Life-threatening Medical Complications Research Articles

Serious Medical and Psychosocial Complications in Pregnant and Postpartum Adolescents at a Pediatric Emergency Department.

This study aimed to describe the clinical characteristics and serious medical and psychosocial complications of pregnant and postpartum adolescent patients at a pediatric emergency department (PED). Demographic and clinical data of all pregnant and postpartum adolescents who presented to the PED of a single tertiary referral hospital between January 2020 and January 2023 were collected and documented retrospectively. Twenty-seven patients with a mean age of 16.7 ± 0.8 years were included in the study. The main presenting complaints were abdominal pain (n = 9), suspicion of pregnancy (n = 5), cough, seizure, and vomiting (3 patients each). Potentially life-threatening medical complications included stroke (n = 3), placental abruption (n = 1), and carbon monoxide intoxication (n = 1). Sexual assault (n = 4), physical assault (n = 2), recurrent pregnancies (n = 5), and suicide attempts (n = 4) were serious psychological and social complications in our patient group. Pregnant and post-partum adolescents may present to PED with serious lifethreatening complications, and permanent sequelae may occur. In addition to sexual and physical violence, various psychological problems are comorbid conditions. These patients should be managed with a multidisciplinary biopsychosocial approach, and these issues considered in their acute treatment and follow-up at emergency departments.

Oxidative Stress, Lipid Peroxidation and Ferroptosis Are Major Pathophysiological Signatures in the Placental Tissue of Women with Late-Onset Preeclampsia.

Preeclampsia, a serious and potentially life-threatening medical complication occurring during pregnancy, is characterized by hypertension and often accompanied by proteinuria and multiorgan dysfunction. It is classified into two subtypes based on the timing of diagnosis: early-onset (EO-PE) and late-onset preeclampsia (LO-PE). Despite being less severe and exhibiting distinct pathophysiological characteristics, LO-PE is more prevalent than EO-PE, although both conditions have a significant impact on placental health. Previous research indicates that different pathophysiological events within the placenta may contribute to the development of preeclampsia across multiple pathways. In our experimental study, we investigated markers of oxidative stress, ferroptosis, and lipid peroxidation pathways in placental tissue samples obtained from women with LO-PE (n = 68) compared to healthy control pregnant women (HC, n = 43). Through a comprehensive analysis, we observed an upregulation of specific molecules associated with these pathways, including NADPH oxidase 1 (NOX-1), NADPH oxidase 2 (NOX-2), transferrin receptor protein 1 (TFRC), arachidonate 5-lipoxygenase (ALOX-5), acyl-CoA synthetase long-chain family member 4 (ACSL-4), glutathione peroxidase 4 (GPX4) and malondialdehyde (MDA) in women with LO-PE. Furthermore, increased ferric tissue deposition (Fe3+) was observed in placenta samples stained with Perls' Prussian blue. The assessment involved gene and protein expression analyses conducted through RT-qPCR experiments and immunohistochemistry assays. Our findings underscore the heightened activation of inflammatory pathways in LO-PE compared to HC, highlighting the pathological mechanisms underlying this pregnancy disorder.

Assessment of single and combined administration of ubiquinone and lactoferrin on histopathology, ultrastructure, oxidative stress, and WNT4 expression gene induced by thioacetamide on hepatorenal system of adult male rats

