Life-threatening Events Research Articles

Hereditary Hemorrhagic Telangiectasia: On the Brink of a New Treatment Era?

Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular disorder with highly variable penetrance, affecting up to 1 in 5,000 individuals. It is characterized by the presence of abnormal blood vessels that can lead to excessive bleeding-most frequently recurrent nosebleeds (epistaxis), skin and mucosal telangiectasias (small, dilated blood vessels), as well as arteriovenous malformations (AVMs) that can form in various organs, particularly the lungs, liver, and brain. HHT is caused by loss-of-function mutations in the BMP9-10/ENG/ALK1/SMAD4 signaling pathway, an important mediator of vascular quiescence. HHT possesses significant challenges for affected individuals, as the complications can range from mild to life-threatening events, depending on the severity and location of the vascular abnormalities. Despite this bleeding disorder being not uncommon, nowadays no specific treatment is as yet available for HHT and most current therapies include repurposed drugs. The aim of this review was to show therapeutic advances on the basis of recent promising clinical trials for HHT.

A novel recommender framework with chatbot to stratify heart attack risk

Cardiovascular diseases are a major cause of mortality and morbidity. Fast detection of life-threatening emergency events and an earlier start of the therapy would save many lives and reduce successive disabilities. Understanding the specific risk factors associated with heart attack and the degree of association is crucial in the clinical diagnosis. Considering the potential benefits of intelligent models in healthcare, many researchers have developed a variety of machine learning (ML)-based models to identify patients at risk of a heart attack. However, the common problem of previous works that used ML concepts was the lack of transparency in black-box models, which makes it difficult to understand how the model made the prediction. In this study, an automated smart recommender system (Explainable Artificial Intelligence) for heart attack prediction and risk stratification was developed. For the purpose, the CatBoost classifier was applied as the initial step. Then, the SHAP (SHapley Additive exPlanation) explainable algorithm was employed to determine reasons behind high or low risk classification. The recommender system can provide insights into the reasoning behind the predictions, including group-based and patient-specific explanations. In the final step, we integrated a Large Language Model (LLM) called BioMistral for chatting functionally to talk to users based on the model output as a digital doctor for consultation. Our smart recommender system achieved high accuracy in predicting a patient risk level with an average AUC of 0.88 and can explain the results transparently. Moreover, a Django-based online application that uses patient data to update medical information about an individual’s heart attack risk was created. The LLM chatbot component would answer user questions about heart attacks and serve as a virtual companion on the route to heart health, our system also can locate nearby hospitals by applying Google Maps API and alert the users. The recommender system could improve patient management and lower heart attack risk while timely therapy aids in avoiding subsequent disabilities.

Successful Treatment of Unilateral Pulmonary Edema as Minimally Invasive Mitral Valve Surgery Complication—Case Presentation

Background/Objectives: In recent decades, the advantages of minimizing surgical trauma have led to the development of minimally invasive surgical procedures. While the benefits often outweigh the risks, several challenges are encountered that are not present in conventional surgical approaches. Unilateral pulmonary edema (UPE) after mitral interventions performed through a right-sided approach is a rare but potentially life-threatening event. Methods: We present the case of a 49-year-old patient who underwent endoscopic mitral valve repair. Immediately following ICU admission, the patient’s oxygen saturation suddenly dropped, and serous discharge was exteriorized from the endotracheal tube, with a thoracic X-ray revealing right-sided unilateral pulmonary edema. Results: The therapeutical course was complex. The patient developed hemodynamic instability, leading to cardiac arrest, which required cardiopulmonary resuscitation and the initiation of peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The endotracheal cannula was replaced with a right-sided double-lumen cannula, and the patient was placed on two ventilators operating independently. The patient was weaned off extracorporeal membrane oxygenation (ECMO) on the fifth day and extubated on the sixth postoperative day. Conclusions: We successfully treated this patient using ECMO and independent lung ventilation. Several cases have been described in the literature, but the pathogenesis and risk factors of UPE remain unclear. Management depends on the severity of UPE, but a deeper understanding of its underlying mechanisms could provide cardiac surgeons with enhanced strategies for preventing UPE and implementing timely interventions.

