Hospital Database Research Articles

Might retrigger with human chorionic gonadotropin be a solution for empty follicle syndrome after gonadotropin releasing hormone agonist trigger?

This study aimed to determine whether the use of human chorionic gonadotropin (hCG) as a trigger could offer a potential solution for addressing empty follicle syndrome following the administration of a trigger for gonadotropin-releasing hormone agonist. A retrospective cohort analysis was conducted using data extracted from the hospital database pertaining to 415 patients who underwent in vitro fertilization (IVF) with an antagonist protocol triggered by a gonadotropin-releasing hormone (GnRH) agonist between December 2019 and January 2023 at the Acıbadem Maslak Hospital Assisted Reproductive Technologies Unit. All cases that failed to obtain oocytes and required rescue were analyzed. This study analyzed 415 women who underwent IVF using GnRH agonist-triggered antagonist protocols. Among them, 6 (1.4%) had empty folicle syndrome (EFS). Patients with EFS had lower luteinizing hormone levels and fewer oocytes, embryos, and blastocysts, resulting in lower oocyte utilization rate. However, pregnancy rates were similar, with no biochemical or ectopic pregnancies observed in the EFS group. Use of an hCG retrigger in hyperresponders with no oocytes after GnRHa trigger may prevent cycle cancelation. Although the rates of egg utilization may decrease, oocyte maturity remains comparable. Frozen embryo transfer following hCG retrigger administration yields similar positive pregnancy test results and live birth rates.

Assessment of Demographic Characteristics Among CAD Patients by Ethnicity

Background: This study was carried out to assess the demographic characteristics among CAD by ethnicity. Methods: Retrospective study was performed in (SGNHC) Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Hospital Database of 837 patients were used to gather the information about the disease during one year period. SPSS version 20 was used for statistical analysis. Results: As the hospital lies in the Capital city and Central Region of the country, most of the population 604 (72.2%) had come from Central region, 126 (15.4%) from Western region, 62(7.6%) from Eastern region, 15(1.8%) from Far-western region and 11(1.3%) from Midwestern region. Conclusion: The study examined 837 CAD patients, primarily Brahmin/Chhetris (44.7%), with an average age of 58.6 years and 71.9% being male. Most patients were from Nepal's Central Region.Acute STEMI was the most common diagnosis, particularly among Newars, while NSTEMI and Angina Pectoris were more prevalent in Dalits. Single vessel disease was frequent in Muslims, with Dalits showing higher rates of triple vessel disease, highlighting demographic and regional variations in CAD severity.CAD has been identified as public health priority in Nepal given the current and predicted burden of all forms of heart disease within the country. This study found that there was a diverse distribution in its well-known traditional risk factors among major Nepalese ethnic groups and demographic characteristics.

Evaluation of micro-remnant niduses of arteriovenous malformations post-gamma knife radiosurgery by 3D-rotational angiography.

Recent innovations in radiological imaging have enabled the detection of micro-remnant niduses of arteriovenous malformations (AVMs) after gamma knife radiosurgery (GKS), which have not been previously perceptible. Herein, we focus on the difficulty of evaluating micro-remnant AVMs after GKS that are hardly perceptible on conventional examinations and propose integrating follow-up three-dimensional rotational angiography (3D-RA) in the previous gamma plan as a solution. We retrospectively searched NTT Medical Center Tokyo hospital database for patients with AVMs who underwent both two-dimensional digital subtraction angiography (2D-DSA) and 3D-RA as follow-up for GKS from February 2021 to January 2024. Patients with suspected nidus occlusion on the latest non-contrast-enhanced magnetic resonance angiography (NC-MRA) were included, and contrast-enhanced magnetic resonance angiography (CE-MRA), 2D-DSA, and 3D-RA were evaluated. Twelve patients with 13 AVM sites were defined as having complete nidus occlusion on upfront NC-MRA. On 2D-DSA, seven AVM sites showed the presence of slight remaining AVMs based on the detection of remnant drainage veins, however the nidus was not detected in three cases. Nevertheless, 3D-RA detected micro-remnant niduses in all seven AVM sites, and four patients underwent re-GKS. Nine patients with ten AVM sites also underwent CE-MRA, and six AVM sites were diagnosed with radiation-induced parenchymal injury. Importing the 3D-RA image into the treatment planning has the potential to be more helpful than NC-MRA or CE-MRA to detect micro-remnant AVMs and evaluate the true remnant volume, and may contribute to a more detailed treatment planning, thereby improving the results of GKS retreatment.

