Potential Life-threatening Conditions Research Articles

Determinants of potential life-threatening maternal conditions (PLTCs) in Tigray, northern Ethiopia: a case‒control study

Globally, potentially life-threatening maternal conditions (PLTCs) are significant public health threats. Ethiopia had the highest prevalence of PLTC (17.55%). However, there is limited evidence on the determinants that increase the occurrence of PLTC in Ethiopia. Therefore, this study aimed to identify determinants of the PLTC in Tigray, northern Ethiopia. A case‒control study was carried out between January 21 and April 20, 2024. Data were collected from 1027 participants (341 cases and 686 controls) through interviews and card reviews. Bivariate and multivariate logistic regression analyses were performed via SPSS version 24 to identify factors associated with the PLTC. In this study, variables such as having no formal education (AOR: 2.78; 95% CI 1.50–5.15), not in a marital union (AOR: 4.33; 95% CI 1.23–15.23), alcohol intake during pregnancy (AOR: 1.77; 95% CI 1.13–2.76), a history of stillbirth (AOR: 3.02; 95% CI 1.81–5.04), twin birth (AOR: 2.24; 95% CI 1.03–4.86), chronic hypertension (AOR: 11.37; 95% CI 3.71–34.88), prior cesarean section (CS) (AOR: 2.40; 95% CI 1.27–4.50), malaria during pregnancy (AOR: 4.10; 95% CI 1.25–13.45), not taking foliate (AOR: 4.10; 95% CI 1.25–13.45), induced labor (AOR: 7.33; 95% CI 4.31–12.47), and CS delivery (AOR: 2.39; 1.59–3.6) were increased risk of PLTC. However, completing recommended prenatal care visits (AOR: 0.59; 95% CI 0.41–0.86) was associated with lower odds of developing PLTC. Therefore, governmental and nongovernmental organizations, programmers, and healthcare providers should use the underlying evidence for the prevention and management of the PLTC.

Management of Sideline Medical Emergencies.

Sideline medical care is typically provided by musculoskeletal specialists and orthopaedic surgeons with varying levels of training and experience. While the most common sports injuries are often benign, the potential for catastrophic injury is omnipresent. Prompt recognition of sideline emergencies and expeditious medical management are necessary to minimize the risk of calamitous events. Paramount to successful sideline coverage are both preseason and game-day preparations. Because the skillset needed for the sideline physician may involve management of injuries not commonly seen in everyday clinical practice, sideline providers should review basic life support protocols, spine boarding, and equipment removal related to their sport(s) before the season begins. Before every game, the medical bag should be adequately stocked, location of the automatic external defibrillator/emergency medical services identified, and introductions to the trainers, coaches, and referees made. In addition to musculoskeletal injuries, the sideline orthopaedic surgeon must also be acquainted with the full spectrum of nonmusculoskeletal emergencies spanning the cardiopulmonary, central nervous, and integumentary systems. Familiarity with anaphylaxis as well as abdominal and neck trauma is also critical. Prompt identification of potential life-threatening conditions, carefully orchestrated treatment, and the athlete's subsequent disposition are essential for the team physician to provide quality care.

Mothers’ choice of health management services for under-five children with common illnesses: evaluating social workers’ impact in Nigerian health sector

ABSTRACT Introduction Every child deserves the right to life. In Nigeria like other African countries, a high burden of child mortality prevails. Attaining a low-mortality rate of children entails that mothers who are the primary caregivers are in the best position to provide quality healthcare management. Method With the phenomenological approach in qualitative research, the researchers sourced data using Focus Group Discussions (FGDs) and In-Depth Interviews (IDI) from 38 mothers of various categories. The participants were purposively selected from four government and mission health institutions in a semi-urban Nsukka town, Enugu State. Data were analyzed thematically. Findings Results revealed that mothers utilize health institutions including government, mission, private, pharmacies and patent medicine vendors when seeking healthcare for their children. Their inability to recognize potential life-threatening conditions is the leading factor in increasing child mortality. Findings show that because participants were concerned about financial challenges; they were ready to adopt traditional medicine as an alternative to modern medicine. The study showed evidence of unsafe strategies mothers adopt for the health management of their under-five children with common illnesses. Participants indicated little knowledge of social workers’ engagement in health institutions. Conclusion Healthy living is essential in the protection from illnesses. Since under-five children are vulnerable to illnesses, their mothers should provide them with quality healthcare management. The study recommends that social workers’ engagement with health providers and users in semi-urban societies could help propagate healthcare awareness and strategies in mothers’ choice of health management for under-five children in Nigeria. Overall, adequate health policy consideration should be given to all under-five children in Nigeria.

