High Morbidity Research Articles

The prevention effect of Limosilactobacillus reuteri on acute kidney injury by regulating gut microbiota.

Acute kidney injury (AKI) has considerably high morbidity and mortality but we do not have proper treatment for it. There is an urgent need to develop new prevention or treatment methods. Gut microbiota has a close connection with renal diseases and has become the new therapy target for AKI. In this study, we found the oral administration of the probiotic Limosilactobacillus reuteri had a prevention effect on the AKI induced by lipopolysaccharide (LPS). It reduced serum concentration of creatinine and urea nitrogen and protected the renal cells from necrosis and apoptosis. Meanwhile, L. reuteri improved the gut barrier function, which is destroyed in AKI, and modulated the gut microbiota and relevant metabolites. Compared with the LPS group, L. reuteri increased the proportion of Proteobacteria and reduced the proportion of Firmicutes, changing the overall structure of the gut microbiota. It also influenced the fecal metabolites and changed the metabolite pathways, such as tyrosine metabolism, pentose and glucuronate interconversions, galactose metabolism, purine metabolism, and insulin resistance. These results showed thatL. reuteri is a potential therapy for AKI as it helps in sustaining the gut barrier integrity and modulating gut microbiota and related metabolites.

Characteristics and Risk Factors for Pediatric Sepsis.

Sepsis is considered a major cause of health loss in children and had high mortality and morbidity. Currently, there is no reliable model for predicting the prognosis of pediatric patients with sepsis. This study aimed to analyze the clinical characteristics of sepsis in children and assess the risk factors associated with poor prognosis in pediatric sepsis patients to identify timely interventions and improve their outcomes. This study analyzed the clinical indicators and laboratory results of septic patients hospitalized in the Pediatric Intensive Care Unit of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China, from January 1, 2019, to December 31, 2021. Risk factors for sepsis were identified by logistic regression analyses. A total of 355 children with sepsis were enrolled, with 333 children (93.8%) in the good prognosis group, and 22 children (6.2%) in the poor prognosis group. Among them, there were 255 patients (71.8%) in the sepsis group, and 100 patients (28.2%) in the severe sepsis group. The length of hospital stay in the poor prognosis group was longer than that in the good prognosis group (P<0.01). The levels of interleukin 1β (IL-1β) in the poor prognosis group were higher than those in the good prognosis group (P>0.05), and the platelet (PLT), albumin (ALB), and hemoglobin (Hb) levels were lower in the poor prognosis group (P<0.01). The IL-8 levels in the severe sepsis group were higher than those in the sepsis group (P<0.05). Multiple logistic regression analysis suggested that lower Hb levels, ALB levels, peak PLT counts, and higher IL-1β levels were independent risk factors for poor prognosis in children with sepsis. Lower Hb, ALB, and PLT counts and elevated IL-1β are independent risk factors for poor prognosis in children with sepsis.

Influenza A virus NS1 effector domain is required for PA-X-mediated host shutoff in infected cells.

Many viruses inhibit general host gene expression to limit innate immune responses and gain preferential access to the cellular translational apparatus for their protein synthesis. This process is known as host shutoff. Influenza A viruses (IAVs) encode two host shutoff proteins: nonstructural protein 1 (NS1) and polymerase acidic X (PA-X). NS1 inhibits host nuclear pre-messenger RNA maturation and export, and PA-X is an endoribonuclease that preferentially cleaves host spliced nuclear and cytoplasmic messenger RNAs. Emerging evidence suggests that in circulating human IAVs NS1 and PA-X co-evolve to ensure optimal magnitude of general host shutoff without compromising viral replication that relies on host cell metabolism. However, the functional interplay between PA-X and NS1 remains unexplored. In this study, we sought to determine whether NS1 function has a direct effect on PA-X activity by analyzing host shutoff in A549 cells infected with wild-type or mutant IAVs with NS1 effector domain deletion. This was done using conventional quantitative reverse transcription polymerase chain reaction techniques and direct RNA sequencing using nanopore technology. Our previous research on the molecular mechanisms of PA-X function identified two prominent features of IAV-infected cells: nuclear accumulation of cytoplasmic poly(A) binding protein (PABPC1) and increase in nuclear poly(A) RNA abundance relative to the cytoplasm. Here we demonstrate that NS1 effector domain function augments PA-X host shutoff and is necessary for nuclear PABPC1 accumulation. By contrast, nuclear poly(A) RNA accumulation is not dependent on either NS1 or PA-X-mediated host shutoff and is accompanied by nuclear retention of viral transcripts. Our study demonstrates for the first time that NS1 and PA-X may functionally interact in mediating host shutoff.IMPORTANCERespiratory viruses including the influenza A virus continue to cause annual epidemics with high morbidity and mortality due to the limited effectiveness of vaccines and antiviral drugs. Among the strategies evolved by viruses to evade immune responses is host shutoff-a general blockade of host messenger RNA and protein synthesis. Disabling influenza A virus host shutoff is being explored in live attenuated vaccine development as an attractive strategy for increasing their effectiveness by boosting antiviral responses. Influenza A virus encodes two proteins that function in host shutoff: the nonstructural protein 1 (NS1) and the polymerase acidic X (PA-X). We and others have characterized some of the NS1 and PA-X mechanisms of action and the additive effects that these viral proteins may have in ensuring the blockade of host gene expression. In this work, we examined whether NS1 and PA-X functionally interact and discovered that NS1 is required for PA-X to function effectively. This work significantly advances our understanding of influenza A virus host shutoff and identifies new potential targets for therapeutic interventions against influenza and further informs the development of improved live attenuated vaccines.

