNB1, and RASGRF1. Moreover, the essay also mentioned that another type of constituent ellagic acid could also have an inhibition effect on tumor progression by binding to Cyclin-Dependent Kinase 6 (CDK6). This study will further investigate the HCC inhibition effect of ellagic acid by providing an overview of the predicted results of the experiment. It will also provide the possible research direction of ellagic acid HCC treatment.

Allogeneic stem cell transplant in primary hemophagocytic lymphohistiocytosis - a single-center experience.

Hemophagocytic Lymphohistiocytosis (HLH) is a rare disorder of immune dysregulation characterized by fever, cytopenias, and splenomegaly. Its primary form poses a therapeutic challenge due to its high fatality when left untreated. We retrospectively analyzed 28 patients who underwent related-donor allogeneic stem cell transplant for primary HLH from 2010 to 2021. Among them were 10 cases of familial HLH, 8 cases of Griscelli syndrome type 2, and 1 case each with PRF1 and STX11 mutations. All the patients underwent transplants with reduced-intensity or myeloablative conditioning and 26 of them achieved neutrophil engraftment at a median of day + 14. The donors were either fully matched (68%) or haploidentical (32%). With a median follow-up of 1 year, overall survival was 68% (n = 19) and disease-free survival was 64.4% (n = 18). OS was better in patients transplanted with a sibling donor (compared to parent donor), who achieved complete donor chimerism, and those transplanted early in the course of the disease (diagnosis to transplant duration less than 6 months).

Evaluation of the levels of salivary paxillin in oral potentially malignant disorders and malignant lesions

BackgroundThe scientific community has been particularly interested in oral squamous cell carcinoma (OSCC) because of the cancer’s extremely high incidence and fatality rates worldwide. It has been proposed that paxillin is involved in certain malignancies as an oncogene. Additionally, several investigations have assessed paxillin expression and investigated its function in developing distinct human carcinomas, including squamous cell carcinoma. Furthermore, it was discovered that there is a strong link between paxillin levels and cancer progression and spread.ObjectiveThis investigation was carried out to analyze and compare the salivary paxillin levels between oral potentially malignant disorders (OPMDs), OSCC and the healthy controls to assess its potential role as a biomarker of oral cancer aiming for early diagnosis and better prognosis of OSCC.MethodsForty-five patients, ranging in age from thirty to seventy-five, were divided into three groups: fifteen patients with OPMDs, fifteen patients with OSCC, and fifteen controls. Paxillin was identified in saliva samples by using an ELISA kit.ResultsPatients with OSCC and OPMDs have considerably greater salivary Paxillin levels than the healthy control group. The receiver operating curve (ROC) analysis was used in our study to distinguish patients with OPMDs from those with OSCC. The ROC curve constructed with the OPMDs group as the positives had lower sensitivity and area under the curve (AUC) values [100% and 1] than the ROC curve with the malignant group as the positives [93.3% and 0.997], respectively. Furthermore, ROC analysis performed between OPMDs group and the malignant group showed a specificity of 73.3% and a cut-off value ≥ 7.9 .ConclusionPaxillin can be considered a reliable biomarker for identifying and comparing OPMDs and OSCC cancerous changes.ClinicalTrials.gov IdentifierNCT06154551- 4/12/2023.

Efficacy and Immunogenicity of a Recombinant Vesicular Stomatitis Virus-Vectored Marburg Vaccine in Cynomolgus Macaques.

Filoviruses, like the Marburg (MARV) and Ebola (EBOV) viruses, have caused outbreaks associated with significant hemorrhagic morbidity and high fatality rates. Vaccines offer one of the best countermeasures for fatal infection, but to date only the EBOV vaccine has received FDA licensure. Given the limited cross protection between the EBOV vaccine and Marburg hemorrhagic fever (MHF), we analyzed the protective efficacy of a similar vaccine, rVSV-MARV, in the lethal cynomolgus macaque model. NHPs vaccinated with a single dose (as little as 1.6 × 107 pfu) of rVSV-MARV seroconverted to MARV G-protein prior to challenge on day 42. Vaccinemia was measured in all vaccinated primates, self-resolved by day 14 post vaccination. Importantly, all vaccinated NHPs survived lethal MARV challenge, and showed no significant alterations in key markers of morbid disease, including clinical signs, and certain hematological and clinical chemistry parameters. Further, apart from one primate (from which tissues were not collected and no causal link was established), no pathology associated with Marburg disease was observed in vaccinated animals. Taken together, rVSV-MARV is a safe and efficacious vaccine against MHF in cynomolgus macaques.