Understanding “danger signs” in healthcare: A concept analysis

Introduction: Danger signs are specific indicators signaling potential serious or life-threatening health conditions, crucial for prompt intervention in healthcare settings. Recognizing these signs can be challenging due to variations in cultural perceptions and individual interpretations. Additionally, danger signs are context-dependent, requiring awareness and contextual analysis. This complexity is amplified when dealing with abstract or non-physical signs. Understanding and consistently applying the concept of danger signs is essential for effective healthcare delivery. Method: This paper utilized Walker and Avant's eight-step concept analysis method, offering a systematic and structured approach for defining and understanding concepts. The method promotes clarity, precision, and thorough exploration of the concept's relationships with others, enhancing comprehensive understanding within its context. Result: Conceptually, danger signs represent a broad array of indicators signaling potential harm or imminent risk. Through analysis, this paper defines danger signs operationally as objective, measurable cues that are context-dependent, indicating the presence of a potential negative outcome. Conclusion: This paper contributes to existing knowledge by identifying danger sign attributes, reducing ambiguity and facilitating clearer application in health specialties training. The enhanced clarity also allows for the development of more precise tools to assess competence in danger sign identification.

Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria

BackgroundThe inclusion of electrocardiogram (ECG) in medical examinations for sports practice serves as a valuable tool for identifying potential life-threatening conditions during physical exercise. However, its applicability in young individuals remains a subject of controversy, primarily due to relatively high rates of false positives and the associated costs of further investigations. Furthermore, the validation of International Criteria for athletes below 12 years of age in optimizing pre-participation screening for young athletes is yet to be established. In light of these considerations, this study aims to describe the prevalence of ECG findings in a sample of children and young-adolescent athletes aged 11–16 years, employing refined Seattle interpretation criteria. Additionally, we seek to compare these findings based on age group and sex. MethodsThis was a retrospective and observational study of 3747 athletes 11–16 year-olds. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. The primary outcome measure was abnormal ECG findings according to the International Recommendations for Electrocardiographic Interpretation in Athletes. ResultsAmong the evaluated population of pediatric and young adolescent athletes (77.5% boys; >99% Caucasian), the vast majority exhibited normal electrocardiogram (ECG) results, with adaptive findings related to sports participation being more frequent among young adolescents and males. The presence of significant ECG abnormalities in young-adolescent athletes was uncommon (2.05%; 1.92% children and 2.32% young-adolescent) and required additional examinations. 0.27% of the total population were diagnosed with a previously unknown cardiac pathology only through the ECG. ConclusionsThis study provides valuable insights into the prevalence of normal, borderline, and abnormal electrocardiogram (ECG) findings in a large population of pediatric and young-adolescent athletes. These findings serve as guidance in detecting potentially serious cardiac alterations within this specific group, considering variations based on age and sex. The study confirms that ECG screening is a useful tool for identifying cardiac abnormalities in pediatric and young-adolescent athletes, even though the prevalence of significant findings in this population is relatively low. Furthermore, our findings support the utilization of the refined Seattle criteria as a sensitive and specific technique for screening pediatric and young-adolescent athletes, further enhancing the accuracy of ECG-based evaluations.

A Reservoir Computing with Boosted Topology Model to Predict Encephalitis and Mortality for Patients with Severe Fever with Thrombocytopenia Syndrome: A Retrospective Multicenter Study.

