Blood Of Patients Research Articles

Abstract PO4-24-10: Prognostic role of SOX2 and STAT3 expression on circulating T lymphocytes and CD44+/CD24neg cells in the locally advanced and metastatic breast cancer

Abstract Introduction: Breast cancer (BC) is associated with a continuous increase in incidence, with high mortality rates in several countries. There are four immunophenotypes of BC, luminal A, luminal B, triple negative (TN), and HER2+. Some proteins in tumor cells and the tumor microenvironment are part of tumorigenesis and metastases. The CD44 molecule is considered an important marker of the inflammatory response. CD44 is present in all leukocytes and on the surface of tumor stem cells, involving tumor invasion and metastasis. Some authors have demonstrated that the signal transducer and activator of transcription 3 (STAT3) and sex-determining region Y-related group box 2 (SOX2) are related to the regulation of somatic cell division and tumorigenesis and metastasis in BC. Aim: To evaluate SOX2 and STAT3 expression on circulating T lymphocytes and CD44+/CD24neg cells in locally advanced and metastatic breast cancer. Methods: A cross-sectional study was conducted at the Hospital de Cancer de Pernambuco (HCP) and the Translational Research Laboratory of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from March 2017 to April 2018. Sixty-five women diagnosed with breast cancer participated in this study, aged between 28 and 64. Of these, 51 women had stage III (locally advanced) breast tumors, and 14 with metastatic disease (stage IV). There were 24 healthy women aged 18 to 65 as a control group. The analysis of CD44, SOX2, and STAT3 expression was performed by flow cytometry. Results: elevated levels of CD44+/CD24neg cells and CD44+/CD24neg/SOX2+ cells were observed in the blood of BC patients with luminal B, HER2+, and TN compared to the control group (p< 0.0001). Low CD44+/CD24neg/STAT3+ levels in the patient's blood compared to the control group. Elevated CD44+/CD24neg and CD44+/CD24neg/STAT3+ cells were observed in locally advanced BC compared to metastatic group (p < 0.05). Patients with TNBC had elevated SOX2+T lymphocyte levels compared to luminal B and HER2+ subtypes groups (p< 0.05). HER2+ patients had low levels of T lymphocytes and SOX2+T cells compared to controls and luminal A groups (p < 0.05). High levels of total T cells (p=0.0007) and low SOX2+T lymphocytes (p=0.02) in locally advanced compared to metastatic disease (stage IV). Elevated levels of SOX2+T lymphocytes in patients with negative lymph nodes (N0) compared to N1 and N2 groups (p=0.004 and p < 0.0001, respectively). High levels of CD44+/CD24negSTAT3+ cells and T lymphocytes and low levels of STAT3+T lymphocytes in locally advanced TN subtype (stage III) compared to metastatic (stage IV). Conclusion: SOX2 and STAT3 expression on circulating T lymphocytes and CD44+/CD24neg cells in peripheral blood are prognostic roles in breast cancer. SOX2 and STAT3 expression are potential predictive biomarkers of disease progression in breast cancer regardless of tumor subtype. Investigating these biomarkers in peripheral blood has some advantages because peripheral blood collection is less invasive, easy to access, and allows evaluation at diagnosis, during treatment, and in cases of recurrence. Citation Format: Denise Viana, Victor Andrade, Marcelo Salgado, Carolina Vasconcelos, Leuridan Torres. Prognostic role of SOX2 and STAT3 expression on circulating T lymphocytes and CD44+/CD24neg cells in the locally advanced and metastatic breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-24-10.

Web-based Deep Learning System for Malaria Parasite Detection in Granular Blood Samples

Abstract: Malaria is a serious health concern for modern humans, affecting people of all ages. Infected mosquitoes carry the fatal parasites responsible for malaria. Malaria can be diagnosed by examining a sample of the patient's blood under a microscope for parasites. The project comprises creating a web tool that employs deep learning to detect malaria parasites in blood smear photos. Convolutional neural network (CNN) models such as ResNet50, VGG19, and Customized CNN can be used to collect and categorize a set of blood smear images in order to identify patterns and characteristics. Convolutional layers, maxpooling layers, entirely linked layers, and a SoftMax layer are all utilized to create a Convolutional Neural Network (CNN) model. This technique can improve the accuracy of parasite diagnosis, increase detection rates, and reduce the disease's impact on global health.

