Life-saving Treatment Research Articles

Acute transfusion reactions in a district hospital: A 2-year retrospective review

Background: Blood transfusion is a life-saving intervention but carries numerous risks. It is therefore paramount to identify various adverse events associated with the procedure and to take stringent measures to reduce its occurrence. The aim of this study was to determine the incidence and analyse the type of acute transfusion reactions occurring in patients who required blood transfusion. Materials and Methods: This study was a retrospective review and analysis of all acute transfusion reactions reported to the blood bank of Methodist Hospital, Wenchi-Ghana from January 2021 to December 2022. Results: During the study period, a total of 5,857 units of blood were issued, out of which there was an incidence of 0.51% (n=30). Most acute transfusion reactions were observed in females and in patients between 26 – 45 years. The most common symptom was pruritus/itching (33.3%), followed by skin rash (23.3%) and urticaria (13.3%). Majority of the reactions were allergic (70%) followed by Febrile non-hemolytic transfusion reaction (20%). The frequency of transfusion reactions was significantly higher with packed red blood cell transfusion (50%). Conclusion: Sensitization of all health personnel involved in the transfusion chain and strict hemovigilance program enforcement will help in improving the safety of blood transfusion.

The Evolution and Complications of Long-Term Mechanical Circulatory Support Devices

Heart failure, a common clinical syndrome caused by functional and structural abnormalities of the heart, affects 64 million people worldwide. Long-term mechanical circulatory support can offer lifesaving treatment for end-stage systolic heart failure patients. However, this treatment is not without complications. This review covers the major complications associated with implantable mechanical circulatory support devices, including strokes, pump thrombosis and gastrointestinal bleeding. These complications were assessed in patients implanted with the following devices: Novacor, HeartMate XVE, CardioWest, Jarvik 2000, HeartMate II, EVAHEART, Incor, VentrAssist, HVAD and HeartMate 3. Complication rates vary among devices and remain despite the introduction of more advanced technology, highlighting the importance of device design and flow patterns. Beyond clinical implications, the cost of complications was explored, highlighting the difference in costs and the need for equitable healthcare, especially with the expected rise in the use of mechanical circulatory support. Future directions include continued improvement through advancements in design and technology to reduce blood stagnation and mitigate high levels of shear stress. Ultimately, these alterations can reduce complications and enhance cost-effectiveness, enhancing both the survival and quality of life for patients receiving mechanical circulatory support.

Few-shot meta-learning for pre-symptomatic detection of Covid-19 from limited health tracker data

Detecting (or screening for) Covid-19 even before symptoms fully manifest, could enable patients to receive timely and life-saving treatment. Prior work has demonstrated that heart rate and step data from low-end wearables analyzed using deep learning models can detect Covid-19 reliably. However, significant individual differences in vital sign manifestation (high inter-subject variability) present a challenge to the generalization of deep learning models across diverse users. The limited amount of data in many medical scenarios further exacerbates this issue. Consequently, neural network models that can learn from limited vital sign data and varied inter-subject patterns are compelling. Meta-learning has emerged as a powerful technique for tackling various machine learning challenges, including insufficient data, domain shifts across datasets, and issues with generalization. This study proposes MetaCovid, a deep adaptation framework that employs meta-learning to address the variability of vital sign manifestation between subjects using only two days of data in order to detect Covid-19 before symptoms manifest. MetaCovid leverages heart rate and step measurements collected from consumer-grade health trackers over the preceding 2 days, extracts 45 digital bio-markers (features), which along with raw data, are fed into a deep GRU-based network with an attention mechanism, followed by uncertainty filtering. MetaCovid is trained using OC-MAML, a one-class few-shot MAML variant that adapts to the target distribution/user using only samples from the majority class. MetaCovid generalized well across two relatively small, publicly available Covid-19 datasets, achieving a recall of 0.81 and 0.92, and detecting 61% (14 out of 23) and 50% (17 out of 34) of users infected with Covid-19 before symptom onset. When OC-MAML was excluded from MetaCovid in an ablation study, the F2 score dropped by 36%, highlighting that meta-learning indeed facilitates adaptation of deep sensing models to varying vital sign patterns. Notably, MetaCovid outperforms the current state-of-art method by predicting Covid-19 early on day N using heart rate and step measurements from only the preceding 2 days compared to 28 days, reducing data requirements by 93%. To the best of our knowledge, our study is the first to propose utilizing meta-learning to mitigate vital sign variability with limited data for Covid-19 screening. We believe that MetaCovid will pave the way for innovative Covid-19 interventions that are accurate even with limited data and help contain the spread of infectious diseases in the future.