Health-related quality of life of outpatients living with acute and chronic diseases in 3 government hospitals in Parigi Moutong District, Central Sulawesi, Indonesia

ObjectivesTo present the EQ-5D utility score in outpatients with chronic and acute diseases and investigate the factors that affect HRQoL in outpatients in three government hospitals in Parigi Moutong District, Central Sulawesi, Indonesia.MethodsWe gathered two primary types of data: clinical conditions from hospital databases and sociodemographic information gathered through participant interviews. We used the EQ-5D index score quintiles as the dependent variable in an ordinal regression analysis to look at the multivariate relationships between the socioeconomic characteristics of the participants and their clinical conditions.ResultsThe median EQ-5D index score of Indonesian outpatients was 1.00 [0.88–1.00]. Mobility and pain/discomfort dimensions are the most frequently reported problems, particularly among participant complaints relating to joints and extremities. Moreover, living in rural regions, retirement age, being female, and having a divorced marital status are sociodemographic variables linked to decreased EQ-5D index scores. Reported issues, particularly in the areas of self-care and activities, increase with the use of herbal medication.ConclusionOur study provides estimates of outpatient EQ-5D index scores applicable for pharmacoeconomic analysis. Outpatients with certain conditions, especially those with impaired mobility and pain, need special attention.

Evaluation of systemic inflammation markers in patients with Hashimoto's thyroiditis.

To investigate markers of systemic inflammation and the effect of thyroid dysfunction on these parameters in patients with Hashimoto's thyroiditis (HT). Patients with HT and volunteer healthy individuals admitted to the general surgery outpatient clinic between January 2020 and June 2023 were enrolled into the study. Patients with HT were divided into euthyroid, hypothyroid, and hyperthyroid subgroups. All participant data were retrospectively extracted from the hospital database. A total of 268 patients (euthyroid, n = 131; hypothyroid, n = 83; and hyperthyroid, n = 54) and 124 controls were included. The platelet-to-lymphocyte ratio was lower in the euthyroid group versus control group, and the neutrophil-to-lymphocyte ratio was lower in controls than the three patient subgroups. Euthyroid and hypothyroid patients with HT exhibited a higher systemic inflammation index than the control group. The pan-immune inflammation index was lower in controls than in euthyroid, hypothyroid, and hyperthyroid patients with HT. In patients with HT, inflammation markers did not significantly differ between subgroups. Markers of systemic inflammation provide meaningful and reliable information in patients with HT, but do not differentiate between euthyroid, hypothyroid, or hyperthyroid patients.

Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study

ObjectiveTo investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco...

Short‑term effects of oxybutynin dosage in individuals with neurogenic bladder following spinal cord injury: A retrospective cohort study.

The aim of the present study was to determine the relationship between dose of oxybutynin and reduction in detrusor pressure in individuals with neurogenic bladder (NGB) secondary to spinal cord injury (SCI). The hospital-based data were examined for all individuals with NGB and SCI who were admitted for urological evaluation between January 1999 and December 2016. Patient characteristics, urodynamics and bladder management details were collected at pre-treatment and post-treatment. The primary outcome used to assess oxybutynin treatment was the change in detrusor pressure (Pdet). Analysis of covariance (ANCOVA) was used to investigate the relationship between dosage of oxybutynin and decrease in Pdet. A total of 245 participants (112 who received no medication and 133 treated with oxybutynin) were included. After controlling for confounding factors, each 1 mg increase in oxybutynin was associated with a mean decrease of 0.9 cmH2O in Pdet (95% CI, -1.4 to -0.3). Stratifying bladder management by indwelling catheter, oxybutynin at a dose of 1 mg was associated with a mean decrease in Pdet of 0.5 cmH2O (95% CI, -1.4 to 0.4) in patients with indwelling catheters and 1.0 cmH2O (95% CI, -1.7 to -0.3) in patients with clean intermittent catheterization and balanced bladder. This study provided guidance for setting the starting dose of drugs associated with response variability in NGB with SCI. Oxybutynin is deemed to be clinically effective for managing NGB in patients with SCI.