Milrinone in persistent pulmonary hypertension of newborn: a scoping review.

Persistent pulmonary hypertension of the newborn (PPHN) is a common neonatal condition in newborns admitted to the neonatal intensive care units (NICUs). PPHN has still a high mortality and morbidity. Inhaled nitric oxide (iNO) is the first line vasodilator therapy for PPHN in high income countries. In low-to-middle income countries (LMICs), availability of iNO remains scarce and expensive. The purpose of this scoping review was to evaluate the current existing literature for milrinone therapy in PPHN and to identify the knowledge gaps in milrinone use in infants with PPHN. The available evidence for milrinone remains limited both as monotherapy and as an adjuvant to iNO. The studies were heterogeneous, conducted in different settings, with different populations and more importantly the endpoints of these trials were short-term outcomes such as changes in oxygenation and blood pressure. Large prospective studies investigating long-term outcomes, mortality, and the need for Extracorporeal membrane oxygenation (ECMO) are warranted. Randomized controlled trials with milrinone as monotherapy are needed in LMICs where iNO availability remains limited. IMPACT: Milrinone has a potential role in the management of PPHN both as an adjuvant to iNO as well as a monotherapy. This scoping review identified the problems existing in the published literature on milrinone and the barriers to generalization of these results. Multi-centre randomized controlled trials on milrinone, especially involving centers from low- and middle-income countries are needed, where it can be evaluated as first-line pulmonary vasodilator therapy.

Arg1 from Cryptococcus neoformans lacks PI3 kinase activity and conveys virulence roles via its IP3-4 kinase activity.

Inositol tris/tetrakis phosphate kinases (IP3-4K) in the human fungal priority pathogens, Cryptococcus neoformans (CnArg1) and Candida albicans (CaIpk2), convey numerous virulence functions, yet it is not known whether the IP3-4K catalytic activity or a scaffolding role is responsible. We therefore generated a C. neoformans strain with a non-functional kinase, referred to as the dead-kinase (dk) CnArg1 strain (dkArg1). We verified that, although dkARG1 cDNA cloned from this strain produced a protein with the expected molecular weight, dkArg1 was catalytically inactive with no IP3-4K activity. Using recombinant CnArg1 and CaIpk2, we confirmed that, unlike the IP3-4K homologs in humans and Saccharomyces cerevisiae, CnArg1 and CaIpk2 do not phosphorylate the lipid-based substrate, phosphatidylinositol 4,5-bisphosphate, and therefore do not function as class I PI3Ks. Inositol polyphosphate profiling using capillary electrophoresis-electrospray ionization-mass spectrometry revealed that IP3 conversion is blocked in the dkArg1 and ARG1 deletion (Cnarg1Δ) strains and that 1-IP7 and a recently discovered isomer (4/6-IP7) are made by wild-type C. neoformans. Importantly, the dkArg1 and Cnarg1Δ strains had similar virulence defects, including suppressed growth at 37°C, melanization, capsule production, and phosphate starvation response, and were avirulent in an insect model, confirming that virulence is dependent on IP3-4K catalytic activity. Our data also implicate the dkArg1 scaffold in transcriptional regulation of arginine metabolism but via a different mechanism to S. cerevisiae since CnArg1 is dispensable for growth on different nitrogen sources. IP3-4K catalytic activity therefore plays a dominant role in fungal virulence, and IPK pathway function has diverged in fungal pathogens.IMPORTANCEThe World Health Organization has emphasized the urgent need for global action in tackling the high morbidity and mortality rates stemming from invasive fungal infections, which are exacerbated by the limited variety and compromised effectiveness of available drug classes. Fungal IP3-4K is a promising target for new therapy, as it is critical for promoting virulence of the human fungal priority pathogens, Cryptococcus neoformans and Candida albicans, and impacts numerous functions, including cell wall integrity. This contrasts to current therapies, which only target a single function. IP3-4K enzymes exert their effect through their inositol polyphosphate products or via the protein scaffold. Here, we confirm that the IP3-4K catalytic activity of CnArg1 promotes all virulence traits in C. neoformans that are attenuated by ARG1 deletion, reinforcing our ongoing efforts to find inositol polyphosphate effector proteins and to create inhibitors targeting the IP3-4K catalytic site, as a new antifungal drug class.