A Case of Hypertensive Retinopathy With Papilledema Manifested as Blurry Vision, Headache, and Dizziness in a Patient With a Recent Diagnosis of Peritoneal Tuberculosis

Hypertension poses significant risks to various organ systems, including the eyes, leading to target-organ damage known as hypertensive retinopathy (HR). This case report explores the case of a 60-year-old male presenting with blurred vision, headache, and dizziness, ultimately diagnosed with grade IV hypertensive retinopathy. The patient had a complex medical history including hypertension, dyslipidemia, ischemic heart disease, diabetes mellitus, and peritoneal tuberculosis, with recent initiation of anti-tuberculosis therapy. Differential diagnoses encompassed various ocular and systemic conditions, highlighting the importance of a thorough evaluation. Fundoscopic examination revealed bilateral papilledema and flame hemorrhages consistent with hypertensive retinopathy. Management involved meticulous blood pressure control and ophthalmological referral. Collaboration between healthcare providers facilitated comprehensive care. Following treatment, the patient's blood pressure improved, necessitating adjustments in antihypertensive medications. This case underscores the critical role of recognizing ocular manifestations in hypertensive patients and the need for interdisciplinary management to mitigate systemic morbidity and mortality. Ongoing research is crucial to enhance diagnostic and therapeutic strategies for hypertensive retinopathy, ensuring optimal patient outcomes.

The USCENTCOM Walking Blood Bank Performance Benchmark and Anticipated Benefit of Universal Low Titer Type O Screening.

The walking blood bank (WBB) is a system for emergency blood acquisition from nearby donors if a patient's blood needs exceed the immediate supply. USCENTCOM medical units will perform a walking blood bank if immediate blood requirements exceed the local supply. A benchmark WBB performance time was needed to provide a training goal for military WBB exercises. An expeditionary WBB performance time benchmark was created from prospective measurements of USCENTCOM medical unit performance times over 9months. The mean total time, and new performance benchmark, for a WBB in USCENTCOM was 41.4min +/- 13.2min. USCENTCOM time from donor arrival to a transfusable unit mean time was 34.4 +/- 12.1min. Expeditionary medical units conducting a WBB should expect to meet or exceed the provided benchmark.

Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008-2021.

Candidemia, linked to high mortality rates, requires prompt antifungal therapy for better outcomes. Treatment is structured as an action bundle, which is beneficial when followed closely. However, the Japanese action bundle lacks detailed guidance on severe complications like endocarditis or ocular issues. To address this, we adjusted the action bundle and assessed outcomes with and without AFT intervention. We strengthened protocols for blood cultures and organ assessments, and the AFT contacted the primary physician when yeast-like fungi were detected in the patient's blood culture bottles. Analyzing 204 candidemia cases from 2008-2021, we observed increased adherence and reduced mortality post-AFT intervention. Ophthalmology consultations rose significantly, but many patients had only one visit, suggesting inadequate follow-up. If endophthalmitis is diagnosed, a change in the treatment approach may be necessary. There is a possibility that abnormal ocular findings will be detected during subsequent visits, which highlights the need for improvement in ophthalmology follow-up rates as a future challenge for our AFT activities.