BackgroundHepatorenal syndrome is a life-threatening medical complication of liver cirrhosis. Hepatic cirrhosis is commonly accompanied by rapid failure of renal functions. Thioacetamide (TAA) is a potent hepatotoxin and a class 2-type carcinogen. Ubiquinone (Coq10) and lactoferrin (LF) are potent antioxidants with antifibrotic and antiinflammatory effects. However, whether Coq10 and LF reduce the hepatorenal injury induced by TAA remains unclear. Here, we investigated the potential protective effect of both/or Coq10 and LF in ameliorating TAA-induced hepatorenal injury and the role of WNT4 gene expression in detecting TAA-induced renal injury in rats. Seventy healthy and mature male Sprague Dawley rats, weighting (200 g ± 20 g) and aging (4–6) weeks were randomly divided into seven groups (n = 10): control, Coq10, LF, TAA, TAA + Coq10, TAA + LF, and TAA + Coq10 + LF. The hepatorenal injury was induced through intraperitoneal (i.p.) injection of TAA (150 mg/kg/twice/weekly) for nine weeks. Coq10 (10 mg/kg/day) and LF (200 mg/kg/day) were orally administered for nine weeks.ResultsTAA induced marked hepatorenal damage, evident by the significant increase in the alanine aminotransferase (ALT), aspartate transaminase (AST), serum creatinine (SCr) activities, and the blood urea nitrogen (BUN) level. Besides, the significant increases in concentrations of malondialdehyde (MDA) and nitric oxide (NOx) together with significant decreases in the activities of catalase (CAT) and superoxide dismutase (SOD). The histopathological analysis of the TAA group showed obvious fibrosis, steatosis, and inflammation of the hepatic parenchyma as well as severe glomerular and tubular damage of the renal parenchyma. In addition, TAA induced marked ultrastructural alterations and up-regulation in the expression of the WNT4 gene in the kidney. Meanwhile, the biochemical, histopathological, and ultrastructural alterations were significantly decreased with significant down-regulation in the expression of WNT4 in the groups exposed to TAA and treated with Coq10 and LF.ConclusionOur data suggested that Coq10 and LF could have protective effects on TAA hepatorenal damage, through improving the hepatic and renal functions, reduction of oxidative stress, structural and ultrastructural alterations, besides down-regulation in the expression of WNT4.

Group B Streptococcus Meningitis in an Adult Woman with Type 2 Diabetes and Ethmoid Roof Defect. Impact on "frontal" Cognitive Functions.

Community-acquired bacterial meningitis in adults represents one of the most severe infectious diseases worldwide with potentially life-threatening medical complications. Several infectious agents can cause acute meningitis. Although group B Streptococcus is more prevalent in newborns, infection can also lead to meningitis in older adults, particularly those with underlying health issues. A 53-year-old woman with a body mass index of 28.7 kg/m2, type 2 diabetes mellitus, and dyslipidaemia presented to the emergency department of Santa Maria della Stella Hospital (Orvieto, Italy) with confusion, low-grade fever, echolalia, and hyperglycaemia. Computed tomography scans of the brain revealed a hypodensity in the left anterior frontal lobe and an osteodural defect of the rhinobase. Meningitis was suspected and empiric broad-spectrum antibiotic therapy with corticosteroids and insulin were administered while the results of the cerebrospinal fluid analysis confirmed the diagnosis of group B Streptococcus meningitis. Repeat imaging at 48 hours revealed enlargement of the hypodense lesion. The frontal assessment battery indicated deficits in executive functions. Prompt treatment led to rapid clinical improvement. Following the restoration of euglycemic status and hemodynamic stabilization, a follow-up magnetic resonance imaging confirmed the ischaemic lesion and showed cerebrospinal fluid in the sella turcica. The patient was then transferred to neurorehabilitation. The complex interactions among multiple risk factors resulted in an atypical clinical case of group B Streptococcus meningitis, which was promptly treated with empiric antibiotic therapy to mitigate neurocognitive deficits. Group B Streptococcus can cause meningitis in adults with poorly controlled type 2 diabetes mellitus and should be promptly treated with empiric broad-spectrum antibiotics.An osteodural defect of the ethmoid roof together with idiopathic intracranial hypertension may result in empty sella turcica and CSF rhinorrhoea, promoting the dissemination of the pathogen.Meningitis patients with pre-existing diabetic cerebral vasculopathy may develop cerebrovascular complications and cognitive impairments.

What we talk about when we talk about severe maternal morbidity: a call to action to critically review severe maternal morbidity as an outcome measure

Severe maternal morbidity has historically functioned as an umbrella term to define major, potentially life-threatening obstetrical, medical, and surgical complications of pregnancy. There is no overarching or consensus definition of the constellation of conditions that have been used variably to define severe maternal morbidity, although it is clear that having a well-honed definition of severe maternal morbidity is important for research, quality improvement, and health policy purposes. Although severe maternal morbidity may ultimately elude a single unifying definition because different features may be relevant depending on context and modality of data acquisition, it is valuable to explore the intellectual frameworks and various applications of severe maternal morbidity in current practice, and to consider the potential benefit of more consolidated terminology for maternal morbidity.