Designing a Multi-Epitope Vaccine Candidate to MERS-CoV: An in silico Approach

Background. Middle East Respiratory Syndrome Coronavirus (MERS-CoV), associated with severe respiratory illness, originates from the Middle East region. The virus is transmitted from animals to humans, with the dromedary camel serving as a significant reservoir. The virus's high fatality rate has spurred research into vaccine development and therapeutics. Objective. This study aimed to employ an in silico approach to design a potential vaccine candidate against MERS-CoV, focusing on the M protein as an antigen. Methods. The FASTA sequence of M protein was used to predict B cell and major histocompatibility complex class I and class II epitopes. The best epitopes were selected from these predicted epitopes. The vaccine candi­date's construct consisted of epitopes, linkers, and a tag. The sequence of the vaccine candidate's construct, consisting of 390 amino acids, was back-translated, optimized, and then inserted into a plasmid for cloning and expression using SnapGene. The 3D structure of the vaccine candidate is docked with TLR-4 receptor. Molecular dynamics simulation was run for this docked complex using GROMACS gmx, version 2021.4. Results. Through computational modeling and analysis, we developed a novel vaccine candidate with pro­mising structural and functional properties. Our results suggest that the designed vaccine candidate has the potential to induce a robust immune response. Conclusions. This in silico approach presents a promising MERS-CoV vaccine candidate designed to trigger both humoral and cellular immune responses. This candidate holds the potential to provide broad-spectrum protection against MERS-CoV.

MicroRNA-21 in urologic cancers: from molecular mechanisms to clinical implications.

The three most common kinds of urologic malignancies are prostate, bladder, and kidney cancer, which typically cause substantial morbidity and mortality. Early detection and effective treatment are essential due to their high fatality rates. As a result, there is an urgent need for innovative research to improve the clinical management of patients with urologic cancers. A type of small noncoding RNAs of 22 nucleotides, microRNAs (miRNAs) are well-known for their important roles in a variety of developmental processes. Among these, microRNA-21 (miR-21) stands out as a commonly studied miRNA with implications in tumorigenesis and cancer development, particularly in urological tumors. Recent research has shed light on the dysregulation of miR-21 in urological tumors, offering insights into its potential as a prognostic, diagnostic, and therapeutic tool. This review delves into the pathogenesis of miR-21 in prostate, bladder, and renal cancers, its utility as a cancer biomarker, and the therapeutic possibilities of targeting miR-21.

A Novel Strategy for Glioblastoma Treatment by Natural Bioactive Molecules Showed a Highly Effective Anti-Cancer Potential.

Glioblastoma (GBM) is a severe form of brain tumor that has a high fatality rate. It grows aggressively and most of the time results in resistance to traditional treatments like chemo- and radiotherapy and surgery. Biodiversity, beyond representing a big resource for human well-being, provides several natural compounds that have shown great potential as anticancer drugs. Many of them are being extensively researched and significantly slow GBM progression by reducing the proliferation rate, migration, and inflammation and also by modulating oxidative stress. Here, the use of some natural compounds, such as Allium lusitanicum, Succisa pratensis, and Dianthus superbus, was explored to tackle GBM; they showed their impact on cell number reduction, which was partially given by cell cycle quiescence. Furthermore, a reduced cell migration ability was reported, accomplished by morphological cytoskeleton changes, which even highlighted a mesenchymal-epithelial transition. Furthermore, metabolic studies showed an induced cell oxidative stress modulation and a massive metabolic rearrangement. Therefore, a new therapeutic option was suggested to overcome the limitations of conventional treatments and thereby improve patient outcomes.

Temporal and Serotypic Dynamics of Actinobacillus pleuropneumoniae in South African Porcine Populations: A Retrospective Study from 1985 to 2023.