Structural Characterization of a Pathogenic Antibody Underlying Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but dangerous side effect of adenoviral-vectored COVID-19 vaccines. VITT had been linked to production of autoantibodies recognizing platelet factor 4 (PF4). Here, we characterize anti-PF4 antibodies obtained from a VITT patient's blood. Intact mass measurements indicate that a significant fraction of these antibodies represent a limited number of clones. MS analysis of large antibody fragments (the light chain and the Fc/2 and Fd fragments of the heavy chain) confirms the monoclonal nature of this component of the anti-PF4 antibodies repertoire and reveals the presence of a mature complex biantennary N-glycan within the Fd segment. Peptide mapping using two complementary proteases and LC-MS/MS was used to determine the amino acid sequence of the entire light chain and over 98% of the heavy chain (excluding a short N-terminal segment). The sequence analysis allows the monoclonal antibody to be assigned to the IgG2 subclass and verifies that the light chain belongs to the λ-type. Incorporation of enzymatic de-N-glycosylation into the peptide mapping routine allows the N-glycan in the Fab region of the antibody to be localized to the framework 3 region of the VH domain. This novel N-glycosylation site is the result of a single mutation within the germline sequence. Peptide mapping also provides information on lower-abundance (polyclonal) components of the anti-PF4 antibody ensemble, revealing the presence of all four subclasses (IgG1-IgG4) and both types of the light chain (λ and κ). This case study demonstrates the power of combining the intact, middle-down, and bottom-up MS approaches for meaningful characterization of ultralow quantities of pathogenic antibodies extracted directly from patients' blood.

Autologous Blood-Derived Products (ABDPs) for the Treatment of Chronic Wounds.

Autologous blood-derived therapies have emerged as a unique and promising treatment option for chronic wounds. From whole blood clots to spun-down clot constituents, these therapies are highly versatile and tend to have a lower cost profile, allow for point-of-service preparation, and inherently carry minimal to no risk of rejection or allergic reaction when compared to many alternative cellular and matrix-like products. Subsequently, a diversity of processing systems, devices, and kits have surfaced on the market for preparing autologous blood-derived products (ABDPs) and many have demonstrated preclinical and clinical efficacy in facilitating chronic wound healing. However, not all ABDPs are created equal, and the lack of standardization among product formulations and cell concentrations as well as varying complexities in preparation protocols has led to unreliable substrate viabilities and overall inconsistent conclusions on efficacy. Additionally, external factors, such as the ease of drawing blood, the health of a patient's blood, and the reimbursement landscape have dissuaded some practitioners from incorporating ABDPs into an algorithm of care for recalcitrant wounds. Here, we attempt to categorize ABDPs into "classes" and examine their efficacy, advantages, and limitations when used as both a primary therapy and an adjunct for treating chronic wounds as well as comment on some potential considerations that may help gear future product development and application.

Multiple sclerosis endophenotypes identified by high-dimensional blood signatures are associated with distinct disease trajectories.

One of the biggest challenges in managing multiple sclerosis is the heterogeneity of clinical manifestations and progression trajectories. It still remains to be elucidated whether this heterogeneity is reflected by discrete immune signatures in the blood as a surrogate of disease pathophysiology. Accordingly, individualized treatment selection based on immunobiological principles is still not feasible. Using two independent multicentric longitudinal cohorts of patients with early multiple sclerosis (n = 309 discovery and n = 232 validation), we were able to identify three distinct peripheral blood immunological endophenotypes by a combination of high-dimensional flow cytometry and serum proteomics, followed by unsupervised clustering. Longitudinal clinical and paraclinical follow-up data collected for the cohorts revealed that these endophenotypes were associated with disease trajectories of inflammation versus early structural damage. Investigating the capacity of immunotherapies to normalize endophenotype-specific immune signatures revealed discrete effect sizes as illustrated by the limited effect of interferon-β on endophenotype 3-related immune signatures. Accordingly, patients who fell into endophenotype 3 subsequently treated with interferon-β exhibited higher disease progression and MRI activity over a 4-year follow-up compared with treatment with other therapies. We therefore propose that ascertaining a patient's blood immune signature before immunomodulatory treatment initiation may facilitate prediction of clinical disease trajectories and enable personalized treatment decisions based on pathobiological principles.