Potentially lifesaving treatment of severe postnatal depression

Potentially lifesaving treatment of severe postnatal depression

Political context of the European vaccine debate on Twitter

At the beginning of the COVID-19 pandemic, fears grew that making vaccination a political (instead of public health) issue may impact the efficacy of this life-saving intervention, spurring the spread of vaccine-hesitant content. In this study, we examine whether there is a relationship between the political interest of social media users and their exposure to vaccine-hesitant content on Twitter. We focus on 17 European countries using a multilingual, longitudinal dataset of tweets spanning the period before COVID, up to the vaccine roll-out. We find that, in most countries, users’ endorsement of vaccine-hesitant content is the highest in the early months of the pandemic, around the time of greatest scientific uncertainty. Further, users who follow politicians from right-wing parties, and those associated with authoritarian or anti-EU stances are more likely to endorse vaccine-hesitant content, whereas those following left-wing politicians, more pro-EU or liberal parties, are less likely. Somewhat surprisingly, politicians did not play an outsized role in the vaccine debates of their countries, receiving a similar number of retweets as other similarly popular users. This systematic, multi-country, longitudinal investigation of the connection of politics with vaccine hesitancy has important implications for public health policy and communication.

Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools

BackgroundMajor incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients—those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have...

Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital

BackgroundDisparities in life-saving interventions for low-income patients with cirrhosis necessitate innovative models of care.AimTo implement a novel generalist-led FLuid ASPiration (FLASP) clinic to reduce emergency department (ED) care for refractory ascites.SettingA large safety net hospital in Los Angeles.ParticipantsMediCal patients with paracentesis in the ED from 6/1/2020 to 1/31/2021 or in FLASP clinic or the ED from 3/1/2021 to 4/30/2022.Program DescriptionAccording to RE-AIM, adoption obtained administrative endorsement and oriented ED staff. Reach engaged ED staff and eligible patients with timely access to FLASP. Implementation trained FLASP clinicians in safer, guideline-based paracentesis, facilitated timely access, and offered patient education and support.Program EvaluationAfter FLASP clinic opened, significantly fewer ED visits were made by patients discharged after paracentesis [rate ratio (RR) of 0.33 (95% CI 0.28, 0.40, p < 0.0001)] but not if subsequently hospitalized (RR = 0.88, 95% CI 0.70, 1.11). Among 2685 paracenteses in 225 FLASP patients, complications were infrequent: 39 (1.5%) spontaneous bacterial peritonitis, 265 (9.9%) acute kidney injury, and 2 (< 0.001%) hypotension. FLASP patients rated satisfaction highly on a Likert-type question.DiscussionPatients with refractory ascites in large safety net hospitals may benefit from an outpatient procedure clinic instead of ED care.

Safety and Effect on Intracranial Pressure of 3% Hypertonic Saline Bolus Via Peripheral Intravenous Catheter for Neurological Emergencies.