New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.

The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. The aim of this up-to-date review was to provide the newest insights on the two adjuvants dexamethasone and dexmedetomidine for regional anesthesia. The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.

Evaluating clinical meaningfulness of anti-β-amyloid therapies amidst amyloid related imaging abnormalities concern in Alzheimer’s disease

Abstract Alzheimer’s disease is the most prevalent form of dementia in the elderly, which is clinically characterised by a gradual and progressive deterioration of cognitive functions. The central and early role of β-amyloid in the pathogenesis of Alzheimer’s disease is supported by a plethora of studies including genetic analyses, biomarker research, and genome-wide association studies in both familial (early-onset) and sporadic (late-onset) forms of Alzheimer’s. Monoclonal antibodies directed against β-amyloid demonstrate slowing of the clinical deterioration of patients with early Alzheimer’s disease. Aducanumab, lecanemab, and donanemab clinical trials showed slowing of Alzheimer’s disease progression on composite scores by 25–40% based on the measure used. Anti-β-amyloid antibodies can cause side effects of bleeding and swelling in the brain, called amyloid related imaging abnormalities. Amyloid related imaging abnormalities typically occur early in treatment and are often asymptomatic, though in rare cases, they can lead to serious or life-threatening events. The aim of this review is to evaluate the clinical meaningfulness of anti-β-amyloid therapies amidst amyloid related imaging abnormalities concern in Alzheimer’s disease.

Splenic injury associated with colonoscopy in hospitalized patients: Incidence, risk factors, management, and outcome.

Background and study aims The frequency of splenic injuries due to coloscopy is largely unknown. Therefore, the aim of this study was to give estimate the risk for hospitalized patients. Patients and methods Using the administrative database from a health insurance company with more than 10 million insured subjects, patients undergoing inpatient colonoscopy associated with a splenic injury within 2 weeks were retrieved from the administrative records based upon OPS (comparable to International Classification of Procedures in Medicine) and ICD-10 codes. In each case identified (n = 141), the individual course of the hospital stay was reconstructed and analyzed by two experienced physicians. Patients with overt other causes of splenic injuries (e. g. abominal surgery, trauma etc.) were not further evaluated. Results Among 190,927 total colonoscopies over a 5-year period, 27 splenic lesions were most likely solely due to colonoscopy. This accounts for 14.1 splenic injuries per 100,000 colonoscopies or one lesion in 7,071 patients. Afflicted patients were older and more likely to be female than male (risk in females: 1 in 5,324 colonoscopies). Surgical interventions were carried out in 17 cases, predominantly splenectomy (n = 15) whereas 10 events were managed conservatively. Transfusions and requirement for intensive care unit treatment were strong predictors of need for surgery. Most lesions (74%) were diagnosed within 48 hours after colonoscopy. Death occurred in two patients, but less likely directly due to the splenic injury. Conclusions Administrative data analysis suggests that splenic injuries due to colonoscopy are more frequent than previously estimated. Endoscopists should be aware of this rare life-threatening adverse event.

Impact of COVID-19 pandemic on the accuracy of telephone triage of callers with shortness of breath and/or chest discomfort in Dutch out-of-hours primary care: A retrospective observational study