Metapneumovirus infection in children in modern conditions: clinical and immunological parallels

Aim. The study of metapneumovirus infection clinical and immunological features in children of different ages. Patients and methods. An analysis of 22 patients with mono-metapneumovirus infection is presented. There were 7 (31.8%) children under the age of 1 year, 8 (36.4%) — 1—3 years old, 7 (31.8%) — 4—7 years old. Diagnosis of metapneumovirus infection was based on clinical data and on PCR analysis of nasopharyngeal mucus. Immunological studies in 10 patients included immunophenotype of patient's blood lymphocytes and analysis of the interferon system. Results. Among children under the age of 1 year 71.4 ± 17.1% were diagnosed with obstructive bronchitis and 28.6 ± 17.1% had pneumonia. In patients aged 1—3 years pneumonia was observed more often (55.6 ± 17.6%), obstructive bronchitis — less often (33.3 ± 16.7%), and in 11.1 ± 11.1% bronchitis occurred without symptoms of bronchial obstruction. In children aged 4—7 years only the upper respiratory tract was affected in 14.3 ± 13.2% of cases, 57.1 ± 18.7% developed bronchitis and 28.6 ± 17.1% — pneumonia. The immune system state was characterized by a low content of T-helpers (CD3 + CD4 + ) and NK-cells (CD3-CD16 + CD56 + ) detected in 7 (70%) and 5 (50%) patients respectively. IFNγ production was reduced in 70% of children and IFNα in 80%. Conclusion. Metapneumovirus infection in children in modern conditions is characterized by the frequent development of inflammatory changes in the bronchopulmonary system in the early stages of the disease. The disease severity was due to both manifestations of respiratory failure and severe symptoms of intoxication. Immunological studies revealed changes in the cellular link and the interferon system in all age groups.

Cardiac Tamponade Caused By Carbon Dioxide Insufflation During Robot-Assisted Thoracic Surgery: A Case Report.

Various complications can occur during robot-assisted thoracic surgery for mediastinal tumors owing to carbon dioxide (CO2) insufflation. This study reports the case of a 43-year-old woman who underwent robot-assisted surgery for an anterior mediastinal tumor with the subxiphoid approach. Shortly after starting CO2 insufflation, the blood pressure decreased significantly. Subsequent examination of the mediastinum revealed a left-sided pericardial injury. Cardiac tamponade due to entry of CO2 gas into the pericardial cavity was suspected. A deliberate incision was made in the right pericardium, ultimately resolving the cardiac tamponade and substantially improving the patient's blood pressure.

Predicting hypertension control using machine learning.

Hypertension is a widely prevalent disease and uncontrolled hypertension predisposes affected individuals to severe adverse effects. Though the importance of controlling hypertension is clear, the multitude of therapeutic regimens and patient factors that affect the success of blood pressure control makes it difficult to predict the likelihood to predict whether a patient's blood pressure will be controlled. This project endeavors to investigate whether machine learning can accurately predict the control of a patient's hypertension within 12 months of a clinical encounter. To build the machine learning model, a retrospective review of the electronic medical records of 350,008 patients 18 years of age and older between January 1, 2015 and June 1, 2022 was performed to form model training and testing cohorts. The data included in the model included medication combinations, patient laboratory values, vital sign measurements, comorbidities, healthcare encounters, and demographic information. The mean age of the patient population was 65.6 years with 161,283 (46.1%) men and 275,001 (78.6%) white. A sliding time window of data was used to both prohibit data leakage from training sets to test sets and to maximize model performance. This sliding window resulted in using the study data to create 287 predictive models each using 2 years of training data and one week of testing data for a total study duration of five and a half years. Model performance was combined across all models. The primary outcome, prediction of blood pressure control within 12 months demonstrated an area under the curve of 0.76 (95% confidence interval; 0.75-0.76), sensitivity of 61.52% (61.0-62.03%), specificity of 75.69% (75.25-76.13%), positive predictive value of 67.75% (67.51-67.99%), and negative predictive value of 70.49% (70.32-70.66%). An AUC of 0.756 is considered to be moderately good for machine learning models. While the accuracy of this model is promising, it is impossible to state with certainty the clinical relevancy of any clinical support ML model without deploying it in a clinical setting and studying its impact on health outcomes. By also incorporating uncertainty analysis for every prediction, the authors believe that this approach offers the best-known solution to predicting hypertension control and that machine learning may be able to improve the accuracy of hypertension control predictions using patient information already available in the electronic health record. This method can serve as a foundation with further research to strengthen the model accuracy and to help determine clinical relevance.