Elevated intracranial pressure (ICP) is a neurological emergency in patients with acute brain injuries. Such a state requires immediate and effective interventions to prevent potential neurological deterioration. Current clinical guidelines recommend hypertonic saline (HTS) and mannitol as first-line therapeutic agents. Notably, HTS is conventionally administered through central venous catheters (CVCs), which may introduce delays in treatment due to the complexities associated with CVC placement. These delays can critically affect patient outcomes, necessitating the exploration of more rapid therapeutic avenues. This study aimed to investigate the safety and effect on ICP of administering rapid boluses of 3% HTS via peripheral intravenous (PIV) catheters. A retrospective cohort study was performed on patients admitted to Sisters of Saint Mary Health Saint Louis University Hospital from March 2019 to September 2022 who received at least one 3% HTS bolus via PIV at a rate of 999mL/hour for neurological emergencies. Outcomes assessed included complications related to 3% HTS bolus and its effect on ICP. Of 216 3% HTS boluses administered in 124 patients, complications occurred in 8 administrations (3.7%). Pain at the injection site (4 administrations; 1.9%) and thrombophlebitis (3 administrations; 1.4%) were most common. The median ICP reduced by 6mm Hg after 3% HTS bolus administration (p < 0.001). Rapid bolus administration of 3% HTS via PIV catheters presents itself as a relatively safe approach to treat neurological emergencies. Its implementation could provide an invaluable alternative to the traditional CVC-based administration, potentially minimizing CVC-associated complications and expediting life-saving interventions for patients with neurological emergencies, especially in the field and emergency department settings.

ECMOve: A Mobilization Device for Extracorporeal Membrane Oxygenation Patients.

Extracorporeal membrane oxygenation (ECMO) is a temporary lifesaving treatment for critically ill patients with severe respiratory or cardiac failure. Studies demonstrated the feasibility of in-hospital mobilizing during and after ECMO treatment preventing neuromuscular weakness and impaired physical functioning. Despite more compact mobile ECMO devices, implementation of ambulatory ECMO remains labor-intensive, complex, and challenging. It requires a large multidisciplinary team to carry equipment, monitor and physically support the patient, and to provide a back-up wheelchair in case of fatigue. Moreover, there is no adequate solution to ensure the stability of the patient's cannula and circuit management during ambulation. We developed a system contributing to improvement and innovation of current ambulatory ECMO patient programs. Our modular cart-in-cart system carries necessary ECMO equipment, features an extendable walking frame, and contains a folding seat for patient transport. An adjustable shoulder brace with lockable tubing-connectors enables safe fixation of the blood tubing. ECMOve provides safety, support, and accessibility while performing ambulatory ECMO for both patient and caregiver. Prototype evaluation in a simulated intensive care unit showed feasibility of our design, but needs to be evaluated in clinical care.

Nursing care of the recumbent canine patient after ventral slot surgery

Ventral slot surgery may be required in canine patients with intervertebral disc (IVD) herniation in the cervical spine. Causes of IVD herniation include trauma, neoplasia and discospondylitis. Herniation results in displacement of disc material into the vertebral canal, causing damage to or inflammation of the spinal cord. Patients can initially appear with varied presentations, from pain to recumbency. Management of the postoperative patient requires intensive monitoring and nursing care. Assessing the progression or deterioration of these patients is vital to allow further and potentially life-saving interventions to be implemented. Nursing care can include pain assessment and management; bladder management, such as expression and assisted posturing; exercise rehabilitation to allow return to normal movement; stress reduction, such as interaction; and enrichment and nutritional management, such as assisted feeding. This article discusses how these patients present, surgical interventions, assessment, post-anaesthetic recovery and ongoing monitoring. Postoperative complications are also discussed, along with how to identify these complications and what nursing care to implement for the benefit of the patient and its recovery.

A288 ALCOHOL RELAPSE AND ADVERSE OUTCOMES IN EARLY VERSUS ROUTINE LIVER TRANSPLANT FOR ALCOHOL-ASSOCIATED LIVER DISEASE IN THE PROVINCE OF BRITISH COLUMBIA