Ведення пацієнтів із легеневою гіпертензією в умовах воєнного стану: реалії та проблеми

Any military actions on the territory of any country can significantly influence on the quality of medical care. Especially, it could reflect on patients with rare diseases requiring expensive treatment. In this article there were analyzed the work of the specialized pulmonary hypertension (PH) center during the period of Russia’s military invasion in Ukraine and presented the results of the outpatient survey due to problems with patient access to medical care and medicine provision in the period from 24-Feb-2022 to 01-Jul-2024 (war period).We selected patients with a diagnosis of PH carried out for the periods: since 01-Jan-2018 until 30-Apr-2020 (pre-war and pre-COVID-19 period) and since 22-Feb-2022 until 01-Jul-2024 (war period): n=328 and n=394 respectively. The selection was made from the electronic hospital database and the electronic registry of patients that have been conducted in the department since 2014. With the help of the Google Form system, a questionnaire was created and sent through modern devices of communication (Viber, Facebook) to fill out online to patients who are registered (applied for outpatient or inpatient care) in the department or are subscribers to the social network accounts of the Ukrainian Association of Patients with Pulmonary hypertension and/or the Lviv City Charitable Foundation «Sisters of Dalili». We got 220 responses. It was established that martial law status in the country did not significantly affect the management of patients with different forms of PH in the specialized center. The number of treated patients and performed right heart catheterization procedures increased by 20 and 22 % respectively during the «war period», compared to the «pre-war» period. 65 % of PH patients who came abroad due to the war used the help of the specialized department for direct referral to PH centers in Poland for further treatment, including surgical one. 41,7 % of respondents changed their place of residence during the war, but only 17,9 % had interruptions in taking of drugs for the PH treatment. Along with the usual sources of free medicines (humanitarian aid from charitable organizations, the government’s free medicines program), one in five patients «shared out» medicines with other patients. In 45 % of the patients who visited foreign PH centers, the therapy previously prescribed in Ukraine was changed to more effective or safer drugs that are not registered in Ukraine.

Splenectomy unveils thrombocytosis in underlying myeloproliferative neoplasms with extrahepatic portal vein obstruction.

Extrahepatic portal vein obstruction (EHPVO) is a rare disease with myeloproliferative neoplasm (MPN) as the most common cause. We report that hypersplenic hematologic changes in EHPVO might be eliminated by MPN. Through experience with splenectomy for variceal control with EHPVO, we suspected that spleen might mask MPN-induced thrombocytosis, and that MPN might have a significant influence on excessive thrombocytosis after splenectomy. To clarify the influence of MPN and spleen on platelet trends, we conducted a retrospective hospital database analysis, evaluating 8 EHPVO patients with splenectomy (2 males, 6 females; from 17 years to 64 years, mean 38.3 years). Three (37.5%) of 8 were diagnosed as MPN by JAK2V617F mutation. The perioperative serum platelet counts in EHPVO without MPN were 10.5, 35.4, and 36.6 (x104/μL) preoperatively, after 1 week and 3 weeks, respectively. The platelet counts in EHPVO with MPN were 34.2, 86.4, and 137.0 (x104/μL), respectively. Splenectomy and MPN showed positive interaction on platelet increasing with statistical significance. We also examined the spleen volume index (SpVI: splenic volume (cm3) / body surface area (m2) and postoperative platelet elevations ratio (PER: 3-week postoperative platelet counts / preoperative platelet counts). However, both SpVI and PER showed no significant difference with or without MPN. Histological examination revealed splenic congestion in all 8 EHPVO cases, and splenic extramedullary hematopoiesis in 2 of 3 MPN. In EHPVO with MPN, hypersplenism causes feigned normalization of platelet count by masking MPN-induced thrombocytosis; however, splenectomy unveils postoperative thrombocytosis. Spleen in EHPVO with MPN also participates in extramedullary hematopoiesis.