Actinobacillus pleuropneumoniae is a major bacterial pathogen causing porcine pleuropneumoniae, which is a disease of notable economic impact and high fatality rates among pigs worldwide. It has been reported that 19 distinct serotypes of this bacterium exist. Despite its global prominence, there exists a scarcity of information regarding its prevalence and distribution in South Africa. Thus, this study used laboratory records to investigate the serotype diversity, temporal distribution, and seasonal patterns of A. pleuropneumoniae isolated from porcine samples spanning from 1985 to 2023 within South Africa. Data from laboratory registries of 354 cases, obtained from three veterinary laboratories in South Africa, were analyzed. The data were categorized into two-time frames: term 1, covering 1985 to 2001, and term 2, spanning from 2002 to 2023. The dataset identified 11 different serotypes, with serotype 7 being the most prevalent at 22.7% (n = 62), which was followed by serotype 5 at 13.8% (n = 42). The study highlighted variations in the prevalence of serotypes among diseased animals over a 38-year period. Serotypes 3, 5, 7 and 8 were commonly observed during this time, while serotype 4 was absent from 1985 to 2001, and serotypes 1, 6, and 10 were absent from 2002 to 2023. The distribution of serotypes showed a diverse variation in the age of affected animals, clinical manifestation, and seasonal occurrence. Key findings revealed that serotype 7 was the most prevalent across all seasons with the highest occurrence in winter. Additionally, Gauteng province showed the highest prevalence of various serotypes. The information collected during this study will serve as a baseline for future epidemiological studies as well as inform control strategies.

SARC-F, SARC-CalF, and SARC-F+EBM as practical predictive tools for the risk of pneumonia in patients with stable schizophrenia—a prospective study

ObjectivesIndividuals diagnosed with schizophrenia have a high incidence and fatality rates due to pneumonia. Sarcopenia is a contributing factor to the development of pneumonia in patients with schizophrenia. In this study, we examine the effectiveness of three simple screening questionnaires, namely SARC-F, SARC-CalF, and SARC-F + EBM, in predicting the occurrence of pneumonia in stable patients with schizophrenia who are experiencing sarcopenia. DesignA prospective study. SettingPatients with stable schizophrenia patients aged ≥50 years in two psychiatric hospitals in western China. MethodsMedical data from patients were collected from September 1 to September 30, 2020. Data specifically from patients diagnosed with pneumonia were collected for a period of one year, from October 2020 to October 2021. Three hundred thirty-five stable schizophrenia patients, among whom 229 were males (68.36 %.), were enrolled in the prospective study. The risk of sarcopenia was evaluated using the SARC-F, SARC-CalF, and SARC-F + EBM scores, with values of ≥4, 11, and 12 indicating an elevated risk of sarcopenia. The collected data were analyzed using logistic regression analysis to establish the association between the scores of these screening tools and the risk of pneumonia in individuals with stable schizophrenia. ResultsThe rate of pneumonia in stable schizophrenia individuals was 24.48 %. Among the included stable schizophrenia patients, the incidence of pneumonia in individuals with SARC-CalF scores ≥11 was higher than in those with SARC-CalF scores less than 11 (29.91 % vs 14.88 %, P = 0.002). In individuals with SARC-F + EBM scores ≥12, the pneumonia occurrence was higher than that in those with SARC-F + EBM scores less than 12 (37.33 % vs 20.77 %, P = 0.003). However, this pattern was not found in patients with stable schizophrenia who had SARC-F scores of 4 or above and less than 4. Following the implementation of logistic regression data analysis, it has been discovered that persons with SARC-CalF scores greater than or equal to 11 were at a significantly increased risk of having pneumonia compared to patients with SARC-CalF scores less than 11 (OR = 2.441, 95 % CI: 1.367–4.36). After adjusting the possible confounders, patients with SARC-CalF scores ≥11 had a greater danger of pneumonia (OR = 2.518, 95%CI: 1.36–4.665). As a result, it was found that individuals with SACR-F+EBM scores ≥12 were more likely to acquire pneumonia (OR = 2.273, 95%CI: 1.304–3.961) when compared to those with scores <12 (OR = 2.273, 95%CI: 1.304–3.961). The results of this study, which controlled for potential confounders, indicated that patients with SARC-F + EBM scores ≥12 were more inclined to acquire pneumonia (OR = 2.181, 95%CI: 1.182–4.026). However, in stable schizophrenia patients with SARC-F scores ≥4 and < 4, this study has not yet observed a similar pattern for pneumonia risk. Conclusions and implicationsThese results demonstrate, in stable adults with schizophrenia, a relationship between pneumonia risk and SARC-F + EBM and SARC-CalF scores. It is, therefore, advised to use these scores to determine whether these patients have pneumonia, especially in hospitals that cannot diagnose sarcopenia.