Clinical Parameters In Patients Research Articles

Predictive Power of the Fried Phenotype in Assessing Postoperative Outcomes in Patients Undergoing Craniotomy for Tumor Resection.

Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor. This retrospective cohort analysis included patients with Current Procedural Terminology codes for supratentorial/infratentorial tumor resections and preoperative frailty scores. Chart review collected the remaining variables for the primary outcome, length of stay (LOS), and secondary outcomes, discharge disposition and postoperative complications. Basic descriptive statistics summarized patient demographics, clinical parameters, and postoperative outcomes. χ2 tests, t-tests, and ANOVA examined associations and mean differences. Logistic and Poisson regressions explored predictor-outcome relationships. Over 7 years, these 153 patients underwent Fried assessments. The Fried score was biased toward females being more frail (nonfrail 38.0% female, prefrail 50.0% female and frail 65.6% female, P = .027) but not by age, body mass index, or tumor type. The mFI-11 was biased by age (nonfrail 67.8 years vs frail 72.3 years, P < .001) and body mass index (nonfrail 27.5 vs frail 30.8, P < .001) but not sex or tumor type. The Fried score was significantly correlated with increased LOS's (odds ratio [OR] = 5.92, 95% CI = 1.66-21.13, P < .001) but the mFI-11 was not (OR = 0.82, 95% CI = 0.35-1.93, P = .64). The Fried phenotype was significantly correlated with discharge disposition location (P = .016), whereas the mFI-11 was not (P = .749). The Fried score was significantly correlated with postoperative complications (OR = 1.36, 95% CI = 1.08-1.71, P = .01), whereas the mFI-11 was not (OR = 1.10, 95% CI = 0.86-1.41, P = .44). The Fried phenotype more accurately correlates with postoperative outcomes including LOS, discharge disposition location, and complications than does the mFI-11 score. These findings can be used to guide preoperative planning, inform consent, and potentially identify patients who may benefit from functional optimization in the preoperative period to improve postoperative outcomes.

Pilot Study on the Effect of Patient Condition and Clinical Parameters on Hypoxia-Induced Factor Expression: HIF1A, EPAS1 and HIF3A in Human Colostrum Cells

Hypoxia-inducible factor 1 (HIF-1) may play a role in mammary gland development, milk production and secretion in mammals. Due to the limited number of scientific reports on the expression of HIF genes in colostrum cells, it was decided to examine the expression of HIF1A, HIF3A and EPAS1 in the these cells, collected from 35 patients who voluntarily agreed to provide their biological material for research, were informed about the purpose of the study and signed a consent to participate in it. The expression of HIF genes was assessed using qPCR. Additionally, the influence of clinical parameters (method of delivery, occurrence of stillbirths in previous pregnancies, BMI level before pregnancy and at the moment of delivery, presence of hypertension during pregnancy, presence of Escherichia coli in vaginal culture, iron supplement and heparin intake during pregnancy) on the gene expression was assessed, revealing statistically significant correlations. The expression of HIF1A was 3.5-fold higher in the case of patients with the presence of E. coli in vaginal culture (p = 0.041) and 2.5 times higher (p = 0.031) in samples from women who used heparin during pregnancy. Approximately 1.7-fold higher expression of the EPAS1 was observed in women who did not supplement iron during pregnancy (p = 0.046). To our knowledge, these are the first studies showing the relationship between HIF expression in cells from breast milk and the method of delivery and health condition of women giving birth. The assessment of HIF expression requires deeper examination in a larger study group, and the results of further studies will allow to determine whether HIF can become biomarkers in pregnancy pathology states.