Long-term outcomes of smoker and drinker with oesophageal squamous cell carcinoma after oesophagectomy: a large-scale propensity score matching analysis

BackgroundOesophageal squamous cell carcinoma (OSCC) poses a considerable health burden, particularly in regions such as East Asia. This study aims to investigate the long-term outcomes of OSCC patients who are...

Apical Sparing in Routine Echocardiography: Occurrence and Clinical Significance.

Apical sparing is an echocardiographic pattern where myocardial strain is preserved at the apex compared to the basal segments. In a normal heart, longitudinal strain shows a gradient with lower values at the base and higher at the apex. This gradient becomes more pronounced in pathological states, such as cardiac amyloidosis, resulting in a relative apical sparing effect. This study explores cardiac conditions associated with apical sparing and the underlying mechanisms. We reviewed echocardiography examinations reporting apical sparing from 2021 to 2024 in our hospital database. Relevant echo exams and clinical data were retrieved and analyzed. Apical sparing was identified in 74 patients. Cardiac amyloidosis was diagnosed in 12 patients (16.2%). Other cardiac pathologies potentially contributing to apical sparing included hypertrophic cardiomyopathy, left ventricular hypertrophy due to hypertension, end-stage renal disease, coronary artery disease (involving the right coronary artery and left circumflex), reversed Takotsubo syndrome, and chemotherapy-induced cardiomyopathy. The clinical context of echocardiography was crucial in guiding the diagnostic work-up. Apical sparing is a nonspecific echocardiographic finding associated with various cardiac conditions. Its diagnostic value depends heavily on the clinical context. Understanding the broader clinical picture is essential for accurate interpretation and diagnosis.

Surgical Outcomes of a Human Umbilical Cord Allograft Over the Ahmed Glaucoma Valve Plate for Refractory Glaucoma.

To report the surgical outcomes of sterile dehydrated human umbilical cord allograft over the Ahmed glaucoma valve (AGV) plate for refractory glaucoma. Thirty-four eyes of 34 patients with refractory glaucoma who underwent AGV with umbilical cord allograft (AmnioPlast THICK™; Life Cell International Private Limited, Mumbai, India) placed over the AGV plate between September 2021 and 2022 at a tertiary eye care centre were included (group1) and compared with 30 eyes of 30 patients undergoing AGV without amnioblasts (group 2). The intraocular pressure (IOP) at day one, one month, six months, and final IOP; the necessity for medications; or additional surgeries for IOP control were extracted from the hospital database. Success was defined as achieving an IOP below 22 mm Hg with or without glaucoma medications. IOP spikes after surgery were identified as a rise in pressure beyond 22 mm Hg at any point beyond six weeks post-surgery following an initial reduction of pressure exceeding 30% from the baseline pre-surgical IOP. A notable reduction in intraocular pressure (37 ± 7.9 mm Hg preoperative versus 14 ± 3.7 mm Hg at the final follow-up and 28 ± 3.6 mm Hg versus 18 ± 6.7 mm Hg in group 1 and 2, respectively) was observed in all eyes, with successful outcomes observed in 23 out of 34 eyes (67%). Ten eyes experienced a pressure spike, occurring at a median time of 12 months (range: 6-18 months), predominantly beyond six months post-surgery in group 1, while group 2 had similar pressure spikes in 21 of 30 eyes at a median time of two months (range: 1-5 months). No eyes necessitated supplementary glaucoma procedures, concluding with a final IOP of 14 ± 3.7 mm Hg at 1.9 ± 0.8 years. Vision loss occurred in only one of the 11 eyes that failed owing to non-glaucoma-related causes in group 1. The human umbilical cord allograft plate over the AGV plate may help in postponing the onset of intraocular pressure spikes beyond traditionally defined timelines. This helps in reducing and delaying the hypertensive phase occurring due to fibrosis.

Mid-term Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) in Acute Complicated Type B Aortic Dissection: A Comprehensive Analysis of Aortic Remodeling Patterns.