Background Anecdotal reports suggest that missed diagnosis in general practice during the first wave of the COVID-19 pandemic contributed to a drop in life-threatening events (LTEs) detected in hospitals. Objectives To investigate the impact of the COVID-19 pandemic on the accuracy of urgency allocation by telephone triage of patients with shortness of breath and/or chest discomfort in out-of-hours primary care (OHS-PC). Accuracy is defined as the correct allocation of high urgency to patients with LTEs and low urgency to those without. Methods Retrospective observational study with data from callers contacting OHS-PC for shortness of breath and/or chest discomfort, between 1 March and 1 June 2019 (pre-pandemic) and 1 March to 1 June 2020 (first wave COVID-19 pandemic). Sensitivity and specificity of telephone urgency allocation were compared during both periods with LTEs, including acute coronary syndrome, and pulmonary embolism, as the reference. Results 3,064 adults (1,840 COVID-19 pandemic and 1,224 pre-pandemic, p < 0.001) were included in the study. The sensitivity of urgency allocation was similar during and before the COVID-19 pandemic (0.68, 95% CI 0.59 to 0.75 vs. 0.68, 95% CI 0.60 to 0.75, p = 0.944). Specificity was slightly higher during the COVID-19 pandemic (0.52, 95% CI 0.50 to 0.55 vs. 0.45, 95% CI 0.42 to 0.48, p < 0.001). Conclusion Despite a surge in calls from adults with shortness of breath and/or chest discomfort during the COVID-19 pandemic, the accuracy of telephone triage for LTEs in OHS-PC remained similar to the pre-pandemic era. Improvement of telephone triage seems necessary in both periods.

Accidental tracheostomy decannulation: Risk factors and complications in pediatric patients using the NSQIP-P database

BackgroundAccidental tracheostomy decannulation (ATD) is a life-threatening event in pediatric patients. The factors associated with ATD in children are largely unknown. Utilizing the National Surgical Quality Improvement Pediatric (NSQIP-P) dataset, we sought to identify the incidence of ATD and associated factors. MethodsPatients who underwent surgery at continuously enrolled American College of Surgeons NSQIP-P hospitals from January 1, 2012, to December 31, 2021, were included. Those who underwent a tracheostomy (CPT 31600 or 31601) as a primary or concurrent procedure were analyzed. ATD was defined by the NSQIP-P REINTUB variable. Multivariable logistic regression analysis and propensity score matching were performed to identify independent associations between demographic variables, relevant comorbidities, intraoperative factors, and ATD. Multivariable regression analyses were performed to identify any association between ATD and unplanned reoperation, pneumonia, extended length of stay, and death in 30 days in both pre-matched and matched cohorts. ResultsA total of 5229 patients undergoing tracheostomy were included in the final analysis for the pre-matched cohort. ATD occurred in 93 (1.8 %) patients, with 42 % (n = 39) of these cases occurring within the first two postoperative days. In the matched cohort, female gender (P = 0.002) and structural pulmonary/airway abnormality (P = 0.016) were independently associated with ATD. Additionally, ATD was associated with unplanned reoperation (P < 0.001) and pneumonia (P = 0.024). The pre-matched cohort showed consistent results with the matched cohort. DiscussionAccidental decannulation is a serious complication following pediatric tracheostomy. By identifying patients at higher risk for ATD and the timing of its occurrence, providers can employ measures targeting these patients during their highest risk period. The sequelae associated with ATD further emphasize the importance of preventing this complication.

Traumatic rupture of duodenal diverticulum-clinical case in catastrophe setting

Duodenal diverticula are anatomical outpouchings of the gastrointestinal tract, with a prevalence of up to 27% in individuals over 50 years old. While often asymptomatic, complications such as diverticulitis, obstruction, and perforation can occur. Traumatic rupture of a duodenal diverticulum is extremely rare, with only a few cases documented in the literature. We report the case of a 64-year-old female involved in a major traffic accident with multiple injuries. Initially stable, she later developed abdominal tenderness and hypotension, prompting a CT scan that revealed pneumoperitoneum without significant hemoperitoneum. Surgical exploration revealed a ruptured duodenal diverticulum, which was treated with diverticulectomy and omentoplasty. Blunt abdominal trauma typically affects the liver, spleen, and retroperitoneal organs, while isolated duodenal injuries remain rare. Mechanisms for duodenal rupture, particularly in the context of seatbelt use, include sudden intra-abdominal pressure increases during deceleration. Imaging, particularly CT, plays a crucial role in the early detection of such injuries, although resource limitations during mass casualty events may delay its use. Surgical management remains the definitive treatment, and early intervention is essential in unstable patients. Traumatic rupture of a duodenal diverticulum is an uncommon yet life-threatening event. Early suspicion, timely imaging, and surgical intervention are key to successful outcomes. Continuous reassessment is crucial, as trauma-related injuries may present later in the clinical course.