Medial Tibial Condylar Valgus Osteotomy improve clinical outcomes and effectively corrects significant Tibial varus deformities without compromising joint line obliquity or patellar heigh

BackgroundTibial condylar valgus osteotomy (TCVO), or Chiba osteotomy, is a recognized procedure for treating advanced knee osteoarthritis in middle-aged individuals. Although its effectiveness is established, limited literature exists on its outcomes for specific conditions such as post-traumatic deformities, Blount disease (BD), and Pagoda-like proximal tibia varus deformities. HypothesisWe hypothesized that TCVO could improve both clinical and radiographic outcomes in patients with severe varus deformities, correcting lower-limb variances while preserving joint line obliquity (JLO) and patellar height in substantial varus deformities. Patients and methodsThis study included 33 patients who underwent TCVO, with etiologies including post-traumatic (26 patients, 78.8%), Blount disease (4 patients, 12.1%), and Pagoda deformities (3 patients, 9.1%). The average age was 32.5 years (standard deviation = 12.8 years). Techniques for deformity correction varied, including Patient Specific Instrumentation (PSI) for 10 patients (30.3%) and locking plate fixation for 13 patients (39.4%). We assessed several radiological parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), Caton-Deschamps index (CDI), and proximal posterior tibial angle (PPTA). Patient-reported outcomes, including the Knee injury and Osteoarthritis Outcome Score (KOOS) and simple knee value (SKV), were recorded both pre-operatively and two years post-operatively. ResultsStatistically significant improvements were observed in clinical scores and alignment changes two years post-operatively, including increases in HKA (from 166.1 to 178.4, p < .0001) and MPTA (from 72.4 to 85.1, p < .0001), and a decrease in JLO (from 9.8 to 3.2, p < .0001). No significant changes were noted in JLCA, PPTA, and CDI, with the patellar height remaining stable post-operatively. The achieved corrections closely matched the pre-operative plans. ConclusionTCVO offers significant improvements in radiological and clinical parameters for patients with substantial tibial varus deformities, effectively maintaining JLO and patellar height. Optimal outcomes from TCVO are dependent on careful patient selection and precise execution of surgical techniques. Level of evidenceIII.

SEND-PD in Parkinsonian Syndromes: Results of a Monocentric Cross-Sectional Study.

Neuropsychiatric symptoms in particular impair health-related quality of life (QoL) of patients with Parkinson's disease and atypical Parkinsonian syndromes. For this reason, various scales have been developed for detection of neuropsychiatric symptoms, such as the Scale for evaluation of neuropsychiatric disorders in Parkinson's disease (SEND-PD). First, the objective of this study was to explore the interrelation between the SEND-PD and clinical parameters in patients with Parkinson's disease and thus confirm its validity. In addition, the applicability in a well-defined cohort of patients with atypical Parkinsonian syndromes was investigated for the very first time. A clinically well-defined cohort of 122 patients with Parkinson's disease (PD), 55 patients with Progressive Supranuclear Palsy (PSP) and 33 patients with Multiple System Atrophy (MSA) were analyzed. First, the SEND-PD was correlated with established disease-specific scores in patients with PD. Next, the results of the SEND-PD were compared between the different Parkinsonian syndromes. The SEND-PD showed a strong significant correlation with several scores, especially the UPDRS I (Rho = 0.655) and GDS-15 (Rho = 0.645). Depressive burden was significantly higher in MSA patients in comparison to the PD patient cohort (PD, 3.8 ± 3.3; MSA, 5.45 ± 3.87), while PSP patients showed significantly less psychotic (PD 1.6 ± 2.1; PSP 0.6 ± 0.9) and impulse control disorders (PD 0.3 ± 1.0; PSP 0.02 ± 0.1). The SEND-PD is a useful, brief and highly applicable screening tool for neuropsychiatric symptoms in PD, but not in atypical Parkinsonism, as their unique neuropsychiatric symptom composition is not fully captured.

Evaluating the clinical utility of cervical cultures in postpartum endometritis management.