This study provides a comprehensive analysis of the clinical outcomes associated with endovascular treatment for acute complicated type B aortic dissection, with a focus on the complex process of aortic remodeling. We conducted a retrospective investigation using data extracted from the Songklanagarind Hospital database between January 2010 and January 2022. Electronic medical records of patients who underwent thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissections were reviewed. The analysis focused on in-hospital outcomes, overall survival, aorta-related survival, reintervention-free survival, and changes in aortic lumen diameter to assess aortic remodeling. Over the study period, 32 patients with acute complicated type B aortic dissections underwent TEVAR. The in-hospital mortality rate was 9.4%, with complications occurring in 21.9% of patients. Temporary acute kidney injury was observed in 9.4% of the cases, wound bleeding in 6.3%, pneumonia in 6.3%, and permanent spinal cord ischemia in 3.1%. Re-intervention was necessary in 6.3% of cases. The overall survival rates at 6 months, 1 year, 3 years, and 6 years were 78%, 75%, 65%, and 44%, respectively. Aorta-related survival rates were 87%, 87%, 83%, and 75% at the corresponding time intervals. The reintervention-free survival rates were 96%, 96%, 71%, and 71%, respectively. Survival analysis revealed that patients with ideal aortic remodeling experienced the most favorable outcomes, whereas those with undesirable aortic remodeling exhibited the least favorable survival. Notably, undesirable pattern of aortic remodeling emerged as a singular factor with a statistically significant influence on predicting survival (hazard ratio 4.37, P-value=0.021). TEVAR resulted in favorable aorta-related survival outcomes. Notably, the identification of changes in aortic lumen diameter alongside false lumen thrombosis, encapsulated within the framework of aortic remodeling patterns, has emerged as a robust predictor of post-TEVAR survival outcomes.

Post-Thrombectomy Subarachnoid Hemorrhage: Incidence, Predictors, Clinical Relevance, and Effect Modulators.

Subarachnoid hemorrhage (SAH) following endovascular thrombectomy (EVT) is a poorly understood phenomenon, and whether it is associated with clinical detriment is unclear. This was an explorative analysis of a national database of real-world hospitalizations in the United States. Patients who underwent EVT were included. Patients were divided into SAH and non-SAH groups, and hospitalization outcomes were compared using multivariable logistic regression models. Regression models were also used to identify significant predictors for post-EVT SAH, and significant modulators of SAH's association with hospitalization outcomes were also assessed. A total of 99,219 EVT patients were identified; 6174 (6.2%) had SAH. Overall, SAH was independently associated with increased odds of in-hospital mortality (21.5% vs. 10.6%, adjusted OR 2.53 [95%CI 2.23-2.87], p < 0.001) and lower odds of routine discharge to home with self-care (18.2% vs. 28.0%, aOR 0.58 [95%CI 0.52-0.65], p < 0.001). Distal/medium vessel occlusion (DMVO), coagulopathy, angioplasty or stenting, concurrent intraparenchymal hemorrhage (IPH), and female sex were associated with higher odds of SAH. DMVO was associated with particularly heightened risk of death (31.8% vs. 7.9%, aOR 6.99 [95%CI 2.99 to 16.3], p < 0.001), which was an effect size significantly larger than other sites of vascular occlusion (interaction p > 0.05). SAH is an uncommon but likely clinically detrimental post-EVT complication. DMVO, coagulopathy, angioplasty or stenting, concurrent IPH, and female sex were independently associated with higher odds of post-EVT SAH. SAH associated with DMVO-EVT may be particularly harmful.

Comparison of surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy: Retrospective cohort study

Aim: We aimed to compare the surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy (TLH) performed in a tertiary center. Materials and Methods: A total of 397 TLH either with or without oophorectomy, for a benign indication, surgeries performed at our tertiary hospital between March 2022 and May 2024 were analyzed in our study. Patients who underwent manual free vaginal morcellation were defined as Group I (n=85, 21.4%) and patients who did not undergo vaginal morcellation were defined as Group II (n=312, 78.6%). Demographic characteristics, laboratory values, operation characteristics and histopathological reports were accessed from the hospital database. Results: The median uterine weight of the morcellation group was greater. Median morcellation time was 9 minutes. While the median operation time of Group I was 80 minutes, it was 70 minutes for Group II. The groups were similar with regard to postoperative urinary tract, intraoperative urinary tract and intraoperative bowel injuries. Intraoperative vaginal or perineal laceration was detected at a greater rate in the morcellation group. Conclusion: For large uteruses, TLH is still the best option for suitable patients when performed by experienced surgeons. It has been revealed that manual free vaginal morcellation, performed without the need for additional incisions, is safe, low-cost and practical in total laparoscopic hysterectomies with benign indications.