4-Methoxycinnamic acid ameliorates post-traumatic stress disorder-like behavior in mice by antagonizing the CRF type 1 receptor

AimsPosttraumatic stress disorder (PTSD) is a debilitating neuropsychiatric illness caused by traumatic or life-threatening events and manifesting as various symptoms, including intrusive re-experiences of trauma, avoidance behaviors, hyperarousal, and negative changes in perception and mood. Main methodsCurrent monoamine-based medications commonly exhibit limited efficacy and significant side effects, which hamper their clinical utility. To address this unmet need, we explored 4-methoxycinnamic acid (4-MCA) as a potential novel treatment for PTSD in a single prolonged stress (SPS)-induced animal model. Key findingsAdministration of 4-MCA (3 and 10 mg/kg, p.o.) significantly mitigated anxiety-like behaviors, alleviated depression-like behaviors, and improved cognitive function in an SPS-treated PTSD mouse model. Further, 4-MCA treatment effectively rectified the fear extinction deficits in the fear conditioning test. Molecular analyses revealed that 4-MCA normalized the elevated corticotropin-releasing hormone (CRH) levels as well as the phosphorylation of protein kinase A (PKA) and cAMP response element-binding protein (CREB) in the amygdala, a pivotal region for fear memory formation. Co-administration of 4-MCA and the CRFR1 antagonist antalarmin at subeffective doses facilitated fear memory extinction. SignificanceThese findings suggest that 4-MCA alleviates SPS-induced PTSD-like behaviors by regulating the CRH-CRFR1-PKA-CREB signaling pathway in the amygdala, and that 4-MCA may be a potential candidate for future PTSD treatment.

Estimating nonlinear anisotropic properties of healthy and aneurysm ascending aortas using magnetic resonance imaging.

An ascending aortic aneurysm is an often asymptomatic localized dilatation of the aorta. Aortic rupture is a life-threatening event that occurs when the stress on the aortic wall exceeds its mechanical strength. Therefore, patient-specific finite element models could play an important role in estimating the risk of rupture. This requires not only the geometry of the aorta but also the nonlinear anisotropic properties of the tissue. In this study, we presented a methodology to estimate the mechanical properties of the aorta from magnetic resonance imaging (MRI). As a theoretical framework, we used finite element models to which we added noise to simulate clinical data from real patient geometry and different properties of healthy and aneurysmal aortic tissues collected from the literature. The proposed methodology considered the nonlinear properties, the zero pressure geometry, the heart motion, and the external tissue support. In addition, we analyzed the aorta as a homogeneous material and as a heterogeneous model with different properties for the ascending and descending parts. The methodology was also applied to pre-surgical,in vivo MRI data of a patient who underwent surgery during which an aortic wall sample was obtained. The results were compared with those obtained from ex vivo biaxial test of the patient's tissue sample. The methodology showed promising results after successfully recovering the nonlinear anisotropic material properties of all analyzed cases. This study demonstrates that the variable used during the optimization process can affect the result. In particular, variables such as principal strains were found to obtain more realistic materials than the displacement field.

Plant-derived cannabinoids for treatment of spasticity in children and adolescents with severe cerebral palsy: Double-blind, placebo-controlled trial

BackgroundTo assess the efficacy, safety, and tolerability of full-spectrum cannabis oil (FSCO) (CBD:THC ratio of 10:1) for the treatment of spasticity in individuals with spastic cerebral palsy (CP) grades IV and V. MethodA pilot trial to assess the feasibility of FSCO in seven CP patients was followed by a prospective double-blind, placebo-controlled parallel trial, with 53 participants aged 5–25 years, randomised in a 1:1 ratio. The double-blind phase lasted six weeks, followed by the open-label phase of six weeks’ duration. The primary endpoint was a change in spasticity measured by the modified Ashworth Scale. Secondary outcomes were changes in motor function (Gross Motor Function Measure 88 scale), quality of life, safety, and tolerability. ResultsThere was no significant difference in spasticity, motor function, and quality of life parameters between patients receiving FSCO or placebo. Patients in the FSCO group were significantly drowsier compared to the placebo group. Adverse events were mild to moderate; there were no life-threatening events. InterpretationThis trial suggests FSCO treatment in children with CP is generally well tolerated and safe. It might have benefits on quality of life. No significant change in spasticity was demonstrated with FSCO treatment compared to the placebo.