Abstract Background Liver transplant is a life-saving treatment for patients with alcohol-associated liver disease (ALD) resulting in decompensated cirrhosis or severe alcoholic hepatitis, significantly reducing mortality compared to supportive treatment. Despite its previous wide acceptance, there is a lack of strong evidence to justify a 6-month abstinence period. In 2019, BC Transplant policies were updated to allow liver transplant within 6-months of alcohol use in carefully selected patients with limited life expectancy and favorable multidisciplinary psychosocial assessment. Aims This study aims to assess alcohol relapse rates and adverse outcomes in patients who received an early liver transplant for ALD. Methods A retrospective chart review was performed on all adult patients who underwent liver transplant in the province of British Columbia between January 1, 2020, and December 31, 2022. Follow up data was extracted until May 31, 2023. Patients were included if they had alcohol documented as a contributing factor to their liver disease prior to transplant. Early transplant was defined as alcohol abstinence of 179-days or less and routine transplant as 180-days or more. Alcohol use and time to alcohol use were determined by patient history, random biochemical testing, and health-care utilization for an alcohol-associated complication. Graft dysfunction or rejection resulting in a change in therapeutic management, noncompliance determined by clinician documentation, rehospitalization, and death were recorded as adverse events. Results 278 patients underwent liver transplant during the study period. 81 patients were classified as alcohol-related, and 15 received early transplant. The mean follow-up period was 20.5 months. Early transplant recipients were more likely to be younger (median 45 vs. 58 years, p = 0.003) and have a higher MELD score at the time of transplant (median 37 vs. 17, p ampersand:003C 0.001). There was no significant difference in post-transplant alcohol relapse (13 vs. 15%, hazard ratio = 0.78, 95% CI [0.17, 3.55], p = 0.74). Graft dysfunction was increased in patients who received early transplant (53 vs. 25%, relative risk = 2.17, 95% CI [1.15, 4.10]). There was no significant difference between rates of noncompliance (0 vs. 9%), rehospitalization (53 vs. 56%), or death (0 vs. 2%). Conclusions Alcohol relapse is similar between early and routine liver transplant. Graft dysfunction is increased in early transplant, although other adverse events including medication noncompliance, rehospitalization, and death are not significant different. These results are favorable for the continued use of early liver transplant for ALD, providing an effective treatment for ALD and significantly reducing mortality in patients with a limited life expectancy. Funding Agencies None

BILATERAL SEROUS RETINAL DETACHMENT AS OCULAR MANIFESTATION IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT

Introduction : Acute lymphoblastic leukemia (ALL) is known to cause several ocular involvements. However, retinal detachment is a rare complication. This report aims to present unusual ocular manifestations in the form of bilateral serous retinal detachment in a pediatric patient.&#x0D; Case Illustration : An 11-year-old girl with a diagnosis of relapsed ALL and thrombocytopenia was referred to the Ophthalmology Department due to sudden blurred vision. The patient was undergoing chemotherapy on the third cycle due to the relapse. Visual acuity was 1/300 in both eyes. Fundus examination showed bilateral serous retinal detachment. No treatment in ophthalmology was given due to the unstable condition of this patient.&#x0D; Discussion : Up to 90% of all leukemia patients have fundus changes during the disease. The presence of unilateral or bilateral serous retinal detachment as a sign of choroidal infiltration may be one of the manifestations of acute leukemia, both as a primary sign and a relapse. Literature has shown that chemotherapy, radiation, and systemic prednisone would improve the visual acuity in these patients. However, in this case, when the patient is unstable and experiencing a series of complications, we decided that life-saving treatment comes first.&#x0D; Conclusion : The incidence of ocular involvements in ALL could be due to the treatment and the disease itself. Prompt recognition of disease led to early systemic treatment and restoration of visual function. The goal of sight-saving comes second after life-saving treatments.

Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic.