To evaluate the utility of cervical cultures in the diagnosis and management of postpartum endometritis. A retrospective study was conducted on 1069 cervical cultures collected from postpartum women with suspected endometritis between 2011 and 2021. Patient demographics, obstetric history, clinical parameters, and culture results were analyzed. Microorganisms were categorized into five groups based on species and virulence. Statistical analysis was performed to identify associations between risk factors, pathogens, and disease severity. The positivity rate for distinct microorganisms in cervical cultures was 33.1%. Escherichia coli (10.8%) and Group B Streptococcus (7.5%) were the most common isolates. Prolonged labor duration and prolonged rupture of membranes were associated with Enterobacterales infections. Elevated white blood cell count was linked to Enterobacterales and beta-hemolytic Streptococci, while the former were also associated with higher rate of postpartum clinic visit. No significant differences in disease severity were found between other microorganism groups. The study suggests that while cervical cultures can identify potential pathogens in postpartum endometritis, their clinical utility is questionable due to the polymicrobial nature of the disease and the isolation of commensal microorganisms. The lack of significant differences in disease severity across various microorganism groups raises questions regarding the contribution of distinct bacterial identification in endometritis management.

Interleukin-6 Receptor Gene rs1800795 Polymorphism and Expression of Interleukin-6 in Gingival Tissue in Patients with Periodontitis.

Periodontitis is a multifactorial inflammatory disease. This chronic periodontal disease is caused by a bacterial infection in the gums, which triggers a host inflammatory response. To eliminate the bacterial infection, immune response mechanisms are activated, leading to inflammation and damage to the periodontal tissues. This process involves many cytokines, including IL-6, a cytokine with antibacterial properties. An ongoing bacterial infection in the periodontal tissues leads to its excessive production, which increases inflammation. In this study, we examined IL-6 receptor gene rs1800795 polymorphism in patients with periodontitis in comparison with healthy subjects, as well as the correlation between rs1800795 genotypes and clinical parameters. Additionally we examined the expression of IL-6 in gingival tissue in patients with periodontitis and control subjects, as well as the correlation between gingival expression of IL-6 and clinical parameters. This study included 200 patients with periodontitis and 158 healthy subjects as the control group. Biopsy specimens of gingival tissue in which IL-6 expression was detected were taken from 14 patients with periodontitis and 8 controls who had undergone minor surgery. There were no statistically significant differences in the distribution of IL-6 rs1800795 genotypes and alleles between patients with periodontitis and control subjects. There were also no statistically significant correlations between IL-6 rs1800795 genotypes and clinical parameters in patients with periodontitis. There were no differences in IL-6 expression in the gingival tissue between patients with periodontitis and controls. There was also no correlation between IL-6 expression in the gingival tissue of patients with periodontitis and clinical parameters. In the control group, IL-6 expression in gingival tissue correlated negatively with the approximal plaque index, which reflects the size of bacterial plaques. The results of our study suggest a protective role for IL-6 against bacterial growth in the periodontal tissue. However, it should be noted that several parameters directly or indirectly affect the accumulation of bacterial plaque.

Clinical course and demographic insights into suicide by self-poisoning: patterns of substance use and socio-economic factors.

To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning. This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age. 1090 patients were included, 727 (67%) were females, median age was 39 years (min-max: 13-91) with 603 (55%) aged 18-44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vsn = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vsn = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vsn = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vsn = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vsn = 205 females, 28.2%; p < 0.001). These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances.

Orbital Adipose Tissue: The Optimal Control for Back-Table Fluorescence Imaging of Orbital Tumors.