Periportal Edema as an Extrarenal Manifestation of Acute Pyelonephritis.

Acute pyelonephritis is a common infection of the upper urinary tract that affects approximately 250,000 adults in the United States. Individuals with acute pyelonephritis require hospitalization and intravenous antimicrobial therapy. Diagnoses of acute pyelonephritis are made on the basis of clinical and laboratory findings. Individuals with complex or severe acute pyelonephritis undergo contrast-enhanced computed tomography (CT) for the diagnosis and assessment of perirenal abnormalities. However, extrarenal manifestations, such as periportal edema and gallbladder wall thickening, may complicate the diagnostic process. We report the case of a 42-year-old woman who presented with fever, dysuria, and flank pain-the hallmarks of urosepsis. CT results confirmed acute pyelonephritis accompanied by periportal edema and elevated levels of hepatic enzymes and C-reactive protein. Despite antibiotic intervention, febrile episodes persisted for 4 days and abated over a fortnight. The patient's blood and urine cultures yielded negative results, which may be attributed to her prior antimicrobial treatment. Recognition of extrarenal signs in acute pyelonephritis is crucial for obtaining accurate diagnoses and understanding their clinical implications.

A novel approach to retrograde autologous priming for infant, pediatric and adult populations undergoing congenital heart surgery.

Retrograde Autologous Priming (RAP) of cardiopulmonary bypass (CPB) circuits is an effective way to reduce prime volume, commonly through the transfer of prime into separate reservoirs or circuit manipulation. We describe a simple and safe technique for RAP without the need for any circuit modifications or manipulations. For this technique, a separate roller pump for ultrafiltration (UF) is used. After adequate heparinization and arterial cannulation, the UF pump is initiated slowly, removing prime through the effluent of the UF, replacing with the patient's blood from the aortic cannula. Once the arterial line and UF circuit are autologous primed, the arterial head displaces reservoir crystalloid toward the UF circuit at a flow rate equal to the UF pump, displacing the crystalloid prime with blood from the UF circuit, autologous priming the boot and oxygenator with blood, crystalloid again being removed by the effluent. After venous cannulation, the venous line prime is replaced with autologous blood, the crystalloid removed by the effluent of the UF circuit via the arterial head. During RAP, if the patient becomes hypovolemic, either autologous volume is transfused back to the patient, or CPB is initiated, without the need for circuitry modifications. The patient population in this sample consisted of 63 patients ranging between 6.1kg and 115.6kg. The smaller the patient, the less blood volume available for RAP and therefore the less prime volume able to be removed. Overall percent removal increases as our patients size increases compared to total circuit volume. This RAP technique is a safe and effective way to achieve a standardized asanguinous prime for many regardless of patient or circuit size in the absence of contraindications such as low starting hematocrit, emergency surgery or physiologic instability. Most importantly, this potentially reduces the amount of hemodilution patients see from CPB initiation and therefore the lowest nadir hematocrit and consequently the amount of required homologous blood products needed during surgery.

Detection of Germline Mosaicism for Robertsonian Translocation 14;14: A Case Report