Extracorporeal membrane oxygenation (ECMO) is a lifesaving medical intervention for patients with severe refractory cardiopulmonary dysfunction. This study aims to characterize hospitalizations and resource use burdens associated with ECMO use during the onset of the pandemic. We performed a retrospective analysis of ECMO use in United States (US) hospitals between 2019 and 2020, utilizing data from the National Inpatient Sample database. Patient demographics, comorbidities, admission characteristics, inpatient mortality, length of hospital stay (LOS), healthcare costs, and ECMO utilization trends were assessed. Of the 17,520 hospitalizations analyzed, the most common reasons for admission were diseases and disorders of the circulatory system (40.5%) and diseases and disorders of the respiratory system (31.2%). The average patient age was 52.5 years, with a male predominance (64.2%). Hospitalizations were predominantly for White Americans (59.5%), followed by Blacks (16.3%) and Hispanics (14.8%). Nearly 88.2% of cases were at an extremely high risk of mortality without intervention. Inpatient mortality was significantly associated with Hispanic descent, a higher Charlson Comorbidity Index (CCI) score, age >60 years, and a higher All Patients Refined Diagnosis Related Groups (APRDRG) risk of mortality. Hospitalizations involving ECMO had a significantly higher inpatient mortality rate compared to non-ECMO hospitalizations (43.1% vs. 2.1%, p<0.0001). The mean LOS was 26 days for ECMO hospitalizations, with ECMO initiation occurring approximately five days from admission. ECMO-related hospitalizations often involve over 10 unique procedures, resulting in an average healthcare cost of US$967,647 per hospitalization, totaling US$16.7 billion. Comparatively, non-ECMO hospitalizations had shorter LOS and lower mean costs (mean LOS, 4.7 days, and US$52,659, respectively). ECMO utilization increased significantly from 2019 to 2020, reflecting rising demand for this life-saving therapy. Compared to non-ECMO hospitalizations, ECMO patients had higher inpatient mortality, associated with Hispanic descent, higher CCI scores, an age >60 years, and a higher APRDRG risk. ECMO hospitalizations had longer stays (26 days) and higher costs (US$967,647 per case, US$16.7 billion total) compared to pre-pandemic levels. ECMO use increased significantly from 2019 to 2020, reflecting rising demand.

What drives poor quality of care for child diarrhea? Experimental evidence from India.

Most health care providers in developing countries know that oral rehydration salts (ORS) are a lifesaving and inexpensive treatment for child diarrhea, yet few prescribe it. This know-do gap has puzzled experts for decades. Using randomized experiments in India, we estimated the extent to which ORS underprescription is driven by perceptions that patients do not want ORS, provider's financial incentives, and ORS stock-outs (out-of-stock events). Patients expressing a preference for ORS increased ORS prescribing by 27 percentage points. Eliminating stock-outs increased ORS provision by 7 percentage points. Removing financial incentives did not affect ORS prescribing on average but did increase ORS prescribing at pharmacies. We estimate that perceptions that patients do not want ORS explain 42% of underprescribing, whereas stock-outs and financial incentives explain only 6 and 5%, respectively.

Examining the Outcomes of Hybrid Coronary Revascularization in Acute STEMI Patients from 2015 to 2022.

The global rise of chronic diseases, especially cardiovascular disease (CVD), poses a significant public health challenge, being a leading cause of death and disability worldwide. In Iran, the surge in CVD incidence and its risk factors, along with a decrease in the age of onset, has notably increased the reliance on coronary artery bypass grafting (CABG) as a life-saving intervention. Staged hybrid coronary revascularization (HCR), which combines percutaneous coronary intervention with delayed CABG, offers a novel approach for patients with complex coronary artery disease, potentially improving survival and reducing complications. Considering the newness of this treatment method and the limitations of previous studies, we investigated the results of staged HCR in acute ST-elevation myocardial infarction (STEMI) patients in this study. This observational study was performed on consecutive patients with acute STEMI who underwent staged HCR and were referred to Valiasr and Razi hospitals in Birjand from 2015 to 2022. The required information (demographic information, angiography result, and operation side effects) was collected in a checklist. If necessary, the patients were contacted by phone. After collecting the data, they were entered into SPSS version 16 software. This study was conducted on 33 patients with a mean age of 64.88 ± 9.24 years (69.7% male). The average hospital stay was 11.6 ± 8.9 days (3 to 72 days). The mean ejection fraction and syntax score were 36.5% ± 10.2% and 31.21 ± 6.7, respectively. Following surgery and during hospitalization, arrhythmias were observed, including 33.3% with premature ventricular contractions, 18.1% with atrial fibrillation, and 3.1% with ventricular tachycardia. The average number of pack cells (red blood cells that have been separated for blood transfusion) and creatinine changes before and after hybrid surgery were 640.9 ± 670.9 cc and 0.055 ± 0.07. In the follow-up, 9.09% of patients had late mortality, 6.1% of patients had urinary tract infections during hospitalization, 6.1% of patients had surgical site infections, 3.1% needed dialysis, and none of the studied patients had premature death or need for reintervention. The results of our study indicated that staged HCR performed early after an ACS is not associated with significant mortality or complications. Therefore, it is advisable to consider staged HCR as a surgical option in appropriate cases.