Control tissue is essential for ensuring the precision of semiquantitative analysis in back-table fluorescence imaging. However, there remains a lack of agreement on the appropriate selection of control tissues. To evaluate the back-table fluorescence imaging performance of different normal tissues and identify the optimal normal tissue, a cohort of 39 patients with orbital tumors were enrolled in the study. Prior to surgery, these patients received indocyanine green (ICG) and following resection, 43 normal control tissues (34 adipose tissues, 3 skin tissues, 3 periosteal tissues, and 3 muscle tissues) were examined using back-table fluorescence imaging. The skin tissue demonstrated significantly elevated fluorescence intensity in comparison to the diseased tissue, whereas the muscle tissue exhibited a broad range and standard deviation of fluorescence signal intensity. Conversely, the adipose and periosteum displayed weak fluorescence signals with a relatively consistent distribution. Additionally, no significant correlations were found between the signal-to-background ratio (SBR) of adipose tissue and patients' ages, genders, weights, disease duration, tumor origins, dosing of administration of ICG infusion, and the time interval between ICG infusion and surgery. However, a positive correlation was observed between the SBR of adipose tissue and its size, with larger adipose tissues (>1 cm) showing an average SBR 27% higher than smaller adipose tissues (≤1 cm). In conclusion, the findings of this study demonstrated that adipose tissue consistently exhibited homogeneous hypofluorescence during back-table fluorescence imaging, regardless of patient clinical variables or imaging parameters. The size of the adipose tissue was identified as the primary factor influencing its fluorescence imaging characteristics, supporting its utility as an ideal control tissue for back-table fluorescence imaging.

Changes in ceramide concentrations and their association with clinical and anamnestic parameters in patients with acute coronary syndrome

Background. Given the metabolic dynamics of acute coronary syndrome (ACS), the study of molecular lipid metabolites is of particular importance because their composition most rapidly reflects the changes occurring at the time of the acute event. Several prospective studies have demonstrated the prognostic value of ceramides, however, the study of their dynamics and association with clinical parameters of patients with ACS is underrepresented. Objective. To investigate changes in Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:0), and Cer(d18:1/24:1) ceramide concentrations and their association with clinical and anamnestic parameters in patients with ACS. Design and methods. Lipidomic analysis by high-performance liquid chromatography tandem mass spectrometry was performed among 110 patients with ACS. Results. At admission to the hospital the ceramide level was the highest and decreased with time (for all p &lt; 0.001). The peculiarities of ceramide concentrations depending on clinical and anamnestic parameters of patients with ACS are shown. Ceramides were found to be weakly correlated with age and high-sensitivity troponin I, and moderately correlated with lipid profile at different time periods. For the first time, information on Cer(d18:1/16:0) and Cer(d18:1/24:0) levels depending on disease debut, Cer(d18:1/16:0) concentration depending on duration of the pain attack, and Cer(d18:1/18:0) level depending on the presence of family history of cardiovascular disease is presented. Conclusion. The dynamics of ceramide concentrations over time and the peculiarities of their levels depending on the clinical and anamnestic parameters of patients with ACS expand the understanding of the importance of lipid metabolites.

Clinical Factors That Influence Repeat 68Ga-PSMA-11 PET/CT Scan Positivity in Patients with Recurrent Prostate Cancer Under Observation After a Negative 68Ga-PSMA-11 PET/CT Scan: A Single-Center Retrospective Study.

This analysis aimed to identify clinical factors associated with positivity on repeat 68Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 68Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann-Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2-1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9-3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative 68Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat 68Ga-PSMA-11 PET/CT.

Clinical Case Series on Assessment of Therapeutic Efficacy of Saroglitazar in MASLD Patients

Objective: This prospective case series aimed to evaluate the efficacy of saroglitazar 4 mg in improving clinical parameters in patients with type 2 diabetes mellitus (T2DM) with steatotic liver disease (SLD), focusing on glycemic control, lipid profile, liver enzymes, and transient elastography parameters (CAP and LSM scores). Materials and Methods: Eight T2DM patients having SLD; defined as Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) were enrolled from a single-center, Dr. Dang’s Clinic, Ghaziabad, Uttar Pradesh India. Saroglitazar 4 mg was administered daily, and various clinical parameters were monitored at baseline, 16 weeks, and 32 weeks. Statistical analysis was performed using paired t-tests to assess changes over time. Results: Saroglitazar treatment significantly reduced HbA1c, Triglycerides (TG), Alanine aminotransferase (ALT), transient elastography parameters (CAP and LSM) along with other lipid and glycemic parameters from baseline to weeks 32. These findings underscore potential role of saroglitazar in managing T2DM and associated SLD by improving metabolic parameters and liver health. Conclusion: Saroglitazar showed significant improvements in glycemic control, lipid profile, liver enzymes, liver fat and fibrosis in MASLD patients, indicating its potential as a therapeutic option for managing metabolic abnormalities and liver complications. Further research is needed to validate these findings.

