Initial Body Temperature Research Articles

Body temperature, systemic inflammation and risk of adverse events in patients with acute coronary syndromes.

Inflammatory processes can trigger acute coronary syndromes (ACS) which may increase core body temperature (BT), a widely available low-cost marker of systemic inflammation. Herein, we aimed to delineate baseline characteristics of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS) patients stratified by initial BT and to assess its predictive utility towards major adverse cardiovascular events (MACE) after the index ACS. From 2012 until 2017, a total of 1044 ACS patients, 517 with STEMI and 527 with NSTE-ACS, were prospectively recruited at the University Hospital Zurich. BT was measured by digital tympanic thermometer along with high-sensitivity C-reactive protein (hs-CRP) and cardiac troponin-T (hs-cTnT) levels prior to coronary angiography. Patients were stratified according to initial BT and uni- and multivariable regression models were fit to assess associations of BT with future MACE risk. Among patients with STEMI, BT was not predictive of 1-year MACE, but a U-shaped relationship between BT and MACE risk was noted in those with NSTE-ACS (p = .029), translating into a 2.4-fold (HR, 2.44, 95% CI, 1.16-5.16) increased 1-year MACE risk in those with BT >36.8°C (reference: 36.6-36.8°C). Results remained robust in multivariable-adjusted analyses accounting for sex, age, diabetes, renal function and hs-cTnT. However, when introducing hs-CRP, the BT-MACE association did not prevail. In prospectively recruited patients with ACS, initial BT shows a U-shaped relationship with 1-year MACE risk among those with NSTE-ACS, but not in those with STEMI. BT is a broadly available low-cost marker to identify ACS patients with high inflammatory burden, at high risk for recurrent ischaemic events, and thus potentially suitable for an anti-inflammatory intervention. ClinicalTrials.gov Identifier: NCT01000701.

Surviving a classic heat stroke/hyperthermia > 42 °C – a case report

IntroductionClassic heat stroke is a severe trauma which can lead to multi-organ dysfunctions and is associated with a high mortality.Case presentationIn this case report we present a 73-year-old patient with a classic heat stroke. His initial core body temperature was over 42 °C and he had a GCS of 3. Due to severe burn injuries the patient was transferred to a specialized burn center. The patient developed different organ failures and showed a prolonged course on the intensive care unit. Although the patient demonstrated different impaired organ systems, he recovered completely after receiving painstaking supportive therapy.ConclusionsThis is a rare case of a patient who fully recovered after a heat stroke with a temperature over 42 °C and severe sequelae.

Outcomes and prognosis of postpartum hemorrhage according to management protocol: an 11-year retrospective study from two referral centers

BackgroundNo standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment.MethodsThis retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26).ResultsInitial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively).ConclusionsPatients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.

Temperature trajectories and mortality in hypothermic sepsis patients

ObjectivesHypothermia is associated with poor outcomes in sepsis patients, and hypothermic sepsis patients exhibit temperature alterations during initial treatment. The objective of this study was to classify hypothermic sepsis patients based on body temperature trajectories and investigate the associations of these patients with 28-day mortality. MethodsThis was a retrospective analysis of prospectively collected data from adult sepsis or septic shock patients who visited three emergency departments between August 2014 and December 2019. Hypothermic sepsis was defined as an initial body temperature <36 °C. delta temperature was calculated by subtracting the 0 h body temperature from the 6 h body temperature. We divided the patients into three groups according to delta temperature: Group A (delta temperature ≤ 0), Group B (0 < delta temperature ≤ 1) and Group C (delta temperature > 1). The primary outcome was 28-day mortality, and a multivariable Cox proportional hazards regression model was generated. ResultsAmong 7344 patients with sepsis or septic shock, 325 hypothermic patients were included in the analysis, and the overall mortality rate was 36%. While initial body temperature was not different between survivors and nonsurvivors, survivors exhibited a higher body temperature at 6 h. The 28-day mortality rates for Groups A, B and C were 53.1%, 36.0%, and 30.0%, respectively, and Group A had significantly higher mortality than Group C did (p < 0.05). Group C demonstrated a 44.2% decrease in 28-day mortality compared to Group A (adjusted hazard ratio of 0.558; 95% confidence interval of 0.330–0.941). ConclusionsIn hypothermic sepsis patients, an increase of 1 °C or more in body temperature after the initial 6 h is associated with a reduced risk of 28-day mortality.

Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients.

To determine the association between spontaneous hypothermia (SH), defined as initial post-resuscitation core body temperature less than 34°C, and diffuse anoxic brain injury (DABI) on initial CT scan of the head (CTH) in post-cardiac arrest patients. This was a retrospective, observational cohort study. This study was performed at the University of Rochester Medical Center Strong Memorial Hospital. All in-hospital and out-of-hospital cardiac arrest patients with return of spontaneous circulation admitted between January 1, 2022, and October 31, 2022, were included. The primary outcomes were the odds of DABI on initial CTH for patients with SH compared with patients without SH post-cardiac arrest using a multivariable logistic regression controlling for patient covariates including basic demographics and arrest features. DABI on initial CTH was measured qualitatively and quantitatively using neuroradiologist interpretation and calculated gray-white matter ratio of the basal ganglia, respectively. Secondary outcome measures included length of stay (LOS), inpatient mortality, and those who underwent withdrawal of life-sustaining therapy (WOLST) or progression to brain death. Out of the observed 150 cases of cardiac arrest, 31 patients (21%) had SH. Of the 128 patients who had an initial CTH performed, 27 (21%) had DABI. The adjusted odds ratio of DABI on initial CTH associated with SH was 3.55 (95% CI, 1.08-11.64; p = 0.036) and 2.18 (95% CI, 0.69-6.91; p = 0.182) when DABI was measured qualitatively and quantitatively, respectively, after controlling for multiple covariates. There was a difference observed in LOS between the groups (3 vs. 10 d; p = 0.0005) and this was driven by early WOLST. Patients presenting with SH after cardiac arrest may be at greater risk of early DABI on initial CTH compared with those with higher body temperatures in the post-arrest period. Recognition of early SH may help to risk stratify post-cardiac arrest patients at highest risk of DABI.

Effects of rewarming therapies on outcomes in accidental hypothermia: A secondary analysis of a multicenter prospective study

BackgroundRewarming therapies for accidental hypothermia (AH) include extracorporeal membrane oxygenation (ECMO) and non-ECMO related (conventional) therapies. However, there are limited data available to inform the selection of conventional rewarming therapy. The aim of the present study was to explore what patients' factors and which rewarming therapy predicted favorable prognosis. MethodsThis study is a secondary analysis of the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study, a multicenter prospective, observational study conducted in Japan. Enrolled in the ICE-CRASH study were patients aged ≥18 years with a core temperature of ≤32 °C who were transported to the emergency departments of 36 tertiary care hospitals in Japan between 1 December 2019 and 31 March 2022, among whom those who were rewarmed with conventional rewarming therapy were included in the present study. Logistic regression analysis was performed with 28-day survival as the objective variable; and seven factors including age, activities of daily living (ADL) independence, sequential organ failure assessment (SOFA) score, and each rewarming technique as explanatory variables. We performed linear regression analysis to identify whether each rewarming technique was associated with rewarming rate. ResultsOf the 499 patients enrolled in the ICE-CRASH study, 371 were eligible for this secondary analysis. The median age was 81 years, 50.9% were male, and the median initial body temperature was 28.8 °C. Age (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94–1.00) and SOFA score (OR: 0.73, 95% CI: 0.67–0.81) were associated with lower survival, whereas ADL independence (OR: 2.31, 95% CI: 1.15–4.63) was associated with higher survival. No conventional rewarming therapy was associated with 28-day survival. Hot bath was associated with a high rewarming rate (regression coefficient: 1.14, 95% CI: 0.75–1.53). ConclusionNo conventional rewarming therapy was associated with improved 28-day survival, which suggests that background factors such as age, ADL, and severity of condition contribute more to prognosis than does the selection of rewarming technique.

Association between the severity of hypothermia and in-hospital mortality in patients with infectious diseases: The J-Point registry.