Expression of MHC II in DRG neurons attenuates paclitaxel-induced cold hypersensitivity in male and female mice.

Chemotherapy is often a life-saving treatment, but the development of intractable pain caused by chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting toxicity that restricts cancer survival rates. Recent reports demonstrate that paclitaxel (PTX) robustly increases anti-inflammatory CD4+ T cells in the dorsal root ganglion (DRG), and that T cells and anti-inflammatory cytokines are protective against CIPN. However, the mechanism by which CD4+ T cells are activated, and the extent cytokines released by CD4+ T cells target DRG neurons are unknown. Here, we are the first to detect major histocompatibility complex II (MHCII) protein in mouse DRG neurons and to find CD4+ T cells breaching the satellite glial cell barrier to be in close proximity to neurons, together suggesting CD4+ T cell activation and targeted cytokine release. MHCII protein is primarily expressed in small nociceptive neurons in male and female mouse DRG but increased after PTX in small nociceptive neurons in only female DRG. Reducing one copy of MHCII in small nociceptive neurons decreased anti-inflammatory IL-10 and IL-4 producing CD4+ T cells in naïve male DRG and increased their hypersensitivity to cold. Administration of PTX to male and female mice that lacked one copy of MHCII in nociceptive neurons decreased anti-inflammatory CD4+ T cells in the DRG and increased the severity of PTX-induced cold hypersensitivity. Collectively, our results demonstrate expression of MHCII protein in mouse DRG neurons, which modulates cytokine producing CD4+ T cells in the DRG and attenuates cold hypersensitivity during homeostasis and after PTX treatment.

Enhancing pastoralist women's knowledge of danger signs through home-based life-saving skills intervention in Northern Kenya: A quasi experimental study

BackgroundMaternal recognition of obstetric danger signs is crucial for reducing maternal mortality and delays in seeking emergency care. However, there is insufficient knowledge about obstetric danger signs among women in rural Kenya, especially in the hard-to-reach pastoralist communities. This study aimed to determine whether home-based life-saving skills intervention improves knowledge about obstetric danger signs among women in Marsabit County, Kenya. MethodsWe conducted a quasi-experimental study with pre-posttests among 256 pregnant women, allocated to intervention and control groups. We implemented sensitization of pregnant women on obstetric danger signs and basic life-saving actions as components of home-based life-saving skills intervention. While the control group continued with routine services. Descriptive statistics was used to analyze demographic data. The chi-square test and Difference-in-Difference analysis were used to compare the intervention's proportion differences and net effect. ResultsAt baseline, no significant differences in the knowledge level existed. Proportions of women who were knowledgeable of >3 danger signs increased significantly during pregnancy [(89.7%) vs. (62.5%), p < .0001], birth [(86.5%) vs. (75.0%), p = .022], postpartum [(92.1%) vs. (74.2%), p < .000] and neonatal period [(96.8%) vs. (66.7%), p < .0001] in the intervention group than the control group at end-line. ConclusionThese results imply that it is possible to improve knowledge of obstetric danger signs among women from hard-to-reach pastoralist communities as part of home-based life-saving skills interventions. Our work contributes to the United Nation's sustainable development goal 3, which focuses on equity and commitment to reaching people needing health services regardless of where they live and their circumstances.