Severe fever with thrombocytopenia syndrome virus (SFTSV) is an emerging tick-borne virus associated with a high rate of mortality, as well as encephalitis. We aim to develop and validate a machine learning model to early predict the potential life-threatening conditions of SFTS. The clinical presentation, demographic information, and laboratory parameters from 327 patients with SFTS at admission in three large tertiary hospitals in Jiangsu, China between 2010 to 2022 are retrieved. We establish a reservoir computing with boosted topology (RC-BT) algorithm to obtain the models' predictions of the encephalitis and mortality of patients with SFTS. The prediction performances of encephalitis and mortality are further tested and validated. Finally, we compare our RC-BT model with the other traditional machine learning algorithms including Lightgbm, support vector machine (SVM), Xgboost, Decision Tree, and Neural Network (NN). For the prediction of encephalitis among patients with SFTS, nine parameters are selected with equal weight, namely calcium, cholesterol, muscle soreness, dry cough, smoking history, temperature at admission, troponin T, potassium, and thermal peak. The accuracy for the validation cohort by the RC-BT model is 0.897 [95% confidence interval (CI) 0.873-0.921]. The sensitivity and negative predictive value (NPV) of the RC-BT model are 0.855 (95% CI 0.824-0.886) and 0.904 (95% CI 0.863-0.945), respectively. Area under curve of the RC-BT model for the validation cohort is 0.899 (95% CI 0.882-0.916). For the prediction of fatality among patients with SFTS, seven parameters are selected with equal weight, namely calcium, cholesterol, history of drinking, headache, field contact, potassium, and dyspnea. The accuracy of the RC-BT model is 0.903 (95% CI 0.881-0.925). The sensitivity and NPV of the RC-BT model are 0.913 (95% CI 0.902-0.924) and 0.946 (95% CI 0.917-0.975), respectively. The area under curve is 0.917 (95% CI 0.902-0.932). Importantly, the RC-BT models outperform the other artificial intelligence-based algorithms in both prediction tasks. Our two RC-BT models of SFTS encephalitis and fatality demonstrate high area under curves, specificity, and NPV, with nine and seven routine clinical parameters, respectively. Our models can not only greatly improve the early prognosis accuracy of SFTS, but can also be widely applied in underdeveloped areas with limited medical resources.

Vertigo in the Elderly: A Systematic Literature Review.

Background: Dizziness and vertigo are among the most prevalent complaints in the elderly and have a major negative influence on (i) the perception of the quality of life; and (ii) the risk of falling. Due to population aging, particularly in wealthy nations, vertigo represents a growing issue and a serious public health concern. In order to approach the patient correctly and to offer the best treatment options, it is mandatory to identify vertigo's underlying causes. The aim of this paper was to identify the different etiologies of vertigo and possibly their frequency in the elderly population, by reviewing the scientific literature of the last decade (2012-2022). Methods: A systematic review was performed according to PRISMA guidelines, searching the Medline database from January 2012 through to December 2022. The search identified 1025 candidate papers, but after the application of specific selection criteria, only five were considered for further analysis. Results: A total of 2148 elderly patients (60-90 y old) presenting with vertigo were reported in the selected papers. A total of 3404 conditions were identified as the cause of vertiginous symptoms, (some patients presented multiple etiologies). All major diagnoses were categorized into different subgroups: the most common origin of vertigo was represented by audio-vestibular disorders (28.4%), followed by cardiovascular (20.4%) and neurological diseases (15.1%). Furthermore, 9.1% of patients were diagnosed with psychiatric conditions, whilst ophthalmologic and musculoskeletal disorders accounted for 7.5% and 6.3% of the cases respectively. Medication adverse effects and metabolic-related diseases were also considered among the causes. For 3.4% of cases the etiology remains unclear. Conclusions: Audio-vestibular disorders represent the most frequent cause of vertigo in the elderly. The etiologies affecting the vertigo patient must be defined in order to identify potential life-threatening conditions, such as cardiovascular and neurological disorders, which according to the data of this review constitute the second and third common causes of vertigo. A multidisciplinary strategy, involving different specialists (such as ENTs, Neurologists, Cardiologists, Geriatricians) is recommended for the correct assessment of these disorders.