Hypothermia is associated with poor prognosis in patients with sepsis. However, no studies have explored the correlation between the severity of hypothermia and prognosis. Using data from the Japanese accidental hypothermia network registry (J-Point registry), we examined adult patients aged ≥18 years with infectious diseases whose initial body temperature was ≤35°C from April 1, 2011 to March 31, 2016, in 12 centers. Patients were divided into three groups according to their body temperature: Tertile 1 (T1) (32.0-35.0°C), Tertile 2 (T2) (28.0-31.9°C), and Tertile 3 (T3) (<28.0°C). In-hospital mortality was employed as a metric to assess outcomes. We conducted a multivariate logistic regression analysis to investigate the relationship between the three categories and the occurrence of in-hospital mortality. A total of 572 patients were registered, and 170 eligible patients were identified. Of these patients, 55 were in T1 (32.0-35.0°C), 76 in T2 (28.0-31.9°C), and 39 in T3 (<28.0°C) groups. The overall in-hospital mortality rate in accidental hypothermia (AH) patients with infectious diseases was 34.1%. The in-hospital mortality rates in the T1, T2, and T3 groups were 34.5%, 36.8%, and 28.2%, respectively. The multivariable analysis demonstrated no significant differences regarding in-hospital mortality among the three groups (T2 vs. T1, adjusted odds ratio [OR]: 1.29; 95% confidence interval [CI]: 0.58-2.89 and T3 vs. T1, adjusted OR: 0.83; 95% CI: 0.30-2.31). In this multicenter retrospective observational study, hypothermia severity was not associated with in-hospital mortality in AH patients with infectious diseases.

Body temperature as a predictor of mortality in COVID-19

It remains uncertain if body temperature (BT) is a useful prognostic indicator in coronavirus disease 2019 (COVID-19). We investigated the relationship between BT and mortality in COVID-19 patients. We used a de-identified database that prospectively collected information from patients screened for COVID-19 at the Mount Sinai facilities from February 28, 2020 to July 28, 2021. All patients diagnosed with COVID-19 that had BT data were included. BT at initial presentation, maximum BT during hospitalization, comorbidity, and vaccination status data were extracted. Mortality rate was assessed as a primary outcome. Among 24,293 cases, patients with initial BT below 36 °C had higher mortality than those with BT of 36–37 °C (p < 0.001, odds ratio 2.82). Initial BT > 38 °C was associated with high mortality with an incremental trend at higher BT. In 10,503 in-patient cases, a positive association was observed between mortality and maximum BT except in patients with BT < 36 °C. Multiple logistic regression analyses including the comorbidities revealed that maximum BT was an independent predictor of mortality. While vaccination did not change the distribution of maximum BT, mortality was decreased in vaccinated patients. Our retrospective cohort study suggests that high maximum BT is an independent predictor of higher mortality in COVID-19 patients.

Spinal epidural abscess as predicting factor for the necessity of early surgical intervention in patients with pyogenic spondylitis

BackgroundPyogenic spondylitis is a condition with low incidence that can lead to neurological sequelae and even life-threatening conditions. While conservative methods, including antibiotics and bracing, are considered the first-line treatment option for pyogenic spondylitis, it is important to identify patients who require early surgical intervention to prevent progressive neurologic deficits or deterioration of the systemic condition. Surgical treatment should be considered in patients with progressive neurologic deficits or deteriorating systemic condition. However, currently, there is a lack of treatment guidelines, particularly with respect to whether surgical treatment is necessary for pyogenic spondylitis. This study aims to analyze the radiological epidural abscess on MRI and clinical factors to predict the need for early surgical intervention in patients with pyogenic spondylitis and provide comprehensive insight into the necessity of early surgical intervention in these patients.MethodsThis study retrospectively reviewed 47 patients with pyogenic spondylitis including spondylodiscitis, vertebral osteomyelitis, epidural abscess, and/or psoas abscess. All patients received plain radiographs, and a gadolinium-enhanced magnetic resonance imaging (MRI) scan. All patients have either tissue biopsies and/or blood cultures for the diagnosis of a pathogen. Demographic data, laboratory tests, and clinical predisposing factors including comorbidities and concurrent other infections were analyzed.ResultsWe analyzed 47 patients, 25 of whom were female, with a mean age of 70,7 years. MRI revealed that 26 of 47 patients had epidural abscesses. The surgical group had a significantly higher incidence of epidural abscess than the non-surgical group (p = 0.001). In addition, both CRP and initial body temperature (BT) were substantially higher in the surgical group compared to the non-surgical group. There was no significant difference between the surgical group and the non-surgical group in terms of age, gender, comorbidities, and concurrent infectious disorders, as well as the number of affected segments and affected spine levels. However, the surgical group had lengthier hospital stays and received more antibiotics.ConclusionThe presence of an epidural abscess on MRI should be regarded crucial in the decision-making process for early surgical treatment in patients with pyogenic spondylitis in order to improve clinical outcomes.