Prediction the prognosis of the poisoned patients undergoing hemodialysis using machine learning algorithms

BackgroundHemodialysis is a life-saving treatment used to eliminate toxins and metabolites from the body during poisoning. Despite its effectiveness, there needs to be more research on this method precisely, with most studies focusing on specific poisoning. This study aims to bridge the existing knowledge gap by developing a machine-learning prediction model for forecasting the prognosis of the poisoned patient undergoing hemodialysis.MethodsUsing a registry database from 2016 to 2022, this study conducted a retrospective cohort study at Loghman Hakim Hospital. First, the relief feature selection algorithm was used to identify the most important variables influencing the prognosis of poisoned patients undergoing hemodialysis. Second, four machine learning algorithms, including extreme gradient boosting (XGBoost), histgradient boosting (HGB), k-nearest neighbors (KNN), and adaptive boosting (AdaBoost), were trained to construct predictive models for predicting the prognosis of poisoned patients undergoing hemodialysis. Finally, the performance of paired feature selection and machine learning (ML) algorithm were evaluated to select the best models using five evaluation metrics including accuracy, sensitivity, specificity the area under the curve (AUC), and f1-score.ResultThe study comprised 980 patients in total. The experimental results showed that ten variables had a significant influence on prognosis outcomes including age, intubation, acidity (PH), previous medical history, bicarbonate (HCO3), Glasgow coma scale (GCS), intensive care unit (ICU) admission, acute kidney injury, and potassium. Out of the four models evaluated, the HGB classifier stood out with superior results on the test dataset. It achieved an impressive mean classification accuracy of 94.8%, a mean specificity of 93.5 a mean sensitivity of 94%, a mean F-score of 89.2%, and a mean receiver operating characteristic (ROC) of 92%.ConclusionML-based predictive models can predict the prognosis of poisoned patients undergoing hemodialysis with high performance. The developed ML models demonstrate valuable potential for providing frontline clinicians with data-driven, evidence-based tools to guide time-sensitive prognosis evaluations and care decisions for poisoned patients in need of hemodialysis. Further large-scale multi-center studies are warranted to validate the efficacy of these models across diverse populations.

Study protocol: fish oil supplement in prevention of oxaliplatin-induced peripheral neuropathy in adjuvant colorectal cancer patients – a randomized controlled trial. (OxaNeuro)

BackgroundOxaliplatin-induced peripheral neuropathy (OIPN) in general and painful OIPN in particular is a debilitating late effect that severely affects cancer survivors’ quality of life and causes premature cessation of potentially lifesaving treatment. No preventive treatments and no effective treatment for chronic OIPN exist despite many attempts. One of several suggested mechanisms includes neuroinflammation as a contributing factor to OIPN. Fish oil containing long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFAs) are precursors to specialized proresolving mediators that mediate the resolution of inflammation. Our primary hypothesis is that a high supplementation of n-3 LCPUFAs will lower the prevalence and severity of OIPN.MethodsThe OxaNeuro project is an investigator-initiated, multicenter, double-blinded, randomized, placebo-controlled clinical study. We will include 120 patients eligible to receive adjuvant oxaliplatin after colorectal cancer surgery. Patients will receive fish oil capsules containing n-3 LCPUFAs or corn oil daily for 8 months.The primary endpoint is the prevalence of OIPN at 8 months defined as relevant symptoms, including one of the following: abnormal nerve conduction screening, abnormal vibration threshold test, abnormal skin biopsy, or abnormal pinprick test. Additional endpoints include the intensity and severity of OIPN-related neuropathic pain, patient-reported OIPN symptoms, quality of life, mental health symptoms, body composition, and cognitive evaluation. Furthermore, we will evaluate inflammatory biomarkers in blood samples and skin biopsies, including the potential OIPN biomarker neurofilament light protein (NfL) which will be measured before each cycle of chemotherapy.DiscussionIf readily available fish oil supplementation alleviates OIPN prevalence and severity, it will significantly improve the lives of both cancer survivors and palliative cancer patients receiving oxaliplatin; it will improve their quality of life, optimize chemotherapeutic treatment plans by lowering the need for dose reduction or premature cessation, and potentially increase survival.Trial registrationClinicalTrial.gov identifier: NCT05404230Protocol version: 1.2, April 25th. 2023

How to do bedside mediastinal decompression in tension pneumomediastinum.

Tension pneumomediastinum is uncommon but it is a rapidly progress condition that can lead to cardiogenic shock. Mediastinal decompression is an emergency procedure and the knowledge of this technique is a life-saving treatment.