Serum Adiponectin Levels Increase in Acute Ischemic Stroke and Correlate with Patients' Outcomes: A Pilot Study.

Stroke is a leading cause of death and severe disability worldwide. Rapid diagnosis is critical to ensure the timely administration of medical treatment. Given that in some cases CT scans fail to show the classic clinical signs of stroke, we aimed to evaluate the diagnostic capacity of adiponectin levels and their association with the clinical parameters of patients with acute ischemic stroke (AIS). Adiponectin was measured within 24 h (T1) and 48 h (T2) of AIS onset in 70 patients. A total of 68 control cases were included in the study. Adiponectin levels were significantly higher in the AIS patients than in the controls (16.64 (3.79; 16.69) vs. 3.78 (3.79; 16.69); p < 0.001), with an accuracy of 0.98 (AUC = 0.99). Lower levels were seen in males and in AIS patients with obesity. Higher levels of adiponectin at T1 were associated with a moderate/severe NIHSS score at patient discharge. Moreover, higher levels of borderline significance were seen in patients who died within 12 months of their AIS episode (p = 0.054). Adiponectin may be a useful biomarker for the identification of AIS patients who do not present classic CT signs and could be used to stratify severe cases. Further studies are needed to validate these results.

Construction and validation of clinical prediction model of tongue base collapse under drug-induced sleep endoscopy in OSA patients

Objective: To analyze the correlation between drug-induced sleep endoscopy (DISE), results, polysomnography (PSG) indicators, and clinical parameters in patients with obstructive sleep apnea (OSA), and to establish and validate a predictive model for tongue base plane obstruction. Methods: This retrospective study analyzed 117 OSA patients diagnosed via PSG and treated at the Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, between October 2014 and March 2022. The cohort comprised of 114 males and 3 females, with an age range of 20 to 54 years (mean age 38.1±8.4 years). Data on DISE results, PSG results, and clinical indicators were collected for all 117 patients. Logistic regression analysis was performed to identify relevant indicators, and a predictive model for tongue base plane obstruction was constructed and internally validated using the R programming language. Results: Univariate logistic regression analysis identified four independent risk factors for predicting tongue root plane obstruction: tonsil grading, N2, N3, and rapid eye movement sleep(REM) stage [OR:0.412(0.260~0.652),1.045(1.012~1.079),0.943(0.903~0.984),0.961(0.925~0.998),P <0.05]. Multivariate logistic regression analysis confirmed tonsil grading and N3 sleep stage (12.48±12.22%) as significant predictors. A nomogram model incorporating these factors demonstrated good predictive performance, with an area under curve(AUC) of 0.82 (95%CI: 0.548-1.000), an optimal cutoff of 0.519, a specificity of 80.0%, and a sensitivity of 86.7%. Internal validation of the model in the validation cohort yielded an AUC of 0.751 (95%CI: 0.625-0.876). Conclusions: Tongue base plane obstruction observed during DISE in OSA patients is associated with tonsil grading and N3 sleep stage duration. The predictive model developed for tongue base plane obstruction based on DISE demonstrates good efficacy, as evidenced by its internal validation.

The Predictors of Spontaneous Coronary Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction at the West Nusa Tenggara General Hospital