A Rare Complication of Atraumatic Splenic Rupture in Infectious Mononucleosis: A Case Report

Aims/Background Atraumatic splenic rupture is a very rare and potentially life-threatening event usually associated with underlying pathological conditions. Splenic rupture in infectious mononucleosis occurs only in 0.1%–0.5% of patients. The aim of the present study was to publish a case report of the atraumatic splenic rupture and to present a mini-review of the international literature. Case Presentation A 30-year-old man of mixed races (Caucasian and African) diagnosed with acute cholecystitis was referred by a rural doctor to a secondary district hospital. His past medical and family history was unremarkable. He did not report any allergies. On arrival, his vital signs were stable. However, laboratory examinations demonstrated: white blood cells 26 × 103/μL (4–11), neutrophils 38.8% (35%–72%), lymphocytes 58% (20%–45%), red blood cells 3.59 M/μL (0–0.6), haemoglobin 10.9 g/dL (13.5–17.5), haematocrit 33.4% (40%–54%), platelets 11.5 fL (6.5–11), prothrombin time 13.2 s (9.4–12.5), glucose 70 mg/dL (74–107), sodium 135 mmol/L (137–146), calcium 7.6 mg/dL (8.8–106), serum glutamic-oxaloacetic transaminase 426 U/L (10–45), serum glutamate pyruvate transaminase 530 U/L (7–45), gamma glutamyl transferase 151 U/L (7–49), total albumins 5.3 g/dL (6.6–8.3), C-reactive protein 235 mg/L (&lt;5), and Epstein-Barr virus 15.50 S/CO (0–1.0). In addition, computed tomography determined hepatosplenomegaly, haemoperitoneum, and spleen rupture. Physical examination revealed abdominal rigidity, left shoulder tip pain, shortened capillary refill time, and neck lymphadenopathy. Results The patient underwent expeditious total splenectomy, postoperative period was uneventful and he was discharged on the sixth postoperative day. He was scheduled to undergo the post-splenectomy vaccinations and regular follow-ups with his general practitioner abroad. Conclusion In patients without a history of trauma, spontaneous splenic rupture should be considered in the differential diagnosis if patients have complaints of abdominal and left shoulder tip pain, and laboratory results indicate low haemoglobin and haematocrit levels.

Life-threatening complications in ophthalmic surgery: a systematic review.

Ophthalmic surgical procedures are widely acknowledged for their safety and efficacy. Undoubtedly, advances in ophthalmic surgery, along with the improvement of anaesthetic techniques, have contributed to the reduction in the occurrence of these events. However, although uncommon, systemic severe and life-threatening adverse events can still occur and it is imperative for an ophthalmologic surgeon to have a comprehensive understanding of them to act in terms of proactive prevention, prompt recognition, and optimal treatment, thus maximizing patients' outcomes. Among life-threatening complication following ophthalmic surgery, cardiovascular events represent the most common ones, including a range of different clinical entities: the oculocardiac reflex, potentially leading to haemodynamic instability and asystole; iatrogenic vascular air embolism, in form of venous air embolism or "pefluorocarbon syndrome", which can lead to obstruction of the pulmonary circulation, respiratory distress and cardiovascular collapse; postoperative venous thromboembolism, in the context of which the management of perioperative antiplatelet and anticoagulant therapy has a crucial role. Furthermore, among infectious complications, that are more commonly limited to the ocular tissues, necrotizing fasciitis represents a potentially lethal infection. This review aims to provide an up-to-date, evidence-based overview of potential life-threatening complications associated with ophthalmic surgery, exploring pathogenesis, risk factors, signs, symptoms, and, briefly, management strategies.