Background: Chromosomal structural rearrangements can lead to fertility problems and recurrent miscarriages. The intricate interplay of genetics during human development can lead to subtle anomalies that may affect reproduction.
 Case Presentation: A 33-year-old woman sought fertility treatment after experiencing six miscarriages. Products of conception from the final pregnancy loss had been karyotyped, revealing a Robertsonian translocation (RT), involving chromosome 14. Fertility investigations showed low anti-Mullerian hormone (AMH) levels but otherwise normal female characteristics with normal sperm parameters of her husband were observed and both partners having a normal karyotype. Two embryos were transferred in an IVF cycle but neither resulted in a successful pregnancy. Subsequently, preimplantation genetic testing for aneuploidy (PGT-A) was applied to trophectoderm biopsy specimens from 4 embryos, which revealed abnormalities involving chromosome 14. Sperm aneuploidy testing failed to detect any increase in the incidence of aneuploidy affecting chromosome 14. Further embryos genetic testing indicated that all identified chromosome 14 abnormalities in the embryos had a maternal (oocyte) origin.
 Conclusion: This case underscores challenges in diagnosing and managing germline mosaicism in fertility. A maternal 14;14 Robertsonian translocation, undetected in the patient's blood but impacting oocytes, likely explains recurrent miscarriage and observed embryo aneuploidies. Genetic mosaicism in reproductive medicine highlights the necessity for advanced testing and personalized treatments. Data integration from various genetic analyses could enhance managing treatment expectations and improving fertility experiences.

Unattended automatic blood pressure measurements versus conventional office readings in predicting hypertension-mediated organ damage.

Hypertension is a leading cardiovascular risk factor. Accurate blood pressure measurement is pivotal in hypertension diagnosis and management. Conventional office measurements (OBP) are error-prone, exacerbated by the white coat effect. Unattended automated office blood pressure measurement (UAOBP) is emerging as an alternative, mitigating the white coat effect. However, its ability to predict hypertension-mediated organ damage (HMOD) remains disputable. This study compares UAOBP with OBP in terms of their association with various HMODs, including left ventricular hypertrophy, left atrial enlargement, left ventricular systolic and diastolic dysfunction, intima-media complex thickening, microalbuminuria and abnormal pulse wave velocity. A total of 219 hypertensive patients were recruited, interviewed, and examined. Subsequently, blood pressure measurements were conducted in a randomized manner: 1) UAOBP: after 5 minutes of solitary rest in the examination room, the patient's blood pressure was automatically measured three times at 1-minute intervals. 2) OBP: after 5 minutes of rest, a physician performed three consecutive blood pressure measurements at 1-minute intervals. Subsequent evaluations aimed to detect HMODs, including echocardiography, carotid artery ultrasound, pulse wave velocity assessment, and laboratory tests. The blood pressure values in UAOBP were significantly lower than those in OBP (mean (SD) 124.7 (14.4) vs. 128.2 (14.2) mmHg, P <0.001 for systolic, and 73.3 (10.2) vs. 75.2 (10.6) mmHg, P <0.001 for diastolic). Correlation and ROC curve analyses revealed no method's superiority in predicting HMOD. The UAOBP did not prove superior in predicting HMOD compared to OBP, Further research is warranted to determine the role of UAOBP in clinical practice.

Evaluation of common carotid artery wall stiffness by shear wave elastography in smokers and non-smokers.

Smoking is one of the most important preventable causes of cardiovascular diseases. Vascular disease caused by smoking is associated with vascular endothelial damage, platelet aggregation, and adhesion. In our study, we examined the effect of chronic smoking on vessel wall stiffness in smokers and control group by measuring carotid artery wall stiffness by shear wave ultrasonography. Sixty-two smokers of similar ages and genders, and 67 people who never smoked in the last ten years were included as the control group in this cross-sectional study. Arterial wall stiffness over the common carotid arteries of all participants was measured by shear wave elastography (SWE). In addition, each patient's blood pressure, fasting blood glucose, body mass index (BMI), HDL and LDL cholesterol measurements were recorded. Arterial wall stiffness values in smokers were found to be statistically significantly higher than in non-smokers. The mean of SWE measurements of the smokers was 47.3 ± 6.2 kPa, and that of the control group was 42.9 ± 4 kPa. The mean values of HDL and LDL of the smokers were 46.9 ± 5.6 mg/dL and 147.3 ± 9.3 mg/dL, respectively, and those of the control group were 50.3 ± 5.1 mg/dL and 136.9 ± 5.9 mg/dL. The LDL cholesterol values were statistically significantly higher in smokers compared to the control group, and HDL cholesterol values were statistically significantly lower in smokers. In our study, the arterial wall stiffness values measured by the SWE technique were higher in smokers than non-smokers.