Background: In ST-segment elevation myocardial infarction (STEMI) management, some patients undergo spontaneous coronary reperfusion (SCR) with a better prognosis than those without SCR, but predictors for SCR remain unclear. Objective: To investigate several potential predictors of SCR, including smoking status, BMI, DAPT loading time, hemoglobin levels, platelet count, random blood sugar levels, uric acid levels, creatinine clearance, and the Syntax score. Material and Methods: This case-control study was conducted at the West Nusa Tenggara General Hospital in Indonesia from December 2022 to September 2023. Data collection encompassed various patient demographics and clinical parameters, including name, medical record number, age, gender, smoking status, BMI, DAPT loading time, hemoglobin levels, platelet count, random blood sugar, uric acid, creatinine clearance, the Syntax score, and the occurrence of SCR. Statistical analysis for this study involved multivariate logistic regression analysis. Result: A total of thirty-two patients were included, evenly divided into 16 subjects allocated to the SCR group and 16 to the non-SCR group. The analysis indicated that only BMI demonstrated a statistically significant association with SCR occurrence. However, the study did not yield conclusive evidence regarding the influence of smoking status, DAPT loading time, hemoglobin levels, platelet count, random blood sugar levels, uric acid levels, creatinine clearance, and the Syntax score on the likelihood of SCR. Conclusion: A normal BMI is identified as a robust predictor for the incidence of SCR in patients diagnosed with STEMI. Keyword: Predictors, Spontaneous Coronary Reperfusion, ST-Segment Elevation Myocardial Infarction.

Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records.

Malnutrition is a critical concern in ICU settings. It is associated with increased morbidity and mortality, yet its prevalence and impact on clinical outcomes in patients with stroke and traumatic brain injury (TBI) remain underexplored. To evaluate the prevalence and impact of malnutrition risk on clinical outcomes in ICU patients with TBI, ischemic stroke, and hemorrhagic stroke, and to identify key risk factors associated with malnutrition risk. This retrospective cohort study utilized electronic health records encompassing ICU admissions from 2017 to 2023. Patients with either stroke or TBI were included, with malnutrition risk assessed using the prognostic nutritional index. Data were extracted and analyzed to determine patient characteristics, clinical and laboratory parameters, and outcomes. This study included 1352 patients (267 TBI, 825 ischemic stroke, and 260 hemorrhagic stroke patients, >30% with pneumonia at admission). Severe malnutrition risk at admission was observed in over 60% of patients. Stroke patients, particularly those with hemorrhagic stroke, exhibited a higher risk of malnutrition compared to TBI patients. Malnutrition risk was associated with significantly higher hospital mortality and increased need for mechanical ventilation. Predictive factors for malnutrition risk included advanced age, higher SOFA scores, lower FOUR and GCS scores, and the presence of pneumonia at admission. Risk of malnutrition is highly prevalent among ICU patients with TBI, ischemic, and hemorrhagic stroke, significantly impacting mortality and other clinical outcomes. Identifying and managing malnutrition early in the ICU setting is crucial for improving patient outcomes. Further prospective, multicenter studies are needed to validate these findings and develop effective interventions.

Differential Diagnosis of Pathological Type of Peripheral Lung Cancer with Multimodal Contrast-Enhanced Ultrasound

ObjectiveThe goal of the work described here was to investigate the role of multimodal contrast-enhanced ultrasound in the differential diagnosis of peripheral lung cancer. MethodsFrom April 2017 to July 2021, 109 patients with confirmed pulmonary malignant lesions who underwent CEUS examination were involved in our study. Seven patients were excluded because of the short duration of CEUS video or unsatisfactory imaging. Finally,102 patients with peripheral lung cancer were enrolled in this study. The maximum diameter of the lesions ranged from 1.6 to 13.0 cm (mean 6.2 ± 2.3 cm). On the basis of the pathological results, the patients were divided into the small cell lung cancer (SCLC) group and non-small cell lung cancer (NSCLC) group (including adenocarcinoma, lung squamous cell carcinoma and large cell neuroendocrine carcinoma). A Logiq E9 ultrasonic machine equipped with a 3.5 to 5.0 MHz C5-1 probe was used. Patient clinical information, CEUS features, CPI patterns and TIC parameters were analyzed and compared between different groups. Statistical analyses were performed with SPSS software and MedCalc software. The receiver operating characteristic curve was plotted. ResultsIn the differential diagnosis of SCLC and NSCLC, color parametric imaging indicated great performance. NSCLC exhibited a centripetal enhancement pattern more frequently (72.7%), while SCLC exhibited an eccentric enhancement pattern more frequently (92.9%) (p < 0.001). In the differential diagnosis of adenocarcinoma and squamous cell carcinoma, logistic regression analysis revealed that patient age of onset ≤60 y, difference in arrival time between lung and tumor ≤3.8 s, drop time of the time–intensity curve >23.2 s and absence of internal necrosis on CEUS were independent predictors for adenocarcinoma (area under the curve = 0.861). ConclusionIn our study, multimodal contrast-enhanced ultrasound provided useful information in the differential diagnosis between small cell lung cancer and non-small cell lung cancer, especially between adenocarcinoma and squamous cell carcinoma.