Hyperglycemic Impact On Sleep Quality In Patients With Type 2 Diabetes Mellitus-A Cross Sectional Study

Background: Diabetes mellitus (DM) causes high morbidity and mortality and loss of quality of life significantly. It is an important public health concern. In epidemiologic studies, people with poor sleep quality are more prone to develop diabetes or metabolism disorder of glucose. Sleep has an important role for metabolic function and specifically homeostasis of glucose metabolism. Many studies have shown a correlation between increased diabetes risk and poor sleep quality or sleep deprivation. DM creates a negative effect impact on quality of sleep on patients. Prevalence of obesity and diabetes becomes greater among aged people, it is of vital importance to fix on sleep for overall medical management. This is aimed to determine hyperglycaemia with sleep quality among the patient. Methods: This was a cross sectional study carried out at Ibrahim General Hospital, National Health Care Network (NHN), Mirpur-10, Dhaka during the period of January 2014 to December 2014. Total 129 respondents were selected purposively for this study. Semi-structured questionnaire was pretested first and then it was used for data collection. Pittsburgh Sleep Quality Index score (PSQI) was used to assess sleep quality. Statistical Package for Social Sciences (SPSS) version 22.0. was used for analysis of the collected data. Results: Among 129 respondents, 98(76%) were male and 31(24%) were female. 93.8% respondents were married and rest 6.2% of them were unmarried. Mean(±SD) age was found 53.64(±9.26) years and range 35 to 70 years. 79.1% of the respondents had co-morbidity of DM, 70(54.3%) had diabetes more than 10 years duration. Mean(±SD) of overall sleep quality score was 9.04(±3.965) and range 1 to 18. Among the respondents of age group &gt;64, 95.70% had poor sleep quality, 76.14% respondents sleep less than 6 hours in a day. So association between sleep quality and glycemic status of type 2 DM was significant(p&lt;0.05). Conclusion: The prevalence of high blood sugar level in Type 2 DM patients have poor sleep quality. Type 2 DM patients with high blood sugar level have to overcompensate kidneys to visit washroom more frequent and lead to disturbance in sleep. Type 2 DM patients with controlled blood sugar level have good sleep quality. It is evident from the study that Type 2 DM patients with high sugar level (Hyperglycaemia) frequently experience sleep difficulties. Bangladesh Armed Forces Med J Vol 56 No (1) June 2023, pp 21-27

Emergency Profile of Pediatric Patients Based on Pediatric Early Warning Score in the Emergency Department of the Adam Malik Hospital

Background: High morbidity and mortality rates in pediatric patients indicate the necessity of a Pediatric Early Warning Score (PEWS) capable of early clinical deterioration identification and providing an opportunity for healthcare professionals to promptly manage patients. This study aimed to serve as foundational data and as an evaluative tool to enhance the proficiency of healthcare workers in assessing patient deterioration. Methods: This study utilized a descriptive method with a cross-sectional design and consecutive sampling technique who were treated from January to December 2022. Results: there were 119 samples, the majority of gender was male (54.6%), the majority of the age group was 1-4 years old (37.8%), and the majority of the disease group was infection (31.1%). Both male and female majority had green PEWS (54.6%) and (45.4%), the majority of patients with an age range of 1 month to 5 years had red PEWS, the majority of infectious disease group had green PEWS, and the majority of patients with green PEWS had discharge outcome. Conclusion: This study provides an overview of characteristics in pediatric patients and shows the majority of pediatric emergency department patients come with non-emergency conditions.