Aprepitant for the Prevention of Post-Operative Nausea and Vomiting in Refractory or High-Risk Patients


 No studies were found that evaluated the clinical effectiveness of aprepitant for the prevention of post-operative nausea and vomiting in patients with a history of post-operative nausea and vomiting refractory to conventional antiemetic prophylaxis that met the criteria for this review.
 In patients with the potential for life-threatening post-operative medical complications due to emesis, limited evidence of variable quality was identified for the clinical effectiveness of aprepitant. The studies varied by population, the combination of interventions and comparators and the outcomes measured, and the findings were mixed.
 No studies were found that evaluated the cost-effectiveness of aprepitant for the prevention of post-operative nausea and vomiting in patients with a history of post-operative nausea and vomiting refractory to conventional antiemetic prophylaxis that met the criteria for this review.
 No studies were found that evaluated the cost-effectiveness of aprepitant for the prevention of post-operative nausea and vomiting in patients with the potential for life-threatening post-operative medical complications due to emesis that met the criteria for this review.
 No evidence-based guidelines were found regarding the use of aprepitant for the prevention of post-operative nausea and vomiting in patients with a history of post-operative nausea and vomiting refractory to conventional antiemetic prophylaxis that met the criteria for this review.
 No evidence-based guidelines were found regarding the use of aprepitant for the prevention of post-operative nausea and vomiting in patients with the potential for life-threatening post-operative medical complications due to emesis that met the criteria for this review.

Electrochemical Biosensing and Deep Learning-Based Approaches in the Diagnosis of COVID-19: A Review

COVID-19 caused by the transmission of SARS-CoV-2 virus taking a huge toll on global health and caused life-threatening medical complications and elevated mortality rates, especially among older adults and people with existing morbidity. Current evidence suggests that the virus spreads primarily through respiratory droplets emitted by infected persons when breathing, coughing, sneezing, or speaking. These droplets can reach another person through their mouth, nose, or eyes, resulting in infection. The “gold standard” for clinical diagnosis of SARS-CoV-2 is the laboratory-based nucleic acid amplification test, which includes the reverse transcription-polymerase chain reaction (RT-PCR) test on nasopharyngeal swab samples. The main concerns with this type of test are the relatively high cost, long processing time, and considerable false-positive or false-negative results. Alternative approaches have been suggested to detect the SARS-CoV-2 virus so that those infected and the people they have been in contact with can be quickly isolated to break the transmission chains and hopefully, control the pandemic. These alternative approaches include electrochemical biosensing and deep learning. In this review, we discuss the current state-of-the-art technology used in both fields for public health surveillance of SARS-CoV-2 and present a comparison of both methods in terms of cost, sampling, timing, accuracy, instrument complexity, global accessibility, feasibility, and adaptability to mutations. Finally, we discuss the issues and potential future research approaches for detecting the SARS-CoV-2 virus utilizing electrochemical biosensing and deep learning.

Trichophagia and trichobezoar in trichotillomania: A narrative mini-review with clinical recommendations

A subset of individuals with trichotillomania (TTM; hair-pulling disorder) engages in trichophagia (TPG; eating hair). In a small minority of these cases, TPG leads to the development of a trichobezoar (TB; hairball) in the gastrointestinal tract, which can result in life-threatening medical complications. The literature on TPG/TB is extremely scarce; however, a substantial number of surgical case reports exist. We conducted a narrative review of this literature with the aim of describing a clinical picture of TTM patients with TB. Most cases are females and peak age at presentation is in middle childhood/adolescence. TBs can remain asymptomatic for years but eventually cause a host of medical complications. Symptoms tend to be nonspecific (e.g., abdominal pain) and patients may deny TTM/TPG when seeking medical treatment. Diagnostic signs include palpable mass in the upper abdomen, bad breath, and alopecia. Many patients have comorbid emotional disorders, but only a small minority has severe mental illness or intellectual disability. Habitual eating of inedible material other than hair appears uncommon, and mostly restricted to early childhood. Fatalities are rare and primarily occur in children after delayed medical attention. Providers should screen for TPG in individuals with TTM of all ages. • Trichobezoar can lead to life-threating medical complications. • Majority of patients are females in first three decades of life. • Patients of all ages often deny the behaviors. • Diagnostic signs include alopecia and bad breath.