When Knowledge Is Not Enough

When Knowledge Is Not Enough

Phenotypic heterogeneity and genotypic spectrum of inborn errors of immunity identified through whole exome sequencing in a Thai patient cohort.

Inborn errors of immunity (IEI) comprise more than 400 rare diseases with potential life-threatening conditions. Clinical manifestations and genetic defects are heterogeneous and diverse among populations. Here, we aimed to characterize the clinical, immunologic, and genetic features of Thai pediatric patients with IEI. The use of whole-exome sequencing (WES) in diagnosis and clinical decision making was also assessed. Thirty six unrelated patients with clinical and laboratory findings consistent with IEI were recruited from January 2010 to December 2020. WES was performed to identify the underlying genetic defects. The median age of disease onset was 4months (range: 1month to 13years), and 24 were male (66.7%). Recurrent sinopulmonary tract infection was the most common clinical presentation followed by septicemia and severe pneumonia. Using WES, we successfully identified the underlying genetic defects in 18 patients (50%). Of the 20 variants identified, six have not been previously described (30%). According to the International Union of Immunological Societies (IUIS), 38.9% of these detected cases (7/18) were found to harbor variants associated with genes in combined immunodeficiencies with associated or syndromic features (Class II). The diagnostic yield of WES in this patient cohort was 50%. Six novel genetic variants in IEI genes were identified. The clinical usefulness of WES in IEI was demonstrated, emphasizing it as an effective diagnostic strategy in these genetically heterogeneous disorders.

Hypoalbuminemia on admission in COVID-19 infection: An early predictor of mortality and adverse events. A retrospective observational study

ObjectivesHypoalbuminemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. The aim of this study was to analyze the value of hypoalbuminemia on admission as a predictor of mortality and adverse events in COVID-19 patients. MethodsWe analyzed retrospective data from a cohort of 609 consecutive patients, with confirmed diagnosis of COVID-19, discharged from hospital (deceased or alive). Demographic characteristics, previous comorbidities, symptoms and laboratory findings on admission were collected. Comorbidities were assessed by Charlson-Age Comorbidity Index. ResultsHypoalbuminemia on admission (<34g/L) was more frequent in nonsurvivors than survivors (65.6% vs. 38%, p<0.001) and was significantly associated with the development of sepsis, macrophage activation syndrome, acute heart failure, acute respiratory distress syndrome and acute kidney injury, regardless of Charlson-Age Comorbidity Index. Hypoalbuminemia was a predictor of mortality in multivariable Cox regression analysis (HR 1.537, 95% CI 1.050–2.250, p=0.027), independently of Charlson-Age Index, gender, lymphocyte count <800/μL, creatinine, high-sensitivity C- reactive protein >8mg/L, lactate dehydrogenase >250U/L, bilateral infiltration on chest X-ray and q-SOFA ≥2. ConclusionsHypoalbuminemia was an early predictor of in-hospital mortality in COVID-19, regardless of age, comorbidity and inflammatory markers. It also had significant association with severe adverse events, independently of Charlson-Age Comorbidity Index. Our results suggest that serum albumin determination on admission may help to identify patients with SARS-CoV-2 infection at high risk of developing potential life-threatening conditions and death.