Evaluation of Three-Dimensional Reconstruction Technology in Precision Hepatectomy for Primary Liver Cancer

Abstract Background Primary Liver Cancer has become a potent threat to the world due to its high morbidity and mortality rate. Up till now, Liver transplantation is the most suggested treatment but it is not feasible owing to the unavailability of donors and high cost. Hepatectomy provides an alternative treatment to this deadliest disease. Precision hepatectomy is performed with the aid of traditional 2 dimensional technology and image processing such as CT scan and Magnetic Resonance Imaging. However, it requires extensive expertise and pose challenges to the young doctors in decision making. Modern imaging and computer technology has opened the new avenues in medical field with the advent of 3 dimensional Reconstruction and visualization methods. Material and Methods We conducted a cohort retrospective study. In this study, we tried to evaluate the efficacy an impacts of 3 dimensional reconstruction on the preoperative planning of hepatectomy, intraoperative conditions and postoperative complications. We took 95 patients and divided them in two groups A and B. Group A has 67 patients who underwent hepatectomy before the application of 3 dimensional reconstruction and 28 patients on whom hepatectomy was performed according to the planning and methods of 3dimensional reconstruction and results were evaluated. Results Our study found that 3 dimensional reconstruction can help in better diagnosis, resection planning and reduce the postoperative complication. Results were not significant difference p &gt; 0.05 on the incidence of postoperative complication between group A and B. Results were significant p &lt; 0.05 for the intraoperative blood loss, optimal surgery time and postoperative hospitalization. Conclusion Hence, 3 dimensional reconstruction is a landmark discovery in medical sciences for the accurate evaluation and resection of complex liver cancers.

Lactic Acid Bacteria-Derived Postbiotics as Adjunctive Agents in Breast Cancer Treatment to Boost the Antineoplastic Effect of a Conventional Therapeutic Comprising Tamoxifen and a New Drug Candidate: An Aziridine–Hydrazide Hydrazone Derivative

Breast cancer is associated with high mortality and morbidity rates. As about 20–30% of patients exhibiting ER-positive phenotype are resistant to hormonal treatment with the standard drug tamoxifen, finding new therapies is a necessity. Postbiotics, metabolites, and macromolecules isolated from probiotic bacteria cultures have been proven to have sufficient bioactivity to exert prohealth and anticancer effects, making them viable adjunctive agents for the treatment of various neoplasms, including breast cancer. In the current study, postbiotics derived from L. plantarum and L. rhamnosus cultures were assessed on an in vitro breast cancer model as potential adjunctive agents to therapy utilizing tamoxifen and a candidate aziridine–hydrazide hydrazone derivative drug. Cell viability and cell death processes, including apoptosis, were analyzed for neoplastic MCF-7 cells treated with postbiotics and synthetic compounds. Cell cycle progression and proliferation were analyzed by PI-based flow cytometry and Ki-67 immunostaining. Postbiotics decreased viability and triggered apoptosis in MCF-7, modestly affecting the cell cycle and showing a lack of negative impact on normal cell viability. Moreover, they enhanced the cytotoxic effect of tamoxifen and the new candidate drug toward MCF-7, accelerating apoptosis and the inhibition of proliferation. This illustrates postbiotics’ potential as natural adjunctive agents supporting anticancer therapy based on synthetic drugs.

Emodin improves renal fibrosis in chronic kidney disease by regulating mitochondrial homeostasis through the mediation of peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1α).

Chronic kidney disease (CKD) is a leading public health issue associated with high morbidity worldwide. However, there are only a few effective therapeutic strategies for CKD. Emodin, an anthraquinone compound from rhubarb, can inhibit fibrosis in tissues and cells. Our study aims to investigate the antifibrotic effect of emodin and the underlying molecular mechanism. A unilateral ureteral obstruction (UUO)-induced rat model was established to evaluate the effect of emodin on renal fibrosis development. Hematoxylin and eosin staining, Masson's trichrome staining, and immunohistochemistry staining were performed to analyze histopathological changes and fibrotic features after emodin treatment. Subsequently, a transforming growth factor-beta 1 (TGF-β1)-induced cell model was used to assess the inhibition of emodin on cell fibrosis in vitro. Furthermore, Western blot analysis and real-time quantitative reverse transcription-polymerase chain reaction were performed to validate the regulatory mechanism of emodin on renal fibrosis progression. As a result, emodin significantly improved histopathological abnormalities in rats with UUO. The expression of fibrosis biomarkers and mitochondrial biogenesis-related proteins also decreased after emodin treatment. Moreover, emodin blocked TGF-β1-induced fibrotic phenotype, lipid accumulation, and mitochondrial homeostasis in NRK-52E cells. Conversely, peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1α) silencing significantly reversed these features in emodin-treated cells. Collectively, emodin plays an important role in regulating PGC-1α-mediated mitochondria function and energy homeostasis. This indicates that emodin exhibits great inhibition against renal fibrosis and acts as a promising inhibitor of CKD.

Measuring the perceived wellbeing of hemodialysis patients: A Mind Genomics cartography.

Chronic Kidney Disease patients under hemodialysis have high morbidity rate, which tends to considerably affect their health-related quality of life. Multiple studies that have made use of different questionnaries report the poor life quality of this patient group. The research in hand implemented the Mind Genomics Approach as a method to asses the health-related quality of life of hemodialysis patients, while relying on conjoint measurements to group individuals with similar patterns of responses to a certain mindset. The study is conducted in 3 clinics with 219 patients. It uncovers three clusters or mindsets: Mindset 1- Feels guardedly optimistic but worried about money, Mindset 2-Feels strongly positive because the state guarantees and the family supports, Mindset 3-Feels positive only about money. Based on the analysis of the collected data, the findings of this study suggest that the quality of life in hemodialysis patients is highly correlated to their financial status. The current study is one of the few first attempts to apply Mind Genomics in medical settings and the first, to our knowledge, in hemodialysis centers. This technology might enable healthcare proffesionals to provide personalized psychological treatment and additional social support to patients, which in turn could improve their clinical outcomes. The study is an example of using technology as a service.

Resolvin D1 Inhibits IL-6-Induced Epithelial-Mesenchymal Transition of Colorectal Cancer Cells by Targeting IL-6/STAT3 Signaling.

Colorectal cancer (CRC) has emerged as a prevalent malignancy worldwide, exhibiting the high morbidity and mortality rates. Resolvin D1 (RvD1) can exert anti-inflammation and anti-cancer effects on various diseases. This study is aimed to explore the role of RvD1 in CRC cells. HCT15 and SW480 cells were stimulated with IL-6 in our study. A series of assays such as CCK-8, colony formation, wound healing, Transwell, Western blotting, and immunofluorescence staining were designed and conducted to figure out the role of RvD1 in CRC cells. RvD1 suppressed IL-6-induced SW480 and HCT15 cell proliferation. In addition, RvD1 inhibited IL-6-induced SW480 and HCT15 cell migration, invasion, and EMT process. In mechanism, RvD1 inhibited the activation of IL-6/STAT3 signaling in SW480 and HCT15 cells. Angoline strengthened the inhibitive effect of RvD1 on cell malignancy. RvD1 inhibited cell growth, migration, invasion and EMT process by inactivating IL-6/STAT3 signaling in CRC.

Regulatory mechanism and expression level of PRPS2 in lung cancer.

Lung cancer, with high morbidity and mortality, is the commonest respiratory system neoplasm, which seriously endangers the life safety of patients. In this study, the effect of PRPS2 on cell progression was preliminarily investigated. Immunohistochemical staining, western blot and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) were performed to verify the expression level of PRPS2 in lung cancer. Lung cancer cell lines with stable downregulation of PRPS2 were constructed in A549 cells and NCIH460 cells. The function of PRPS2 silencing on the proliferation ability was verified by the EdU and cell colony formation experiment. Scratch and transwell tests were conducted to verify the role of PRPS2 silencing on the migratory and invasive ability of cells. The impact of PRPS2 silencing on cell apoptosis and cell cycle was verified by flow cytometry test. The effects of PRPS2 silencing on apoptosis-associated proteins were assessed by western blot assay. The function of PRPS2 silencing on tumor growth in vivo was studied through xenograft tumor experiment. In comparison with normal tissues, PRPS2 was upregulated in lung cancer tissues. PRPS2 knockdown notably hindered the migratory ability, invasive ability and proliferation, but accelerated cell apoptosis. In vivo experiments confirmed that PRPS2 silencing blocked the growth of transplanted tumors. In lung cancer, PRPS2 silencing suppressed the malignant progression, indicating that PRPS2 might be a novel biomarker for lung cancer treatment and diagnosis.

A mortality indicator in acute pulmonary embolism: the inferior vena cava contrast reflux score feasibility

Objective: Acute pulmonary embolism (APE) is frequently associated with high morbidity and mortality rates. Numerous studies have investigated the prognostic significance of cardiovascular computed tomography (CT) parameters. This study aimed to investigate potential CT scan predictors of 24-hour mortality in APE and to evaluate the value of the inferior vena cava (IVC) reflux score calculated on CT scan in predicting mortality. Methods: This study was a single-center, retrospective study. Approval from the local ethics committee (decision no. 2023/76) was obtained before patients’ data scanning. Patients who were admitted to the emergency department (ED) of a tertiary education and research hospital in Turkey between January 1, 2019, and December 31, 2021, who were diagnosed with APE at CT scan in the ED and whose treatment was started, and who did not meet the exclusion criteria were included in the study. The relationship between CT scan findings and early and late mortality was evaluated. Results: The study population comprised 226 patients, meeting the inclusion and exclusion criteria. Of the 226 patients, a total of 39 (17.3%) patients died, 16 (7.1%) within the first 24 hours. In evaluating CT scan parameters, the inferior vena cava (IVC) reflux score showed a statistically significant difference between the groups with and without mortality (24-hour P=0.001; 30-day P=0.001). Patients who died within the first 24-hour and 30-day after admission showed a reflux grade 3 into IVC more often than survivors (24-hour odds ratio (OR): 14.57, 95% confidence interval (CI): 3.64,58.1; P=0.001); 30-day (OR: 6.54, 95% CI: 2.51,16.98; P=0.001). However, other CT parameters were evaluated, and no statistical relationship was found between the groups with and without mortality. Conclusion: The cardiovascular CT scan findings may not be suitable for use as predictors of mortality. However, the IVC reflux score may be a good indicator of both early and late mortality.

Differences In Quality of Life of Nasopharyngeal Carcinoma Patients at Rsi Sultan Agung Semarang Observational Analytical Studies in Age, Gender, and Stage of Cancer

Nasopharyngeal carcinoma is a malignant tumor in the head and neck area of squamous cell type located in the nasopharynx. Nasopharyngeal carcinoma in Indonesia is the 4th most malignant cancer and is considered one of the most malignant tumors with high mortality and morbidity. This study aims to determine the difference in quality of life in nasopharyngeal carcinoma patients with characteristics (age, gender, and stage of cancer) nasopharyngeal tumors. The research method was carried out with analytical observational through a cross sectional approach. The measuring instruments used in the form of EORTC QLQ-C30 and EORTC QLQ-H&amp;N35 questionnaires were used to measure the quality of life of nasopharyngeal carcinoma patients at RSI Sultan Agung Semarang. The data were analyzed using a binary logistic regression test. The results of the study of nasopharyngeal carcinoma patients according to the characteristics at RSI Sultan Agung Semarang based on 13 respondents were dominated by male patients totaling 8 people (61.54%), aged 45 years as many as 8 people (61.54%), and cancer stages were divided into 6 people (≥46.15%) and 7 people (53.85%) in the early and advanced stages. The results of the Wald Test did not significantly differ in the quality of life of nasopharyngeal carcinoma patients at RSI Sultan Agung Semarang with each sig intention. The independent variables were age (p = 0.187), gender (p = 0.227), and cancer stage (p = 0.558). The independent variable that most affected the level of quality of life of nasopharyngeal carcinoma patients was gender with a value of Exp(B) = 5.394. The conclusion of this study is that there is no difference in quality of life in nasopharyngeal carcinoma patients with characteristics (age, gender, and stage of cancer) nasopharyngeal tumors.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 151-156

The Risk of Venous Thromboembolism and Ischemic Stroke Stratified by VTE Risk Following Multiple Myeloma: A Korean Population-Based Cohort Study