Burden of illness among Medicare and non-Medicare US populations with acquired thrombotic thrombocytopenic purpura

Background Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare hematologic disorder that can lead to serious life-threatening medical complications. Objective The aim of this study was to describe aTTP-related hospital resource utilization, cost, complications, and overall survival among US Medicare and non-Medicare populations following aTTP episodes prior to the US approval of caplacizumab. Methods This retrospective study utilized administrative claims data for Medicare Fee-for-Service (FFS) beneficiaries (100% sample) and a sample of commercial, managed Medicaid [MM], Medicare Advantage [MA] plan members from the Inovalon MORE2 Registry. aTTP patients ages 18+ were identified between 2010 and 2018 using a published validated algorithm: ≥1 hospitalization for thrombotic microangiopathy + therapeutic plasma exchange (TPE). 2,279 patients were identified; 65.2% were enrolled in Medicare FFS, 13.6% in commercial, 15.7% in MM, and 5.4% in MA. Mean hospitalization days for aTTP index episode ranged between 12 and 17 days; ∼60% of patients required intensive care. Mean payments for index hospitalization varied by payer [Medicare FFS: $29,024; MA: $12,860; commercial: $9,996 and MM: $10,470]. Among FFS patients, 15.7% died during initial hospitalization and 21.0% died within first 30 days of the event. During follow-up, 11.6–19.6% experienced aTTP-related exacerbation. Incidence rate of relapse and complications per 100 person-years was 5.6 [Medicare FFS: 3.6; MA: 8.7; commercial: 10.4 and MM: 14.7] and 16.7 [FFS: 15.5; MA: 20.5; commercial: 21.7 and MM: 19.1], respectively. Among Medicare patients with and without aTTP, mortality risk was 2.9 (95 % CI: 2.4–3.4) times higher for aTTP vs. non-aTTP patients. Conclusion This is the first real-world study evaluating burden of illness among aTTP patients in the US across payer types. Despite being treated with TPE, patients with aTTP have lower survival rates in comparison to a matched cohort without aTTP. These findings highlight the need for more effective and novel therapies to reduce disease burden for this population. Key points In US Medicare and managed care populations with aTTP between 2010 and 2018, aTTP can lead to significant utilization of ICU services due to clinical complications, and/or relapse following hospital discharge. Despite treatment with therapeutic plasma exchange, acute mortality remains high (15.7%) indicating the need for more effective and novel treatments.

Is the 5-factor modified Frailty Index a prognostic marker in geriatric ankle fractures?

The 5-factor modified Frailty Index (mFI-5), which is the latest version of the Frailty Index, is a tool that calculates the risk of complications after treatment by scoring the comorbidity status of the patient. The aim of this study was to evaluate the efficacy of the mFI-5 in predicting complications in geriatric patients with an ankle fracture. A retrospective examination was made of a total of 94 patients aged >65 years who were treated for an ankle fracture in our hospital between 2015 and 2020. Weber type A, B, and C fractures were included in the study. For each patient, the mFI-5 was calculated for the comorbidity status of diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension requiring drugs, and non-independent functional status. Multivariance logistic regression analysis was used to evaluate the mFI-5 points as a predictor of negative outcomes. The mFI-5 was observed to be effective in the prediction of the complications of hospital re-admission, wound site infec-tion, life-threatening medical complications, and the presence of any complication (p<0.05). In the prediction of whether or not there was any complication, the mFI-5 was determined to be a more effective tool than body mass index, American Society of Anesthesiol-ogist, age, length of stay in hospital, and duration of operation (p<0.05, OR=2.726, 95% Confidence Interval=1.285-5.783). The mFI-5 is a sensitive tool for the prediction of complications which may develop following geriatric ankle frac-ture. The five comorbidities which constitute the mFI-5 are easily obtained from the patient anamnesis, and this renders it a practical clinical tool to identify high-risk patients, determine the preoperative risks, and improve the health-care service.