Multi-dimensional epidemiology and informatics data on COVID-19 wave at the end of zero COVID policy in China.

China exited strict Zero-COVID policy with a surge in Omicron variant infections in December 2022. Given China's pandemic policy and population immunity, employing Baidu Index (BDI) to analyze the evolving disease landscape and estimate the nationwide pneumonia hospitalizations in the post Zero COVID period, validated by hospital data, holds informative potential for future outbreaks. Retrospective observational analyses were conducted at the conclusion of the Zero-COVID policy, integrating internet search data alongside offline records. Methodologies employed were multidimensional, encompassing lagged Spearman correlation analysis, growth rate assessments, independent sample T-tests, Granger causality examinations, and Bayesian structural time series (BSTS) models for comprehensive data scrutiny. Various diseases exhibited a notable upsurge in the BDI after the policy change, consistent with the broader trajectory of the COVID-19 pandemic. Robust connections emerged between COVID-19 and diverse health conditions, predominantly impacting the respiratory, circulatory, ophthalmological, and neurological domains. Notably, 34 diseases displayed a relatively high correlation (r > 0.5) with COVID-19. Among these, 12 exhibited a growth rate exceeding 50% post-policy transition, with myocarditis escalating by 1,708% and pneumonia by 1,332%. In these 34 diseases, causal relationships have been confirmed for 23 of them, while 28 garnered validation from hospital-based evidence. Notably, 19 diseases obtained concurrent validation from both Granger causality and hospital-based data. Finally, the BSTS models approximated approximately 4,332,655 inpatients diagnosed with pneumonia nationwide during the 2 months subsequent to the policy relaxation. This investigation elucidated substantial associations between COVID-19 and respiratory, circulatory, ophthalmological, and neurological disorders. The outcomes from comprehensive multi-dimensional cross-over studies notably augmented the robustness of our comprehension of COVID-19's disease spectrum, advocating for the prospective utility of internet-derived data. Our research highlights the potential of Internet behavior in predicting pandemic-related syndromes, emphasizing its importance for public health strategies, resource allocation, and preparedness for future outbreaks.

Low Levels of Adropin Predict Adverse Clinical Outcomes in Outpatients with Newly Diagnosed Prediabetes after Acute Myocardial Infarction.

Adropin-a multifunctional peptide with tissue-protective capacity that regulates energy homeostasis, sensitivity to insulin and inflammatory response-seems to show an inverse association with the presence of cardiovascular and renal diseases, obesity and diabetes mellitus in the general population. The purpose of the study is to elucidate whether adropin may be a plausible predictive biomarker for clinical outcomes in post-ST elevation of myocardial infarction (STEMI) patients with newly diagnosed prediabetes according to the American Diabetes Association criteria. A total of 1214 post-STEMI patients who received percutaneous coronary intervention were identified in a local database of the private hospital "Vita Center" (Zaporozhye, Ukraine). Between November 2020 and June 2024, we prospectively enrolled 498 patients with prediabetes in this open prospective cohort study and followed them for 3 years. The combined clinical endpoint at follow-up was defined as cardiovascular death due to acute myocardial infarction, heart failure, sudden death due to arrhythmia or cardiac surgery, and/or all-cause death. We identified 126 clinical events and found that serum levels of adropin < 2.15 ng/mL (area under the curve = 0.836; 95% confidence interval = 0.745-0.928; sensitivity = 84.9%; specificity = 72.7%; likelihood ratio = 3.11; p = 0.0001) predicted clinical outcomes. Multivariate logistic regression showed that a Gensini score ≥ 32 (Odds ratio [OR] = 1.07; p = 0.001), adropin ≤ 2.15 ng/mL (OR = 1.18; p = 0.001), use of SGLT2i (OR = 0.94; p = 0.010) and GLP-1 receptor agonist (OR = 0.95; p = 0.040) were independent predictors of clinical outcome. Kaplan-Meier plots showed that patients with lower adropin levels (≤2.15 ng/mL) had worse clinical outcomes compared to patients with higher adropin levels (>2.15 ng/mL). In conclusion, low levels of adropin (≤2.15 ng/mL) independently predicted clinical outcomes in post-STEMI patients with newly detected prediabetes and improved the discriminative ability of the Gensini score for 3-year follow-up events. Future clinical studies are needed to clarify whether adropin is a promising molecule to be incorporated into conventional risk scores for the prediction of MACCEs after STEMI.