Long Suffering Type 1 Diabetes Mellitus During Metabolic Acidosis on Positiveness of Ketones in Urine Patients

Examination of ketones in the patient's urine and measuring the patient's blood sugar level will determine whether there will be metabolic acidosis in patients with type 1 diabetes mellitus, which is a metabolic disorder that can be caused by various etiologies, such as chronic hyperglycemia due to impaired insulin secretion or impaired insulin action. alone. Diabetes Mellitus type 1 itself is more caused by reduced insulin secretion due to damage to pancreatic -cells. This study was conducted to examine ketones in urine on the duration of suffering from type 1 diabetes mellitus when metabolic acidosis occurs Data collection in this study was carried out by accidental sampling method by researchers to collect secondary and primary data on urine ketones in patients with metabolic acidosis. Based on research that has been done, data obtained from 34 patients with type 1 diabetes mellitus at the Sigerongan Health Center, as many as 8 patients with positive results of urine ketones with a prevalence of +2 totaling 3 people and +3 totaling 5 people. Judging from the high level of glucose (hyperglycemia) that is &gt; 200 mg/dl and the positivity of ketone bodies in the patient's urine as a sign of metabolic acidosis. With a long-susceptibility to suffer from diabetes mellitus 1-5 years and above. The results of measuring ketone levels in the patient's urine show that there is no relationship with the duration of suffering from diabetes mellitus in the urine but blood sugar levels.

Identification of a murder caused by brodifacoum poisoning based on clinical examinations and LC-MS/MS results.

Brodifacoum exerts its antagonistic effect against the metabolism of vitamin K, an essential component in the synthesis of blood coagulation factors. This effect ultimately hinders the blood's capacity to clot effectively, rendering it a commonly employed rodenticide. Instances of lethal poisonings are exceedingly rare owing to expeditious medical intervention and treatment. Within this report, we present a case of brodifacoum-induced homicide, wherein the patient exhibited distinct clinical examinations and symptoms. Moreover, the patient's blood sample exhibited a noteworthy brodifacoum concentration of 0.681µg/mL even after a period of 43 days following the incident of poisoning. Although an autopsy was not conducted due to religious restrictions, we endeavor to reasonably deduce the cause of death and furnish corroborative evidence for clinical diagnosis, treatment, and forensic examination in instances involving brodifacoum poisoning.

Balancing efficacy and adverse reactions using everolimus in a patient with metastatic malignant insulinoma: Case report.

Malignant insulinoma is a rare neuroendocrine tumor responsible for excessive insulin secretion and life-threatening hypoglycemia episodes. Computed tomography (CT) of the abdomen can identify a pancreatic tumor corresponding to insulinoma. Loco-regional metastases define the metastatic cases. The first-line therapeutic approach is surgery, while other medical treatments like diazoxide and everolimus play also a role. These treatments have shown efficacy in regulating blood glucose and, to some extent, controlling tumor progression. We present the case of a 48-year-old female who was admitted for severe hypoglycemia episodes. She presented neuroglycopenic symptoms without any other clinical features. High levels of C-peptide and insulin during severe hypoglycemia confirmed the presence of endogenous hyperinsulinism. The CT scan of the abdomen confirmed the existence of an insulinoma along with several hepatic metastases. Surgery was proposed as a first-line approach. However, due to the persistent occurrence of severe hypoglycemia episodes, other treatment options were necessary such as diazoxide and everolimus. Diazoxide caused a significant improvement in the patient's blood glucose levels. Nonetheless, glycemic control was unsustainable, obligating the switch to everolimus, which showed better control of blood glucose levels with challenging management due to the appearance of grade 3 stomatitis as a side effect. The patient died 1 year after the diagnosis due to tumor progression. Balancing the benefits of enhanced glycemic control with the difficulties posed by side effect management of everolimus underscores the need to carefully consider both efficacy and potential adverse events.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Definition of Patient Blood Management

Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context.