Background: Multiple myeloma (MM) is associated with high morbidity and mortality, with elevated rates of arterial thrombosis and venous thromboembolism (VTE) and ischemic stroke (IS). We aimed to estimate the incidence of VTE and IS categorized by the VTE risk grade among individuals with MM in Korea. Additionally, we explored the potential of the IMPEDE VTE score as a tool for assessing IS risk in patients with MM. Methods: This retrospective cohort study comprised 37,168 individuals aged ≥ 18 years newly diagnosed with MM between January 2008 and December 2021 using the representative claims database of the Korean population. The risk of the incidence of VTE and IS within 6 months after MM diagnosis was stratified based on high-risk (IMPEDE VTE score ≥ 8) and low-risk (&lt;8) categories. The hazard ratios (HRs) were estimated using Cox proportional hazard models. Results: The VTE incidence was 120.4 per 1000 person-years and IS incidence was 149.3 per 1000 person-years. Statistically significant differences were observed in the cumulative incidence rates of VTE between groups with high and low VTE scores (p &lt; 0.001) and between individuals aged ≤ 65 years (p &lt; 0.001) and those with a Charlson comorbidity index (CCI) ≥ 3 compared to lower scores (p &lt; 0.001). Additionally, the cumulative incidence rate of IS differed significantly across all groups (p &lt; 0.001). The HR for the high-risk group in VTE and IS occurrence was 1.59 (95% CI, 1.26–2.00) and 3.47 (95% CI, 2.99–4.02), respectively. Conclusions: It is important to screen and manage high-risk groups for the early development of VTE or IS in patients with newly diagnosed MM.

A Case Report of 80-Year-Old Male with Total Atrioventricular Block, Acute Decompensated Heart Failure, and Non-ST-Elevation Myocardial Infarction Very High Risk: A Complicated Case in Limited Resources Setting

Background: Cardiovascular disease is still a major problem globally, with high morbidity and mortality rates. The progression of cardiovascular disease is so dynamic that it can leave the patient in a terminal condition. Given the high mortality and morbidity accompanied by rapid disease progression, understanding the appropriate management of each patient with comorbid heart disease is very important. Case presentation: We report an 80-year-old male with TAVB (Total Atrioventricular Block), ADHF (Acute Decompensated Heart Failure), and NSTEMI (Non-ST-Elevation Myocardial Infarction). The patient was treated and stabilized intensively in our center based on protocol. Due to the rapid progression of the disease, we referred the patient to the tertiary hospital in Bali for further advanced treatment. Conclusion: The mortality rate in cases of cardiovascular diseases is relatively high, requiring rapid and adequate treatment to provide better clinical outcomes.

Prevalence, Predictors, and Outcomes of Type 2 NSTEMI in Hospitalized Patients With COVID-19.

Data on the incidence of type 2 non-ST-segment-elevation myocardial infarction (T2MI) in hospitalized patients with COVID-19 has been limited to single-center studies. Given that certain characteristics, such as obesity and type 2 diabetes, have been associated with higher mortality in COVID-19 infections, we aimed to define the incidence of T2MI in a national cohort and identify pre-hospital patient characteristics associated with T2MI in hospitalized patients with COVID-19. Using the national American Heart Association COVID-19 Cardiovascular Disease Quality Improvement Registry, we performed a retrospective 4:1 matched (age, sex, race, and body mass index) analysis of controls versus cases with T2MI. We performed (1) conditional multivariable logistic regression to identify predictive pre-hospital patient characteristics of T2MI for patients hospitalized with COVID-19 and (2) stratified proportional hazards regression to investigate the association of T2MI with morbidity and mortality. From January 2020 through May 2021, there were 709 (2.2%) out of 32 015 patients with T2MI. Five hundred seventy-nine cases with T2MI were matched to 2171 controls (mean age 70; 43% female). Known coronary artery disease, heart failure, chronic kidney disease, hypertension, payor source, and presenting heart rate were associated with higher odds of T2MI. Anti-hyperglycemic medication and anti-coagulation use before admission were associated with lower odds of T2MI. Those with T2MI had higher morbidity and mortality (hazard ratio, 1.40 [95% CI, 1.13-1.74]; P=0.002). In hospitalized patients with COVID-19, those with a T2MI compared with those without had higher morbidity and mortality. Outpatient anti-hyperglycemic and anti-coagulation use were the only pre-admission factors associated with reduced odds of T2MI.