Burden of Illness Among Medicare and Non-Medicare Populations with Acquired Thrombotic Thrombocytopenic Purpura, 2010-2018

Background and Objective Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare hematologic disorder that causes microvascular thromboses and can lead to serious and life-threatening medical complications. The aim of this study was to describe aTTP-related resource utilization, cost, complications, and overall survival (OS) among US Medicare and non-Medicare populations following aTTP episodes. Methods This retrospective study utilized administrative claims data for Medicare Fee-for-Service (FFS) beneficiaries (100% sample) and a sample of commercial, managed Medicaid [MM], Medicare Advantage [MA] plan members from the Inovalon MORE2 Registry. Patients aged 18+ with aTTP were identified using a validated algorithm (Wahl et al, 2010): ≥1 hospitalization for thrombotic microangiopathy + therapeutic plasma exchange (TPE) between 2010 and 2018. Patients with hemolytic-uremic syndrome or other conditions mimicking aTTP during same hospitalization were excluded. Outcomes included characterization of index hospitalization (including length of stay), diagnosis-related group (DRG) payment amount (2019 US$ [Medicare payments also included outlier payments]), and risk of mortality. OS was compared for Medicare FFS patients with aTTP to a 1:1 matched cohort of Medicare FFS beneficiaries without aTTP (matched on age, gender, region, index year, socioeconomic status, disability insurance benefits, and Charlson comorbidity index score). Median survival time and 1-year/2-year survival rates were estimated using Kaplan Meier methodology and hazard ratio was obtained using Cox proportional hazard model. In a subgroup analysis of aTTP patients across payer channels with at least 6 months of baseline and 1 month of follow-up data, percentage of patients with readmission for TPE (exacerbation if &amp;lt;30 days post-discharge; relapse if &amp;gt;30 days post-discharge) and rate of post-discharge clinical complications per 100 person-years was calculated. Results During the 9-year period, 2,279 patients met the study criteria for aTTP; 65.2% (N=1,486) were enrolled in Medicare FFS: 13.6% (N=312) in commercial, 15.7% (N=358) in MM, and 5.4% (N=123) in MA. Mean (SD) age (in years) varied by payers as expected: Medicare FFS: 65.9 (13.9); MA: 63.8 (13.6); commercial: 45.0 (14.3); MM: 37.5 (14.0). Mean (SD) hospitalization for index event ranged from 12.4 (9.4) to 15.8 (11.8) days; majority of patients required intensive care (Medicare FFS: 61.4% [mean (SD) ICU days: 8.3 (8.2)]; MA: 61.8%; commercial: 62.2%; MM: 60.1%). Among Medicare FFS patients, 15.7% died during initial hospitalization and 21.0% died within first 30 days of the event (mean (SD) time to death: 11.7 (7.2) days). Among matched cohorts of Medicare patients with and without aTTP (N=833 in each cohort), OS was lower for patients with aTTP (Figure 1). Specifically, 1-year survival rates among aTTP patients was 71.8% (95% CI: 68.6%-74.8%) vs. 95.6% (94.0%-96.8%) for those without aTTP. Two-year survival rates among aTTP patients was 66.6% (63.2%-69.8%) vs. 91.1% (88.8%-92.9%) for those without aTTP. Risk of mortality was 2.9 times higher for patients with aTTP vs. without aTTP (95% CI: 2.4-3.4). Mean (SD) DRG payment for index hospitalization varied by payers: Medicare FFS: $29,024 ($32,565); MA: $12,860 ($6,981); commercial: $9,996 ($5,995); MM: $10,470 ($7,370). During follow-up, 18.4%-22.4% of patients experienced aTTP-related exacerbation [Medicare FFS: 18.4%; MA: 21.9%; commercial: 22.4% and MM: 22.2%]. Annual incidence rate of relapse per 100 person-years was 5.6 [Medicare FFS: 3.6; MA: 8.7; commercial: 10.4 and MM: 14.7] and annual incidence rate of complications per 100 person-years was 16.7 [Medicare FFS: 15.5; MA: 20.5; commercial: 21.7 and MM: 19.1]. Conclusions This is the first real-world study evaluating burden of illness among aTTP patients in the US across payer types. Despite being treated with TPE, patients with aTTP have high acute mortality and are nearly three times as likely to die compared with the general Medicare population without aTTP. During the initial hospitalization, many required intensive care. Following discharge, approximately 1 in 5 was readmitted within 30 days and had higher incidence for clinical complications associated with aTTP. The study findings highlight the need for more effective therapies to reduce disease burden for this population. Disclosures Pollissard: Sanofi: Current Employment, Current equity holder in publicly-traded company. Shah:Avalere Health: Current Employment. Punekar:Sanofi: Other: Employee of Sanofi at the time of study and may hold stock/stock options in Sanofi. Petrilla:Avalere Health: Current Employment. Pham:Sanofi: Consultancy; Alexion: Other: Speaker.

Burden of Injury and Illness in the Road Race Medical Tent: A Narrative Review.

To summarize the literature relating to prehospital care at 5 km through marathon distance road races and present the epidemiology of common medical encounters, significant medical complications, and medical outcomes. We searched PubMed and Google Scholar for the published literature pertaining to road race medical tent encounters at 5 km through marathon distance road races from 2000 to 2018. We included English-language, original articles reporting on injury and illness incidence. Standard medical encounter definitions have recently been formulated in response to the previous lack of uniform definitions. The incidence of medical complications at road races may be influenced by environmental conditions and race distance. Minor and moderate medical encounters, such as dermatologic injuries, musculoskeletal injuries, and exercise-associated collapse, are common. Serious and life-threatening medical complications, including exertional heat stroke, exercise-associated hyponatremia, and cardiac arrest, are less frequent. Fatalities are also rare, with rates of 0.3 to 5 per 100 000 participants reported at marathons. The ratio of hospital transports to medical encounters is low. On-site medical services play a key role in the safety of both runners and the community. Future research and care initiatives in this field should focus on optimizing treatment protocols, promoting injury prevention efforts and reducing host community costs.

The 5-Factor Modified Frailty Index Predicts Complications, Hospital Admission, and Mortality Following Arthroscopic Rotator Cuff Repair

The purpose of this study is to evaluate the utility of the modified frailty index-5 (mFI-5) as a predictor for postoperative complications in patients undergoing arthroscopic rotator cuff repair (RCR). The National Surgical Quality Improvement Program database was queried for patients undergoing arthroscopic RCR between 2006 and 2016. The mFI-5, a 5-factor score comprising comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status limiting independence, was calculated for each patient. Multivariate logistic regression models were used to evaluate the mFI-5 score as a predictor for complications including medical complications, surgical-site infections, hospital admission, discharge to a facility, and mortality. In total, 24,477 patients met criteria for inclusion. The mFI-5 was a strong predictor for medical complications (P < .001), hospital admission (P < .001), length of stay (P= .007), and discharge to a facility (P= .001) but not surgical-site infections (P= .153). For each point increase in mFI-5 score, the risk for a medical complication increased by 66%, readmission by 52%, and adverse discharge by 45%. However, of all the measured complications, the mFI-5 was the strongest predictor for mortality, with the risk more than doubling for each increase in mFI-5 point (odds ratio 2.66, P= .025). The mFI-5 is a sensitive tool for predicting life-threatening medical complications, hospital admission, increased length of stay, adverse discharge, and mortality following arthroscopic RCR. The 5 comorbidities comprising the mFI-5 are easily obtained through the patient history, making it a practical clinical tool for identifying high-risk patients, informing preoperative counseling, and improving value-based health care. Level III, prognostic.

Development of a comprehensive prognostic model of lymphedema risk for breast cancer survivors.

e23083 Background: Lymphedema is a side-effect of cancer treatment affecting up to 1 in 5 cancer survivors. It is associated with life-threatening medical complications and higher medical costs. To facilitate early detection and treatment of lymphedema in high-risk patients, improved prognostic modeling is required. Methods: The study cohort comprised of female breast cancer survivors at the Princess Margaret Cancer Centre during 2016-18. Using lymphedema diagnosis as the end-point, the Cox proportional-hazards model was applied to patient, disease, and treatment-related parameters to assess performance of established and putative novel prognostic factors for lymphedema. Concordance index (C-index) and Kaplan-Meier analyses were used to evaluate prognostic performance. Results: A total of 176 breast cancer survivors were included in the preliminary analysis. On univariable analysis, traditional treatment-related risk factors for lymphedema (e.g. axillary lymph node dissection, number of lymph nodes dissected, use of radiotherapy) were significant (p &lt; 0.05). Additionally, other treatment-related factors (e.g. radiation boost, supraclavicular radiation), disease factors (e.g. tumor size, number of positive lymph nodes, cancer stage), and patient/biological factors (e.g. developing a surgical seroma) were significant (p &lt; 0.05). Multivariable analysis revealed one traditional treatment-related factor (i.e. number of lymph nodes dissected) and other treatment details (e.g. radiation boost, axillary/supraclavicular radiation) to be the most significant factors. Combining radiation treatment details with traditional treatment-related lymphedema risk factors improved the C-index from 0.609 to 0.710 and separated patients into high- and low-risk groups with 2-year lymphedema-free survivals of 26% (15-44%) and 85% (74-97%) respectively (p &lt; 0.001). Conclusions: Prognostication of lymphedema risk can be improved by considering radiation treatment details, including use of radiation boost and site of radiotherapy. Biological factors, such as developing a surgical seroma, may reveal predisposition towards edema. Validation on an independent data set is being completed. Prospective validation is also required.

Chronic alcohol consumption exacerbates murine cytomegalovirus infection via impairing nonspecific and specific NK activation in mice.

Chronic alcohol consumption increases the susceptibility to infectious diseases by compromising the immune system. Cytomegalovirus infection is common in humans and usually is asymptomatic in immunocompetent people. However, it can induce life‐threatening medical complications in immunocompromised individuals such as alcoholics. How chronic alcohol consumption exacerbates cytomegalovirus infection is not known. Herein, we used a mouse cytomegalovirus model to study the underlying cellular and molecular mechanism. We found that alcohol consumption increased viral titers in spleen after 4 days of infection, enhanced body weight loss and inhibited splenomegaly during the acute phase of infection. Blood level of IFN‐β, splenic IFN‐γ and granzyme B‐producing NK cells were lower in alcohol‐consuming mice than in water‐drinking mice at 12 hours after viral infection. Moreover, alcohol consumption decreased IL‐15‐producing DC after 36 hours infection, inhibited NK cell, specifically Ly49H+ NK cell maturation and proliferation 3‐6 days after viral infection. Surprisingly, alcohol consumption enhanced NK cell and CD8+ T‐cell continuous activation and increased granzyme B‐producing cells. However, alcohol consumption decreased the expression of perforin in spleen and liver. Taken together, chronic alcohol consumption exacerbates cytomegalovirus infection via impairing nonspecific and specific NK cell activation, specifically IFN‐γ and perforin production.

Influenza B viruses circulated during last 5 years in Mongolia.

Influenza B virus-caused illness has recently been considered as an urgent public health problem due to substantial morbidity, mortality and life-threatening medical complications. In this study, we have reported the main characteristics of influenza B virus in Mongolia, including prevalence, lineages, suitability with vaccine strains and drug susceptibility against the virus. 15768 specimens were tested by qPCR for detecting influenza viruses. From positive specimens for influenza B virus, the clinical isolates were isolated using MDCK cells. Sequencing analysis, hemagglutination inhibition assay and Neuraminidase inhibitor (NAI) drug susceptibility testing were performed for the clinical isolates. Influenza B virus was around in 3.46% of the samples in Mongolia, and B/Victoria clade-1A and B/Yamagata clade-3 lineages were predominant. Importantly, it was confirmed that the lineages corresponded to the vaccine strains. Moreover, drug susceptibility tests revealed that some Mongolian clinical isolates showed reduced susceptibility to antiviral agents. Interestingly, G104R was identified as a novel mutation, which might have a significant role in drug resistance of the virus. These results describe the characteristics of influenza B viruses that have caused respiratory illness in the population of Mongolia between 2013 and 2017.