Impact of nebulization versus metered-dose inhaler utilization on viral particle dispersion in patients with COVID-19

Background Conflicting guidance exists regarding the characterization of nebulization as an aerosol-generating procedure and subsequent risk of transmission of SARS-CoV-2 to healthcare workers. Aim/Objective This study sought to address whether SARS-CoV-2 viral load distribution was impacted by bronchodilator delivery via nebulizer versus metered-dose inhaler (MDI). Methods Adults infected with COVID-19 were enrolled and received a single dose of albuterol sulfate nebulized solution (2.5 mg/3 mL via breath-actuated nebulizer with filtered mouthpiece) or albuterol sulfate hydrofluoroalkane inhalation aerosol (90 µg/actuation; two puffs via MDI with spacer) in a randomized crossover sequence. Air and surfaces were sampled at predefined locations within patients’ hospital rooms to assess SARS-CoV-2 dispersion over three periods (baseline, MDI, and nebulizer). Findings/Results Eleven patients received crossover therapy. Six patients had detectable SARS-CoV-2 RNA during one treatment period ( n = 3 each for MDI and nebulizer) and one during both treatment periods. No viral RNA was found in the rooms of four (36.4%) patients. Overall, few environmental samples (17/397; 4.3%) contained detectable viral RNA, with no meaningful differences in positivity rate across periods; RNA genome copy numbers were low in positive samples. No correlation between dispersion and patient clinical status or environmental parameters was observed. Discussion In this first prospective trial evaluating viral load distribution following use of nebulizer versus MDI in hospitalized patients with COVID-19, low environmental contamination was found regardless of administration method. Findings support the use of either device when needed to treat patients with COVID-19.

Comprehensive assessment of the results of zorba dance-based rehabilitation in patients after myocardial infarction

Abstract Introduction Dance movement engages global muscle sequences of the human body, improves physical performance, and helps reduce stress and excessive muscle tension. Dance exercises allow you to better control your movement and muscles. Zorba Greek dancing as a form of physical activity brings benefits in the form of improved mental health, well-being and quality of life. Rehabilitation may contribute to improving cardiorespiratory fitness and mental condition in the group of patients after myocardial infarction. Aim of the study The aim of the study was to evaluate a rehabilitation program based on Zorba dance on selected clinical parameters in patients after myocardial infarction. Materials and methods The study included 99 patients after myocardial infarction who were rehabilitated for 5 weeks. Patients were enrolled into two groups. Group I (50 patients) performed cycle ergometer training and the Greek dance Zorba. Group II (49 patients) performed cycle ergometer training and rehabilitation exercises. At the beginning and after rehabilitation, patients' BMI, balance (scales: Tinetti, Berg, 30CST), gait (6MWT), psychophysical status (SF-36, WHO-5, FCIS), and breathlessness (mMRC scale) were assessed. Results After undergoing rehabilitation, there was a reduction in BMI (I vs. II p&amp;lt;0.01), improvement in balance on the Tinetti (I vs. II p&amp;lt;0.01) and Berg scale (I vs. II p&amp;lt;0.01), improvement in the 30CS test score (I vs. II p= 0.018), improvement in WHO-5 (I vs. II p&amp;lt; 0.01), and reduction in dyspnea (mMRC) (I vs. II p&amp;lt; 0.01) in the Zorba group. Conclusions Both methods of rehabilitation improve functional efficiency; However, rehabilitation with the use of Zorba dance additionally improves balance in patients after myocardial infarction.

Experience and prognostic analysis with avelumab switch maintenance treatment in metastatic urothelial carcinoma.

Avelumab is approved for metastatic urothelial carcinoma (mUC) maintenance therapy and prolongs overall survival (OS). We explored trends related to avelumab treatment of mUC patients. A total of 72 patients with mUC treated with first-line chemotherapy, from January 2019 to November 2022, at our affiliated institutions, were analyzed. We compared clinical parameters and the prognosis of patients treated with avelumab (Ave; n=43), because of progression during first-line chemotherapy, with untreated patients (Ave-untreated; n=29). Among the Ave-treated group, we classified patients showing a complete or partial response or stable disease in their best response to avelumab maintenance therapy as avelumab (Ave)-suitable patients; these were retrospectively analyzed. Potential prognostic factors, including the geriatric nutritional risk index (GNRI) for determining patients suitable for Ave, were evaluated. The basic clinical parameters of patients when first-line treatment was initiated were not statistically different between the two groups. The Ave-suitable group (median 26.6 months, 95% confidence interval [CI]: 19.4-not reached [NR]) showed significantly longer median OS after first-line treatment than the Ave-untreated group (median 12.0 months, 95% CI: 7.5-NR) with tolerable adverse events. The cut-off values of prognostic factors were set by receiver operating characteristic curve. Low age and GNRI sustainability revealed as significant prognostic factors for being Ave-suitable both in univariate and multivariate analysis. In mUC, avelumab maintenance prolonged OS within tolerable safety profiles. GNRI sustainability may be used as biomarker to predict being Ave-suitable.

Prognostic Factors in Idiopathic Sudden Sensorineural Hearing Loss: The Experience of Two Audiology Tertiary Referral Centres.

Background and Objectives: Although different hypotheses have been proposed over time, there is a dearth of information on factors able to predict the response to treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) and hearing recovery. The aim of this study was to apply univariate and multivariate statistical models in a retrospective clinical setting of patients given therapy for ISSNHL at our tertiary academic audiological centers to investigate the prognostic value of clinical signs, symptoms, and comorbidities in relation to hearing recovery. Materials and Methods: The inclusion criteria were: history of ISSNHL diagnosed and treated at the Padova or Modena tertiary academic audiological centers; age ≥ 18 years; availability of clinical and audiological outcome data. The exclusion criteria were: hearing loss in acoustic schwannoma, endolymphatic hydrops, meningitis, trauma (head trauma, temporal bone fracture, acoustic trauma), barotrauma, perilymphatic fistula; exposure to noise levels ≥ 80 dB in the work environment; any unilateral or bilateral hearing loss (except for presbycusis) prior to ISSNHL diagnosis; any disorders affecting the external or middle ear; any previous ear surgery; refusal to make medical data available for research purposes. Eighty-six consecutive patients (38 females, 48 males; median age: 58 years; interquartile range: 47.00-69.00 years) were included. A systemic steroid therapy was administered to all patients, either orally with prednisone or intravenously with methylprednisolone. Second-line therapy included intratympanic steroid injections and/or hyperbaric oxygen therapy. Results: A multivariate logistic regression model was used, including the non-multicollinear clinical and audiological variables, which showed a p-value < 0.10 at the univariate analyses (namely age at diagnosis, time to diagnosis, oral steroid dose, and PTA on the affected side). Only PTA on the affected side retained its statistical significance (OR: 1.0615, 95% CI: 1.0185-1.1063, p = 0.005). Conclusions: The analysis of our data showed an association between the hearing threshold before treatment and the recovery from ISSNHL. Further studies on larger cohorts (especially in a prospective setting) are needed to shed more light on the prognostic role of clinical parameters in patients with ISSNHL. In a correct counseling setting, with regard to the patient's concern about not being able to recover hearing, it is important to offer perspectives of appropriate hearing rehabilitation approaches.