Exploration of quantitative-effectiveness association between acupuncture temporal parameters and stable chronic obstructive pulmonary disease: A systematic review and dose-response meta-analysis of randomized controlled trials

IntroductionChronic Obstructive Pulmonary Disease (COPD) is a globally common chronic respiratory disease with a high morbidity and mortality rate. Acupuncture has been proven effective for COPD. A dose-response meta-analysis was conducted to assess the correlation between the acupuncture temporal parameters(session, frequency, and duration) and its effectiveness in patients with stable COPD. MethodsAcupuncture randomized controlled trials on COPD were searched in eight databases from their inception to June 2023. The "doses" were defined as the acupuncture session, frequency, and duration. The outcomes mainly included Forced Expiratory Volume in one-second rate (FEV1%) and Six-minute Walking Distance (6MWD). The assessment of bias risk and literature quality were conducted independently using the Cochrane risk of bias tool and the Standards for reporting interventions in clinical trials of acupuncture. The dose-response relationship was modeled using robust error element regression, and meta-analysis was operated by R 4.3.1 and Stata 15.0. The protocol was registered in PROSPERO with the registration number CRD42023401406. ResultOut of 1669 records, 17 RCTs with 1165 participants were finally included in the meta-analysis. There was notable heterogeneity among the studies, but sensitivity analysis demonstrated good robustness. The findings revealed a significant improvement in the following outcomes for stable COPD patients in the acupuncture group: FEV1% (MD=3.50, 95%CI: 2.05–4.95), 6MWD (MD=47.39, 95%CI: 29.29–65.50), St. George's respiratory questionnaire (SGRQ; MD=−8.25, 95%CI: −11.38 to −5.12); COPD assessment test (CAT; MD=−2.91, 95%CI: −3.99 to −1.83). The relationship between the acupuncture session, duration, and FEV1%, 6MWD followed a "Λ" curve pattern, while the relationship between acupuncture frequency and FEV1%, 6MWD exhibited logarithmic growth. Firstly, After 12 acupuncture sessions, FEV1% and 6MWD increased by 7.06% (95%CI: 4.56–9.55) and 36.28 m (95%CI: 20.37–52.20), respectively. The peak improvement in FEV1% and 6MWD was observed after 18 acupuncture sessions (MD=7.89, 95% CI: 5.33–10.45) and 45 sessions (MD=125.43, 95% CI: 72.80–178.07) each. Additionally, weekly acupuncture resulted in a 4.14% improvement in FEV1% (95% CI: 2.55–5.72) and a 42.49 m increase in 6MWD (95%CI: 17.16–67.81). Notably, the maximum effects on FEV1% and 6MWD improvement were achieved with different acupuncture frequencies, specifically three times a week (MD=6.00, 95% CI: 5.34–6.66) and once a day(MD=112.41, 95% CI: 77.27–147.56), respectively. Furthermore, after a 28-day duration of acupuncture treatment, FEV1% increased by 4.74% (95% CI: 3.73–5.75) and 6MWD increased by 47.34 m (95%CI: 22.01–72.67). During 60 days of acupuncture treatment, the FEV1% and 6MWD improvement reached their highest levels at 8.76% (95% CI: 7.05–10.47) and 88.06 m (95% CI: 45.96–130.16), respectively. ConclusionAcupuncture was effective in improving FEV1%, 6MWD, SGRQ, and CAT in patients with stable COPD. There was a dose-response relationship between the time parameters of acupuncture (session, frequency, and duration) and the efficacy of COPD treatment (FEV1% and 6MWD). The minimal clinically important difference could be achieved after 12 acupuncture sessions. Acupuncture with a medium-frequency (2–3 times per week) over 60 days may result in the greatest improvement in FEV1%, while higher-frequency acupuncture (5–7 times per week) for 2 months may lead to the maximum improvements in 6MWD. It indicated that the optimal acupuncture duration for different indicators remains consistent, while the optimal frequencies may differ. To confirm these results, it is necessary to conduct multicenter, large-scale randomized controlled trials. Ethics and disseminationEthical approval is not required for literature-based studies. The results will be published in peer-reviewed journals or conferences.

Supraglottitis: An airway emergency

Supraglottitis is a life-threatening condition and refers to inflammation of the epiglottis and the surrounding supraglottic structures. Children usually present with only a swollen epiglottis, termed epiglottitis. Fortunately, the incidence of epiglottitis in children has declined following routine Haemophilus influenzae type B vaccination, but the incidence in adults has increased. Supraglottitis has a high morbidity and mortality from the associated risk of airway obstruction. Therefore, early recognition and urgent secondary care referral is paramount. However, the presentation of this condition can be subtle and differs between children and adults; this can lead to difficulties in diagnosis. This article will review the clinical presentation and management of supraglottitis, an important differential for acute sore throat and hoarse voice.