Hypoalbuminemia on admission in COVID-19 infection: An early predictor of mortality and adverse events. A retrospective observational study

ObjectivesHypoalbuminemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. The aim of this study was to analyze the value of hypoalbuminemia on admission as a predictor of mortality and adverse events in COVID-19 patients. MethodsWe analyzed retrospective data from a cohort of 609 consecutive patients, with confirmed diagnosis of COVID-19, discharged from hospital (deceased or alive). Demographic characteristics, previous comorbidities, symptoms and laboratory findings on admission were collected. Comorbidities were assessed by Charlson-Age Comorbidity Index. ResultsHypoalbuminemia on admission (<34g/L) was more frequent in nonsurvivors than survivors (65.6% vs. 38%, p<0.001) and was significantly associated with the development of sepsis, macrophage activation syndrome, acute heart failure, acute respiratory distress syndrome and acute kidney injury, regardless of Charlson-Age Comorbidity Index. Hypoalbuminemia was a predictor of mortality in multivariable Cox regression analysis (HR 1.537, 95% CI 1.050–2.250, p=0.027), independently of Charlson-Age Index, gender, lymphocyte count <800/μL, creatinine, high-sensitivity C- reactive protein >8mg/L, lactate dehydrogenase >250U/L, bilateral infiltration on chest X-ray and q-SOFA ≥2. ConclusionsHypoalbuminemia was an early predictor of in-hospital mortality in COVID-19, regardless of age, comorbidity and inflammatory markers. It also had significant association with severe adverse events, independently of Charlson-Age Comorbidity Index. Our results suggest that serum albumin determination on admission may help to identify patients with SARS-CoV-2 infection at high risk of developing potential life-threatening conditions and death.

Value of point-of-care ultrasonography compared with computed tomography scan in detecting potential life-threatening conditions in blunt chest trauma patients

BackgroundUltrasonography is a suitable modality that can potentially improve patient care, saving time and lives.PurposeThis article has evaluated the caveats and pitfalls of point-of-care ultrasonography in the diagnosis of pneumothorax, hemothorax and contusion.Materials and methodsThis prospective study was performed in 157 patients with blunt chest trauma in 3 university hospitals. Ultrasonography was performed by 2 board-certified emergency medicine specialists and an emergency medicine resident PGY-3 after passing the training process successfully.ResultsThe false-negative cases were not significantly correlated with accompanying traumatic injuries. Lung ultrasonography accompanied by chest physical examination show accuracy 91.8. Point-of-care ultrasonography (PoCUS) showed sensitivity 75.0%, specificity 100%, positive-predictive value (PPV) of 100% and a negative-predictive value (NPV) of 94.9% for the diagnosis of pneumothorax. For hemothorax, bedside PoCUS had a sensitivity of 45.4%, specificity of 100%, PPV of 100% and NPV of 91.8%. PoCUS was assessed 58.1% sensitive and 100% specific for detecting lung contusion with positive-predictive value (PPV) of 100% and a negative-predictive value (NPV) of 86.3%. Performing US resulted in no false-positive cases.ConclusionsPoint-of-care ultrasonography was highly sensitive to detect pneumothorax and can be beneficial for the disposition of stable patients and to detect PTX in unstable patients before transferring to the operating room. It is also moderately appropriate for the diagnosis of hemothorax and lung contusion compared to the gold standard, CT scan. It is essential to consider the false-negative and false-positive instances of lung ultrasound in various situations to enhance management and disposition of blunt thoracic injuries.

Assessing Delay in Receiving Adequate and Appropriate Treatment: A Client Perspective among Women Admitted to Emergency Obstetric Hospitals of Ethiopia