Disordered electron transfer: New forms of defective steroidogenesis and mitochondriopathy.

Most disorders of steroidogenesis, such as forms of congenital adrenal hyperplasia (CAH) are caused by mutations in genes encoding the steroidogenic enzymes and are often recognized clinically by cortisol deficiency, hyper- or hypo-androgenism, and/or altered mineralocorticoid function. Most steroidogenic enzymes are forms of cytochrome P450. Most P450s, including several steroidogenic enzymes, are microsomal, requiring electron donation by P450 oxidoreductase (POR); but several steroidogenic enzymes are mitochondrial P450s, requiring electron donation via ferredoxin reductase (FDXR) and ferredoxin (FDX). POR deficiency is a rare but well-described form of CAH characterized by impaired activity of 21-hydroxylase (P450c21, CYP21A2) and 17-hydroxylase/17,20-lyase (P450c17, CYP17A1); more severely affected individuals also have the Antley-Bixler skeletal malformation syndrome and disordered genital development in both sexes, and hence is easily recognized. The 17,20-lyase activity of P450c17 requires both POR and cytochrome b5 (b5), which promote electron transfer. Mutations of POR, b5, or P450c17 can cause selective 17,20-lyase deficiency. In addition to providing electrons to mitochondrial P450s, FDX and FDXR are required for the synthesis of iron-sulfur clusters, which are used by many enzymes. Recent work has identified FDXR mutations in patients with visual impairment, optic atrophy, neuropathic hearing loss and developmental delay, resembling the global neurologic disorders seen with mitochondrial diseases. Many of these patients have had life-threatening events or deadly infections, often without an apparent triggering event. Adrenal insufficiency has been predicted in such individuals but has only been documented recently. Neurologists, neonatologists and geneticists should seek endocrine assistance in evaluating and treating patients with mutations in FDXR.

Metafictional Narrative Experimentation in Rabih Alameddine’s The Wrong End of the Telescope

ABSTRACT This paper examines the metafictional narrative experimentations in Rabih Alameddine’s The Wrong End of the Telescope (2021). It underscores the experimentations of narrative discourse and its relation in exposing the dilemmas, pains and sorrows of refugees who are displaced and settle in a Greek refugee camp in Lesbos. The refugee camp has become a spatial location for memorizing traumatic scenes and remembering war-related psychological wounds. Rabih Alameddine is a Lebanese-American diasporic novelist, and an Anglophone Arab writer. In The Wrong End of the Telescope, Alameddine unveils the dilemmas, disorientations, traumatic disorders, severe anxieties, and the depression of displaced refugees. Moreover, Alameddine defies the conventional technique of narration and entails diversions, contours, detours, and digressions. He experiments with the literary parameters and techniques to create a centrifuge of humanistic and socio-political spaces. Moreover, there are fragmented narratives and overlapping, blurring spatial and temporal boundaries. Thus, Alameddine plays with the imagination of the readers and sweeps over places through various spaces of displaced characters’ tragic stories. The Wrong End of the Telescope vividly represents traumas and memories associated with refugees witnessing life-threatening events accompanied by fear, helplessness, and horror. They experience repetitive violent memories, monstrous flashbacks, and nightmares of living through wars, the loss of loved ones, and the displacement from their homeland.

Exploring the Development of Safety Culture among Physicians with Text Mining of Patient Safety Reports: A Retrospective Study.

Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are shown up in patient safety reports, however, were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports. A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the 'KH Coder'. A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison. The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful; 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: 'explanation of adverse event to patients and families,' 'central venous catheter,' 'intraoperative procedure and injury,' 'minimally invasive surgery,' 'life-threatening events,' 'blood loss,' and 'medical emergency team and critical care.' These seven concepts showed significant differences among the three periods, except for 'blood loss'. The 'explanation of adverse event to patients and families' decreased in proportion from 11.3% to 8.8% (p<0.05). The 'central venous catheter' decreased from 17.3% to 11.3% (p<0.01). Meanwhile, 'minimally invasive surgeries' and 'intraoperative procedures' increased from 3.9% to 12.9% (p<0.01) and from 10.8% to 14.6% (p<0.05), respectively. Focusing on patients' events, 'life-threatening events' decreased from 13.0% to 8.1% (p<0.01); however, 'medical emergency teams and critical care' increased from 3.3% to 10.6% (p<0.01). Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians' perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and priority of patient care appeared with the development of safety culture.

Cardiac toxicities of Bruton’s tyrosine kinase inhibitors: The risk of pericarditis and cardiac tamponade

Bruton’s tyrosine kinase (BTK) inhibitors are widely used in the management of chronic lymphocytic leukaemia (CLL) and other B-cell malignancies. Despite their therapeutic efficacy, BTK inhibitors are associated with cardiac toxicities, most notably atrial fibrillation and hypertension. However, our recent case series highlights the rare yet underappreciated risk of pericarditis and cardiac tamponade in patients treated with both first- and second-generation BTK inhibitors. This article highlights the need for vigilance in clinical practice and the importance of timely echocardiography. The challenges of early diagnosis are discussed, as well as the role of emerging technologies, such as point-of-care ultrasound and AI-based diagnostics. Ultimately, a cautious, informed approach is crucial to balance the benefits of BTK therapy with the risk of rare but life-threatening cardiac events.

Association between different GLP-1 receptor agonists and acute pancreatitis: case series and real-world pharmacovigilance analysis.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown notable advancements in managing blood sugar control. Nevertheless, there remains a gap in real-world data regarding the variation in acute pancreatitis (AP) risk among different GLP-1 RAs. Our study aimed to characterize and evaluate AP associated with different GLP-1 RAs (exenatide, lixisenatide, liraglutide, albiglutide, semaglutide, dulaglutide and tirzepatide) in a public adverse events database and to review the relevant case reports. We described a case series of patients experiencing AP while on GLP-1 RAs. Additionally, we utilized various algorithms including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma Poisson shrinker (MGPS) to analyze data from the Food and Drug Administration's Adverse Event Reporting System (FAERS) regarding suspected adverse events of AP linked to GLP-1 RAs from January 2005 to September 2023. Our case series comprised thirty-nine patients who experienced AP events while on GLP-1 RAs. Within the FAERS database, we retrieved a total of 6,751 individual case safety reports (ICSRs) involving various GLP-1 RAs. The median age of the patients included in our study was 57 years (range: 14-99), with 98.3% of cases classified as serious. Signals indicating AP were observed across all GLP-1 RAs, with particular emphasis on exenatide and liraglutide. There is a notable reporting signal of AP associated with all GLP-1 RAs. Healthcare providers must remain vigilant and closely monitor this potentially life-threatening adverse event.

UK Medical Cannabis Registry: a cohort study of patients prescribed cannabis-based oils and dried flower for generalised anxiety disorder

ABSTRACT Background Generalized anxiety disorder (GAD) is a common mental health condition. The endocannabinoid system has become a focus for new therapies, increasing interest in cannabis-based medicinal products (CBMPs). This study uses data from the UK Medical Cannabis Registry (UKMCR) to investigate real-world outcomes and safety of different CBMP formulations in GAD patients. Methods This study analyzed patient-reported outcomes from 302 GAD patients prescribed CBMPs (oil-based, dried flower, or a combination). Anxiety (GAD-7), sleep quality (SQS), and quality of life (EQ-5D-5 L) were assessed at 1, 3, 6, and 12 months. Adverse events were recorded. Results All CBMP formulations were associated with improvements in anxiety, sleep, and quality of life over 12 months (p < 0.050). At 12 months, there were no significant differences in outcomes between formulations (p > 0.050). The majority of reported adverse events (n = 707) were mild (n = 343) or moderate (n = 285) in severity, with no life-threatening events observed. Conclusion This study provides real-world evidence supporting the potential of CBMPs for improving GAD symptoms. Patients prescribed both oil-based and dried flower formulations have similar outcomes over 12 months. Further research is needed to determine the optimal CBMP formulation and long-term effects.