539 Contact Burns Associated with Concomitant use of Methamphetamines and Heat Stroke, Resulting in Neurological Sequela

Abstract Introduction On a summer day in the desert southwest, ground surfaces can soar to 180 degrees Fahrenheit, posing significant risk to individuals who sustain contact with such surfaces, particularly if unable to get up. These individuals are also at risk for heat stroke. This summer, an increased number of patients admitted with contact burns were positive for methamphetamine and concomitant heat stroke. The purpose of this case series is to describe the hospital course and outcomes of this subset of patients. Methods A retrospective chart review of patients admitted between June and September 2022 was completed. Criteria for inclusion included contact burn, initial core body temperature &amp;gt; 38.8°C, and a methamphetamine positive drug screen. Outcome measures included length of stay, discharge disposition, number of operations, admission Glasgow Coma Score, neurology work-up and sequela. Results A total of 23 patients were admitted who suffered contact burns and tested positive for methamphetamine. Ten of those patients had core body temperatures greater than 38.8°C upon initial evaluation. The mean age was 36.6 years (24-62), with an average temperature of 42.3°C (40.5-43.1°. All 10 were found down in the community with altered mental status, the average Glasgow Coma Scale was 5.9 (3- 12). CT scans were done on 9, all were negative for acute intracranial abnormalities. Neurology was consulted for 3 patients with 2 having EEGs performed, both displayed slowing and attenuation secondary to hyperthermia. Ten of these patients were concurrently positive for fentanyl. The mean total burn surface area burned was 9.6% (4-17.5%), The average number of operations was 4.1/patient (1-11). Of the 8 patients discharged the average LOS was 30 days (10-61), 2 patients remain hospitalized in the ICU with a current LOS of 61-71 days. Of the 8 patients discharged, all required post-acute care with only 1 meeting rehabilitation criteria. Conclusions Elevated temperatures in the Southwestern United States have been known to cause an increase in surface-related contact burns during the summer months. Historically, the at-risk patient population has been elderly individuals prone to falls with limited physical ability to get up. This summer highlighted a new phenomenon of younger individuals suffering both contact burns and heat stroke secondary to the combination of methamphetamine use and elevated summer temperatures. This patient population suffered significant morbidity, and none were able to be discharged home. This case series highlights the dangers posed by ambiently heated surfaces during the summer months, particularly in combination with illicit drug use. Applicability of Research to Practice This case series, demonstrates the increased risk of sequela associated with burn patients who have comorbid substance abuse disorder.

A CFD Analysis of Core Temperature for Different Durian Paste Packages Layouts during Air-Blast Freezing

Food freezing is a process of crystallising the water particles inside the food and turning it into ice. One of the rapid freezing techniques is known as air-blast freezing. It is a process that rapidly freezes products from chilled or ambient temperature to their desired temperature instantly. SOLIDWORKS Flow Simulation is utilised in this project to analyse the core temperature change for five different durian paste package layouts during the air-blast freezing. There are L1 horizontally single stacked, L2 horizontally double stacked, L3 vertically stacked, L4 fin-like stacked without gaps and L5 fin-like stacked with 3.925 mm gaps. All layouts have a fixed number of 90 durian paste packages per run to ensure consistent and accurate results. These combinations have an initial body temperature of 26°C and were simulated for 240 minutes under an air temperature of -30°C. According to the simulation results, L5 achieved the fastest freezing speed among all five layouts, with a core temperature of 26°C dropping to -20°C in 90 minutes, followed by L3 in 140 minutes, L1 in 150 minutes. Moreover, L5 gives a more evenly distributed temperature around all surfaces with a maximum core temperature after 240 minutes of freezing as it has a higher total surface area to volume ratio, which results in more surface area exposure to cool air. Therefore, L5 fin like-stacked with gaps in between has shown to have more uniform and consistent freezing and advantage in terms of freezing speed.