Background: In Ethiopia, the maternal death is still unacceptably high, but instead of women dying in their 'hovels', they die in hospitals. For improving quality of medical care in obstetric emergencies, appropriate timing is extremely important and key to reduce maternal mortality. The aim of the study was to assess delay in receiving adequate and appropriate treatment for women faced emergency obstetric complications admitted to emergency room on five referral hospitals of Ethiopia. Methods: Facility based Cross-sectional study was conducted on five referral hospitals of Ethiopia. Mixed of health facilities (university and non-university hospitals) that provide specialized obstetric care and perform a minimum number of 1,000 deliveries per year was considered. Women faced obstetric complications and fulfill world Health Organizations Criteria for potential life-threatening conditions was included in the study. A total of 360 study subjects were sampled. Samples was proportionally allocated to each facilities based on their clients flow and systematic random sampling technique was used to select study subjects. Data was collected using exist interview and from maternal cards. Data was analyzed using SPSS software. Multivariable analysis was conducted using logistic regression; variables with the largest p-value of 0.2 in bivariable analysis were included. Result: The mean age of the respondent was 30 year with standard deviation of (SD , ± 6). Out of the total sampled, 60% of them faced obstetric complications at home. Even though, the time of getting appropriate treatment for a women faced obstetric complications vary from complication to complication they faced, but the median time were 1.10 hours. About 49 percent of women faced obstetric complications were delayed to get appropriate treatment which was above the median time. Of which, one in six women were delayed to received appropriate treatment because of training issues. women who got information about emergency obstetric complications were two times more likely to reduce delay in receiving appropriate treatment than women who did not get the information (AOR: 2.09, 95% CI, 1.0-4.36). Conclusion : About 49 percent of women were delayed in receiving appropriate treatment, and women who were got information about emergency obstetric complications were got appropriate treatment on time. Therefore referral hospitals of Ethiopia, are recommended to check there liaison system and emergency medical management protocols. Keywords : Emergency obstetric care, Multivariable analysis, SPSS software, Third delay

Incidental findings in lumbar spine MRI: their prevalence and potential impact on patient management

BackgroundTo document the prevalence of extra spinal findings in lumbar MRIResultsAmong the scanned 400 patients, 90 cases had incidental non-spinal findings, and in 30 out of these 90 patients, the finding was the only reason for their complaint.ConclusionsRadiologists should give attention to the non-spinal findings in lumbar spine MRI, as the detected pathology could be the source of pain or could potential life-threatening conditions.

Extended-FAST plus MDCT in pneumothorax diagnosis of major trauma: time to revisit ATLS imaging approach?

Pneumothorax (PNX) detection is of the utmost clinical relevance because it may quickly progress to cause hemodynamic instability as a consequence of invasive ventilation. Radiography is characterized by a low sensitivity to detect this disease; in recent years, chest ultrasound (US) has gained increased visibility in the diagnosis of acute respiratory emergencies including PNX. The aim of this retrospective study was to evaluate the clinical impact of extended focused assessment with sonography in trauma (E-FAST) during the past 6years of experience with this technique in our Level I trauma center. Between January 2013 and December 2018, we performed a retrospective case-series study including 3320 consecutive patients admitted to the emergency department of our hospital because of major trauma. Extended-US was always performed and reported immediately after FAST during primary survey and before multidetector computed tomography (MDCT) scans. The presence of PNX was determined using the well-known accepted US criteria. US findings were compared with computed tomography (CT) findings, the reference standard for PNX detection. Of the 6640 lungs observed with E-FAST, there were 1244 PNX cases, while 1328 PNX cases were detected either on the basis of MDCT or on the basis of the presence of air flush during the thoracic decompression in the emergency room. Among the 84 false negatives, 12 patients had subcutaneous emphysema, 38 had a body mass index higher than 27, 6 had a thoracic wall hematoma, and 4 had chest penetrating trauma. There were 10 false positives in the diagnosis of PNX at US examination, with mild extension and not clinically significant. The overall sensitivity of E-FAST for PNX detection was 93.6% (1244/1328), the specificity of E-FAST was 99.8% (5312/5322), the negative predictive value (NPV) was 98.4% (5312/5396), and the positive predictive value (PPV) was 99.2% (1328/1338). Our results demonstrate that bedside thoracic US is characterized by a very good accuracy in the diagnostic work-up of major trauma patients, even in difficult conditions, allowing rapid diagnosis of PNX. The novelty of this research lies in the possibility of diagnosing potential life-threatening conditions in a very short time by means of US, thus proposing a revision of the Advanced Trauma Life Support (ATLS) guidelines in order to incorporate it in the work-up of high-energy injured patients.

25 Very High Rates of Pancreatic Fluid Collections in Patients With the Triad of Hypertriglyceridemia-Induced Acute Pancreatitis and Diabetes Ketoacidosis

INTRODUCTION: The triad of hypertriglyceridemia (HTG) induced acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) has been reported. Patients with the triad are a special subgroup of AP patients that may need different management due to potential life-threatening conditions presenting all at once. Outcomes of pancreatic fluid collections (PFCs) in this population has not yet been studied. We sought to investigate AP mortality, morbidity and PFC outcomes in patients with the triad. METHODS: We perform a cohort study of a prospectively maintained database of patients admitted with AP at a tertiary center in the last 15 years. We strictly included patients who met AP diagnosis by Revised Atlanta Classification. Study groups were: AP-only vs. HTG-AP + DKA, AP + DKA, and HTG-AP. Primary outcome was inpatient mortality, morbidity (SIRS, ICU, AKI, ARDS), severity of AP and complication of AP. Multivariable logistic regression models were constructed using STATA software version 9.4. RESULTS: Over two thousand patients were reviewed, of whom 124 patients had the triad (HTG-AP, DKA), 100 had HTG-AP only (triglyceride levels &gt;1,000 mg/dL), 67 had AP + DKA and we included 101 with AP-only (control) for the analysis. Patients with HTG-AP + DKA had higher rates of PFCs 59% compared to AP-only 22%, HTG-AP 29% and AP + DKA 20% (P &lt; 0.001). HTG-AP + DKA were more likely to have acute peripancreatic fluid collections (APFC) 46% compared to AP-only 17%, HTG-AP 19% and AP + DKA 13% (P &lt; 0.001). HTG-AP were more likely to have pseudocysts 11% compared to AP-only 4%, HTG-AP + DKA 4%, and AP + DKA 2% (P = 0.06). No difference in PFC drainage was found (P = 0.97). Patients with AP+DKA were more likely to develop AKI 63% compared to AP-only 8%, HTG-AP + DKA 34% and HTG-AP 33% (P &lt; 0.001). HTG-AP patients were more likely to have ARDS 25% compared to AP-only 2%, AP + DKA 10% and HTG-AP + DKA 17% (P &lt; 0.001). HTG-AP were more likely to require enteral tube feeding and total parenteral nutrition (Table 1). No difference inpatient mortality was found. CONCLUSION: Patients with the triad of HTG-AP + DKA have significantly higher rates of pancreatic fluid collections. But PFCs seems to resolve in its own as there was not difference in interventions for the PFCs. Less aggressive strategy for PFCs management in this patient population can be followed.

The Effects of Lithium on Calcium and Parathormone Levels: A Cross-sectional Study with Healthy Controls

Despite lithium associated hyperparathyroidism (LAH) can lead to many complications, little notice has been paid to this sideeffect. The aim of this study was to investigate the effects of lithium on calcium and parathyroid hormone levels and the relation between lithium use and thyroid diseases. This cross-sectional study was carried out with 87 lithiumtreated patients and 65 volunteers who had a similar age and gender distribution with the lithium group. Serum levels of corrected calcium, intact parathormone, phosphorus, magnesium, alkaline phosphatase, free thyroxine, thyroid stimulating hormone, thyroid autoantibodies and creatinine were assessed, and also, thyroid and parathyroid ultrasonography was conducted. Further detailed investigations were made depending on the elevation of the initially measured calcium and/ or parathormone levels. Median values of serum levels of the corrected calcium and the intact parathormone were significantly higher in the lithium group. Calcium levels had a mild correlation with the duration of lithium treatment. In the first assessment, while all control individuals had values within the normal reference range, 11 lithium-treated patients had corrected calcium and/or intact parathormone levels above the normal reference levels. All of the five patients, who were diagnosed with LAH after further investigation, were also diagnosed with a thyroid disorder. These results demonstrate that lithium treatment has a relationship with calcium and parathormone levels. The 5.7% prevalence of LAH and potential life-threatening conditions associated with LAH necessitates the use of available low-cost METHODS to monitor blood calcium levels of lithium-treated patients for early diagnosis.

Sonographic diagnosis of meconium peritonitis: a case report

Background: In certain situations, the radiologist may be the first physician to suggest the presence of a pediatric abnormality. The possibility of early diagnosis of potential life-threatening emergency conditions is one of the important contributions of ultrasound to the referring clinician. Our case demonstrates the value sonographic diagnosis of meconium peritonitis (MP). Case Presentation: We present a case of a newborn infant who was diagnosed to have echogenic bowel with a few specks of peritoneal calcification and loculated ascites. Early detection with ultrasound led to immediate surgical intervention and patient recovered without any immediate or long-term complications. Conclusion: MP is a chemical peritonitis caused by fetal intestinal perforation which occurs mostly in utero. Its incidence is extremely rare, but serious neonatal morbidity or even mortality can occur if the diagnosis is delayed. Prenatal diagnosis is essential in prompting early postnatal surgical intervention, and also, improving neonatal outcome.

Clinical Mimics: An Emergency Medicine–Focused Review of Syncope Mimics

BackgroundSyncope is an event that causes a transient loss of consciousness (LOC) secondary to global cerebral hypoperfusion. The transient nature of the event can make diagnosis in the emergency department (ED) difficult, as symptoms have often resolved by time of initial presentation. The symptoms and presentation of syncope are similar to many other conditions, which can lead to difficulty in establishing a diagnosis in the ED. ObjectiveThis review evaluates patients presenting with a history concerning for possible syncope, mimics of syncope, and approach to managing syncope mimics. DiscussionSyncope is caused by transient LOC secondary to global cerebral hypoperfusion. Many conditions can present similarly to syncope, making diagnosis in the ED difficult. Some of the most emergent conditions include seizures, stroke, metabolic disorders, and head trauma. Other nonemergent conditions include cataplexy, pseudosyncope, or deconditioning. Many laboratory studies and imaging can be nondiagnostic during ED evaluation. For patients presenting with apparent syncope, immediate treatment should focus on identifying and treating life-threatening conditions. History and physical examination can help guide further diagnostic evaluation and management. ConclusionsPatients with apparent syncope should be evaluated for potential immediate life-threatening conditions. A thorough history and physical examination can aid in distinguishing syncope from common mimics and help identify and subsequently treat life-threatening conditions.

Laboratory procedures update on Hirschsprung disease.

The detection of ganglion cells in rectal biopsies of infants or toddlers with severe constipation is routinely performed by pediatric pathologists in many institutions. Hirschsprung disease (HD) is defined by the lack of ganglion cells (aganglionosis). The early recognition and the prompt implementation of surgical procedures obviously protect infants affected with HD from potential life-threatening conditions, including enterocolitis and debilitating constipation. Image-based and non-image-based clinical techniques and some laboratory tests have been reevaluated along the years, but often fragmentarily. Immunohistochemical markers have been increasingly used in pathology laboratories to detect ganglion cells and nerve fibers. Recently, calretinin, a vitamin D-dependent calcium-binding protein with expression in ganglion cells and nerves, has been described as an adjunctive or primary diagnostic test in HD. The aim of the present study was to systematically summarize and update laboratory procedures targeting ganglion cells in rectal biopsies. Procedures and tests have been reviewed and values of specificity and sensitivity have been calculated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Contrast enema has the lowest sensitivity and specificity of all of the 3-index investigations under the lens: contrast enema, anorectal manometry, and biopsy with histology. The latter procedure seems to have the highest sensitivity and specificity. Acetylcholinesterase staining on fresh-frozen material has been found to have slightly higher rates of sensitivity and specificity when compared with hematoxylin and eosin only. Calretinin staining may be supportive for the diagnosis, although some cases with false-positivity may be of some concern. Hematoxylin and eosin with or without acetylcholinesterase remains the criterion standard according to our PRISMA-based data. In our opinion, the number of false-positive results with potential overtreatment may limit the increasing advocacy for calretinin staining. Both the "primum non nocere" dictum and the "loss aversion heuristic" need to be satisfied harmoniously by preventing harm from unnecessary surgery.