New 5-Factor Modified Frailty Index Predicts Morbidity and Mortality in Primary Hip and Knee Arthroplasty

BackgroundWhile the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty. MethodsA retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables. ResultsOne hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001). ConclusionsThe mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes. Level of EvidenceIII.

Subclinical eating disorders in a sample of secondary school girls and comorbidity with depression in Sharkia Governorate, Egypt

Background Eating disorders are complex psychiatric syndromes in which cognitive distortions related to food and body weight and disturbed eating patterns can lead to significant and potentially life-threatening medical and nutritional complications. Aim of the work The aim of this study was to evaluate the frequency of subclinical forms of eating disorders and the association between it and depression in school girls in Sharkia Governorate, Egypt. Patients and methods In this two-stage cross-sectional study, we screened 2000 secondary school girls using eating disorder test. Those scoring 30 or less (n=415) and a control group randomly selected from those scoring 30 or more (N=215) were assessed using the eating disorder module of the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV) axis-I disorders (SCID-I). SCID-I positive patients from stage 2 were screened for depressive symptoms using Beck Depression Inventory and diagnosed as having major depressive disorder according to DSM-IV criteria. Results The prevalence of subclinical eating disorders was 25.5% (subthreshold anorexia 3.5%, subthreshold bulimia nervosa 3.0%, SWC 10.0%, and subthreshold binge-eating disorder 9.0%), and the prevalence of major depressive disorder in SEDS patients was 10.8%. Conclusion Subclinical eating disorders are more frequent than typical eating disorders. Subclinical forms of eating disorders may represent a high-risk group for developing serious eating disorders; identifying this group will give an opportunity of prevention. Depressive disorder is frequent in patients with subclinical eating disorders.

Anorexia Nervosa/Atypical Anorexia Nervosa

Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.

An approach to neuroleptic malignant syndrome from a clinical case

IntroductionNeuroleptic malignant syndrome (NMS) takes place in patients in treatment with neuroleptics and it is potentially lethal, being important an early diagnostic and therapeutic approach.ObjectivesTo analyze from a clinical case the clinical and epidemiological features, and therapeutical approach to NMS.MethodReview of some articles in Mental Health journals and analysis of the following clinical case: 68-year-old woman with bipolar disorder, hospitalized in manic phase. Usual treatment: lithium, trazodone, quetiapine and asenapine. During the admission to hospital, the patient started presenting hyperthermia, sweating, electrolyte disturbances, limb rigidity, and elevation of CPK levels. The suspicion was NMS, so neuroleptics were stopped and fluids and dantrolene were initiated, with favorable evolution.ResultsThe discharge diagnosis was NMS. Neuroleptics were gradually reintroduced under vigilance. The patient is stable and has not had new complications. NMS is an uncommon (0.02% to 3% among patients taking neuroleptic agents), but life-threatening condition. Its symptoms are hyperthermia, autonomic nervous system dysfunction, limb rigidity, altered consciousness… The attendant infections, consume of lithium, dehydration, iron deficiency and sharp changes in neuroleptic treatment are predisposing factors. The withdrawal of neuroleptics is the key of the treatment. Benzodiazepines can improve the prognosis, and electroconvulsive therapy can be necessary if there is no response to previous measures.ConclusionsNeuroleptic malignant syndrome is a life-threatening medical complication we should try to avoid by a correct and careful use of neuroleptics. Additionally, it is important the early treatment, taking withdrawal of neuroleptics as the key starting point.Disclosure of interestThe authors have not supplied their declaration of competing interest.