WRIST WITH SYNOVIAL WHITE BLOOD CELLS: SEPTIC VERSUS SUSPECTED INFECTIOUS ARTHRITIS

Purpose: Accurate diagnosis of acute painful swollen wrists can be difficult. We aimed to identify the differentiating clinical and laboratory parameters for septic and suspected infectious arthritis of the wrist. Methods: This retrospective study reviewed and compared the data of 49 patients (55 wrists) with synovial fluid white blood cell (WBC) counts ¿20,000/mm3. 25 patients with 29 septic wrists with positive staining or culture results, and 24 patients with 26 suspected infectious wrists. Results: Patients with suspected infection underwent fewer operations (1.0 versus 2.1 times) and required shorter periods of hospitalization (34.0 versus 49.7 days) than those with septic wrists. C-reactive protein (CRP) levels before treatment, and postoperative day five for suspected infectious arthritis were lower than those for septic arthritis. Diabetes was more prevalent in patients with septic arthritis (13/25) than those with suspected infection (2/24). However, the average synovial WBC count and average highest temperature before treatment were not different between the two groups. Conclusions: Patients with suspected infectious wrists had lower initial CRP levels and a lower prevalence of diabetes. However, the initial synovial WBC count and body temperature were similar, implying that the initial management of suspected arthritis should be similar to that of septic arthritis.

Forecasting Hospital Visits Due to Influenza Based on Emergency Department Visits for Fever: A Feasibility Study on Emergency Department-Based Syndromic Surveillance.

This study evaluated the use of chief complaint data from emergency departments (EDs) to detect the increment of influenza cases identified from the nationwide medical service usage and developed a forecast model to predict the number of patients with influenza using the daily number of ED visits due to fever. The National Health Insurance Service (NHIS) and the National Emergency Department Information System (NEDIS) databases from 2015 to 2019 were used. The definition of fever included having an initial body temperature ≥ 38.0 °C at an ED department or having a report of fever as a patient’s chief complaint. The moving average number of visits to the ED due to fever for the previous seven days was used. Patients in the NHIS with the International Classification of Diseases-10 codes of J09, J10, or J11 were classified as influenza cases, with a window duration of 100 days, assuming the claims were from the same season. We developed a forecast model according to an autoregressive integrated moving average (ARIMA) method using the data from 2015 to 2017 and validated it using the data from 2018 to 2019. Of the 29,142,229 ED visits from 2015 to 2019, 39.9% reported either a fever as a chief complaint or a ≥38.0 °C initial body temperature at the ED. ARIMA (1,1,1) (0,0,1)7 was the most appropriate model for predicting ED visits due to fever. The mean absolute percentage error (MAPE) value showed the prediction accuracy of the model. The correlation coefficient between the number of ED visits and the number of patients with influenza in the NHIS up to 14 days before the forecast, with the exceptions of the eighth, ninth, and twelfth days, was higher than 0.70 (p-value = 0.001). ED-based syndromic surveillances of fever were feasible for the early detection of hospital visits due to influenza.

Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures.

PurposeTo investigate the different impact of delayed administration of appropriate antimicrobial therapy (AAT) on short-term mortality of bacteraemia patients initially presenting with various body temperatures (BTs).Materials and MethodsA six-year, two-center cohort consisting of adults with community-onset bacteraemia in emergency departments (EDs) was retrospectively collected. Through the multivariable analyses, clinical impacts of delayed AAT, assessed by the time gap between the first dose of AAT and ED arrival, on 30-day mortality (primary outcomes) were respectively examined in the different groups of initial BTs (iBTs).ResultsOf the 3171 adults, despite the similarities of delayed AAT in six iBT categories, hourly AAT delay was associated with an average increase in 30-day mortality rates of 0.24% in the group of iBT <36.0℃, 0.40% in the 36.0℃–36.9℃ group, 0.48% in the 37.0℃–37.9℃ group, 0.59% in the 38.0℃–38.9℃ group, 0.58% in the 39.0℃–39.9℃ group, and 0.71% in the ≥40.0℃ group, after respective adjusting independent predictors of mortality. Furthermore, for 589 patients who inappropriately received empirical antimicrobial treatment (ie, delayed AAT ≥ 24 hours), with a cutoff of 34.0℃, each 1℃ increase in iBTs was independently associated with an average increase in 30-day mortality rates of 42%.ConclusionFor adults with community-onset bacteraemia, the iBT-related differences in the prognostic impacts of delayed administration of appropriate antimicrobials might be evident.

Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan)

BackgroundThe association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA).MethodsFrom the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0–36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis.ResultsOf the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27–0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56–1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes.ConclusionsIn adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.

Study of association and significance of hyponatremia in patients with lower respiratory tract infection (LRTI)

Introduction: Pneumonia, the severe form of lower respiratory tract infection (LRTI) is one of the most important causes of morbidity and mortality in children especially from the developing nations. Pneumonia is the infection and associated inflammation of the lung parenchyma. Pneumonia is the leading infectious killer of under 5 children claiming more lives than any other diseases. The burden is more in the developing nations. Around 15% of under 5 mortality is attributed to pneumonia. Hyponatremia is a common electrolyte imbalance which occurs in children with pneumonia. Many studies have reported the incidence of hyponatremia around 40 to 45%. Aim &amp; Objective-: To see the frequency of hyponatremia in patients with LRTI &amp; its significance in relation to disease severity. Materials &amp; Methods: It was a hospital based observational study. The study has been conducted in the Department of pediatrics, S C B Medical college hospital &amp; SVPPPGIP, Cuttack. Result: Hyponatremia was a frequent finding in children with bronchopneumonia (44.6%). Patients with hyponatremia group had initial high body temperature in present study (101.9ºc vs99.7). Conclusion: There is importance of measuring serum electrolytes in patients with LRTI. Appropriate fluid should be done in case of LRTI.

A Model of Combined Exposure to Nicotine and Tetrahydrocannabinol via Electronic Cigarettes in Pregnant Rats.

Nicotine and cannabis are two of the most commonly consumed licit and illicit drugs during pregnancy, often consumed together via e-cigarettes. Vaping is assumed to be a safer alternative than traditional routes of consumption, yet the potential consequences of prenatal e-cigarette exposure are largely unknown, particularly when these two drugs are co-consumed. In a novel co-exposure model, pregnant Sprague-Dawley rats received nicotine (36 mg/mL), tetrahydrocannabinol (THC) (100 mg/mL), the combination, or the vehicle via e-cigarettes daily from gestational days 5–20, mimicking the first and second human trimesters. Maternal blood samples were collected throughout pregnancy to measure drug and metabolite levels, and core body temperatures before and after exposure were also measured. Pregnant dams exposed to combined nicotine and THC had lower plasma nicotine and cotinine levels than those exposed to nicotine alone; similarly, the combined exposure group also had lower plasma THC and THC metabolite (THC-OH and THC-COOH) levels than those exposed to THC alone. Prenatal nicotine exposure gradually decreased initial core body temperatures each day, with chronic exposure, whereas exposure to THC decreased temperatures during the individual sessions. Despite these physiological effects, no changes were observed in food or water intake, weight gain, or basic litter outcomes. The use of this model can help elucidate the effects of co-exposure to THC and nicotine via e-cigarettes on both users and their offspring. Understanding the effects of co-use during pregnancy is critical for improving education for pregnant mothers about prenatal e-cigarette use and has important implications for public policy.

Real-World Efficacy of Regdanvimab on Clinical Outcomes in Patients with Mild to Moderate COVID-19.

Background: This study aims to evaluate the real-world effectiveness of regdanvimab on clinical outcomes in patients with mild to moderate coronavirus disease 2019 (COVID-19). Methods: This retrospective observational study included 152 patients (89 received regdanvimab and 63 did not) diagnosed with mild to moderate COVID-19 between August 2021 and October 2021 and admitted to Armed Forces Goyang Hospital. We collected information on the use of regdanvimab, remdesivir, dexamethasone, and supplemental oxygen; symptom severity score (SSS); and laboratory test results. A linear mixed-effects model was used to test the effectiveness of regdanvimab usage on SSS and the results of laboratory tests. A multivariate logistic regression model was used to calculate the odds ratio (OR) for additional therapeutic options, such as remdesivir, dexamethasone, and supplemental oxygen. Results: The patients who received regdanvimab were older, showed a higher rate of vaccination, and had a higher Charlson comorbidity index, initial body temperature, and percentages of pneumonia at admission. The use of regdanvimab showed no interactive effects on the SSS and laboratory findings. Older age, male sex, obesity, high initial body temperature, and the presence of pneumonia at admission were associated with increased ORs for the use of these additional treatments. The use of regdanvimab reduced the probability of requiring additional therapies such as remdesivir, dexamethasone, and oxygen supplementation by 90.3% (95% confidence interval (CI), 60.3–97.6), 85.8% (95% CI, 34.2–96.9), and 89.8% (95% CI, 48.3–98), respectively. Conclusions: Regdanvimab usage was well tolerated and was associated with a decreased probability of requiring remdesivir, dexamethasone, and oxygen therapy. However, changes in SSS were not significantly different by the drug usage.

Effect of different combinations of initial body temperature and target temperature on neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted temperature management

We hypothesized that different combinations of initial and target temperatures during targeted temperature management (TTM) may be associated with neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. Adult patients with OHCA who underwent TTM were enrolled. The study participants were divided into four groups: lower initial body temperature and lower target temperature (Low-Low group), lower initial body temperature and higher target temperature (Low-High group), higher initial body temperature and lower target temperature (High-Low group), and higher initial body temperature and higher target temperature (High-High group). Initial body temperature was dichotomized based on the median value (35.6 ◦C) as a cutoff, and the target temperature was dichotomized with a target temperature of 34 ◦C as a cutoff. The primary outcome was defined as a favorable 28-day neurological outcome. In total, 231 patients were included in the analysis, and 74 (32.0%), 43 (18.6%), 82 (35.5%), and 32 (13.9%) patients were classified into the Low-Low, Low-High, High-Low, and High-High groups, respectively. The proportion of patients with favorable 28-day neurological outcomes differed among the study groups (Low-Low, 14 (18.9%); Low-High, 7 (16.3%); High-Low, 37 (45.1%); High-High, 11 (34.4%); p = 0.001). In the multivariable analysis, the Low-High group was independently associated with a less favorable 28-day neurological outcome compared to the High-Low group (adjusted odds ratio, 0.22; 95% confidence interval, 0.06–0.91; p = 0.036). In conclusion, higher initial body temperature and lower target temperature during TTM were independently associated with a more favorable 28-day neurological outcome compared to the lower initial body temperature and higher target temperature in patients resuscitated from OHCA of medical etiology.

Доклиническая оценка лечения на модели хронического остеомиелита у кроликов

Introduction. Chronic osteomyelitis is one of the problems in orthopedic surgery. Recently, in the treatment of chronic osteomyelitis, biodegradable materials are increasingly used as a local antibiotic carrier. In our study, we used bone allograft, which prepared by Marburg system. The purpose of the study was to evaluate preclinical changes of use the antibiotic-impregnated bone allograft on osteomyelitis model in rabbit. Materials and methods. Osteomyelitis was caused in rabbits by the human strain Staphylococcus aureus, which is introduced into bone defects created in the distal femur. Three groups were selected depending on the filling: group 1 - antibiotic impregnated biodegradable material “PerOssal”, group 2 –whole bone allograft soaked in antibiotic, group 3 - perforated bone allograft soaked in antibiotic. We used a clinical examination for the evaluating decreasing of chronic osteomyelitis process.Results. The body temperature of all experimental animals was measured with a non-contact thermometer during the entire observation period, which was 42 days. The average temperature in rabbits in groups before surgery was 36.90 in-group 1; in-group 2 - 36.40; in-group 3 - 36.20. On the first day after the operation, in groups 1 and 3, there was no significant difference with the initial body temperature in rabbits before the operation, while in-group 2, the body temperature on the first day after the operation was 39.00. In the early postoperative period, the maximum increase in body temperature is observed on the 3rd day in-group 1 up to 39.20 and in-group 3 38.20. In-group 2, the maximum rise in temperature was on the 2nd day after surgery up to 38.60. The average weight in operated rabbits before surgery was 2983.3 g in-group 1; in-group 2 - 3206.7 gr; in-group 3 - 2300.0 gr. In the 1st group in the postoperative period in the 1st group there is a deficit on the early postoperative day amounted to 1.3 g in dynamics decreased up to 5 days and then there was a stable increase in weight, which in general by the 42nd day was 783, 4 grams. In-group 2, on the first day, there was a maximum body weight deficit of up to 92.3 g, with a subsequent increase, and in general, for the entire observation period, the increase was 200 g. In-group 3, on the first postoperative day, the body weight deficit was 13.9 grams. In the dynamics, there was a slight instability in weight, for example, on day 5, body weight was 3284.6 g, with a decrease on day 6 to 3169.2 g. Visually assessing the wound in-group 1, wound suppuration, divergence or instability of the sutures were not noted. In-group 3, on the 28th day after the operation, there was a slight infiltration of soft tissues in the area after the surgical wound. In the 2nd group on the 14th day there was a slight infiltration of soft tissues in the area after the surgical wound, and on the 28th and 42nd days there was suppuration of the postoperative wound.Conclusion. Thus, in this study we showed, that perforated bone allograft is an available biomaterial can be used in bone regenerative surgery.Key words: Preclinical evaluation algorithm, chronic osteomyelitis, rabbits model, preclinical study