Prior Advanced Care Planning and Outcomes of Cardiopulmonary Resuscitation in the Emergency Department of a Comprehensive Cancer Center.

Cardiopulmonary resuscitation (CPR) outcomes vary for patients with cancer. Here, we characterized cancer patients who underwent CPR in the emergency department (ED), their outcomes, and the effects of advanced care planning (ACP). The hospital databases and electronic medical records of cancer patients at a comprehensive cancer center who underwent CPR in the ED from 6 March 2016 to 31 December 2022 were reviewed for patient characteristics, return of spontaneous circulation (ROSC), conversion to do-not-resuscitate (DNR) status afterward, hospital and intensive care unit (ICU) length of stay, mortality, cost of hospitalization, and prior GOC discussions. CPR occurred in 0.05% of all ED visits. Of the 100 included patients, 67 patients achieved ROSC, with 15% surviving to hospital discharge. The median survival was 26 h, and the 30-day mortality rate was 89%. Patients with and without prior ACP had no significant differences in demographics, metastatic involvement, achievement of ROSC, or in-hospital mortality, but patients with ACP were more likely to change their code status to DNR and had shorter stays in the ICU or hospital. In conclusion, few cancer patients undergo CPR in the ED. Whether this results from an increase in terminally ill patients choosing DNR status requires further study. ACP was associated with increased conversion to DNR after resuscitation and decreased hospital or ICU stays without an increase in overall mortality.

Acute splenic pathology on CT in patients with babesiosis.

To better understand the occurrence of splenic disease as a potential manifestation of babesiosis by retrospectively estimating the frequency of acute splenic injury on abdominal and pelvic CT in a cohort of patients with active babesia infection. In a search of our single institution, suburban teaching community hospital database, 57 patients were found to have positive babesia infection between the years 2021-2023. 29 of these patients underwent abdominal and pelvic CT (22 with and 7 without intravenous contrast), and 3 underwent abdominal ultrasound without any CT. The imaging was reviewed for the presence or absence of splenic abnormalities, and for follow-up imaging. Parasitemia levels at the time of imaging were also reviewed; parasitemia levels < 4% are associated with mild to moderate disease, whereas parasitemia levels > 4% are associated with severe disease. 21/32 (66%) patients who underwent any type of abdominal imaging (ultrasound, MRI, and CT) had splenomegaly. Of the 22 patients who had IV contrast-enhanced CT scans, 6 were found to have splenic infarction (27%). One of these 22 patients had multiple rounded non-peripheral hypoenhancing foci on both CT and MRI which did not meet criteria for infarction, in association with splenomegaly, and which resolved after treatment. 0/6 patients in the splenic infarction group had parasitemia levels greater than 4%, while 4 of the 16 patients (4/16) without infarction had parasitemia levels of greater than 4%. Our study showed that splenic disease in patients with babesiosis mostly took the form of splenomegaly, and in a substantial minority of patients as splenic infarction. There were no cases of splenic rupture and perisplenic hematoma in our case series, likely reflecting a limitation of the relatively small study size. Concordant with prior studies, we found no identifiable association between parasitemia levels and the presence of splenic infarction.

Cost-effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India.

Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited. The study focused on children (<15years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold. Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5%±7.6% and 27.9%±8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized. The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness.