Presence Of Respiratory Failure Research Articles

Development of prediction models for carbapenem-resistant Klebsiella pneumoniae acquisition and prognosis in adult patients

ObjectivesTo explore the risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and establish nomograms to predict the probability of CRKP infection and mortality in adult patients.MethodsPatients infected with KP from August 2019 to April 2021 in a tertiary hospital in Shanghai were enrolled. Risk factors associated with CRKP and 30-day mortality were identified using multivariate logistic regression analysis and Cox regression analysis.ResultsOverall, 467 patients with KP infection were enrolled, wherein 210 (45.0%) patients were infected with CRKP and 257 (55.0%) patients with carbapenem-susceptible K. pneumoniae (CSKP). Five factors, namely Charlson’s Comorbidity Index (CCI) ≥ 3, the use of central venous catheterization, prior hospitalization during the 3 months before infection, and previous exposure to carbapenems and broad-spectrum β-lactams, were found to be independently associated with CRKP infection. Based on these parameters, the nomogram showed a better performance as indicated by C-index of 0.94 (95% confidence interval [CI]: 0.92–0.96) and well-fitted calibration curves. CRKP was independently associated with 30-day mortality. Multivariate Cox regression analysis revealed that age ≥65 years, higher CCI scores, higher Sequential Organ Failure Assessment scores, the presence of respiratory failure, albumin levels ≤30 g/L, and non-appropriate treatments in 3 days, were associated with 30-day mortality.ConclusionThe predictive nomogram established in this study can facilitate the clinicians to make better clinical decisions when treating patients with KP infection.

Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database.

Studies indicated potential harm from empirical broad-spectrum therapy. A recent study of hospitalizations for community-acquired pneumonia suggested that empirical anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy was associated with an increased risk of death and other complications. However, limited evidence supports empirical anti-MRSA therapy for older patients with aspiration pneumonia. In a nationwide Japanese database, patients aged ≥65 years on admission with aspiration pneumonia were analyzed. Patients were divided based on presence of respiratory failure and further sub-categorized based on their condition within 3 days of hospital admission, either receiving a combination of anti-MRSA agents and other antibiotics, or not using MRSA agents. An inverse probability weighting method with estimated propensity scores was used. Out of 81,306 eligible patients, 55,098 had respiratory failure, and 26,208 did not. In the group with and without respiratory failure, 0.93% and 0.42% of the patients, respectively, received anti-MRSA agents. In patients with respiratory failure, in-hospital mortality (31.38% vs. 19.03%, p < 0.001), 30-day mortality, and 90-day mortality were significantly higher, and oxygen administration length was significantly longer in the anti-MRSA agent combination group. Anti-MRSA agent combination use did not improve the outcomes in older patients with aspiration pneumonia and respiratory failure, and should be carefully and comprehensively considered.

The novel SALT-M score predicts 1-year post-transplant mortality in patients with severe acute-on-chronic liver failure

Twenty-eight-day mortality ranges from 30-90% in patients with acute-on-chronic liver failure grades 2/3 (severe ACLF). Though liver transplantation (LT) has demonstrated a survival benefit, the scarcity of donor organs and uncertainty regarding post-LT mortality among patients with severe ACLF may cause hesitancy. We developed and externally validated a model to predict 1-year post-LT mortality in severe ACLF, called the Sundaram ACLF-LT-Mortality (SALT-M) score, and estimated the median length of stay (LoS) after LT (ACLF-LT-LoS). In 15 LT centers in the US, we retrospectively identified a cohort of patients with severe ACLF transplanted between 2014-2019, followed up to Jan'2022. Candidate predictors included demographics, clinical and laboratory values, and organ failures. We selected predictors in the final model using clinical criteria and externally validated them in two French cohorts. We provided measures of overall performance, discrimination, and calibration. We used multivariable median regression to estimate LoS after adjusting for clinically relevant factors. We included 735 patients, of whom 521 (70.8%) had severe ACLF (120 ACLF-3, external cohort). The median age was 55 years, and 104 with severe ACLF (19.9%) died within 1-year post-LT. Our final model included age >50 years, use of 1/≥2 inotropes, presence of respiratory failure, diabetes mellitus, and BMI (continuous). The c-statistic was 0.72 (derivation) and 0.80 (validation), indicating adequate discrimination and calibration based on the observed/expected probability plots. Age, respiratory failure, BMI, and presence of infection independently predicted median LoS. The SALT-M score predicts mortality within 1-year after LT in patients with ACLF. The ACLF-LT-LoS score predicted median post-LT stay. Future studies using these scores could assist in determining transplant benefits. Liver transplantation (LT) may be the only life-saving procedure available to patients with acute-on-chronic liver failure (ACLF), but clinically instability can augment the perceived risk of post-transplant mortality at 1 year. We developed a parsimonious score with clinically and readily available parameters to objectively assess 1-year post-LT survival and predict median length of stay after LT. We developed and externally validated a clinical model called the Sundaram ACLF-LT-Mortality score in 521 US patients with ACLF with 2 or ≥3 organ failure(s) and 120 French patients with ACLF grade 3. The c-statistic was 0.72 in the development cohort and 0.80 in the validation cohort. We also provided an estimation of the median length of stay after LT in these patients. Our models can be used in discussions on the risks/benefits of LT in patients listed with severe ACLF. Nevertheless, the score is far from perfect and other factors, such as patient's preference and center-specific factors, need to be considered when using these tools.

Localized immune dysregulation is associated with lung injury in severe pediatric COVID-19

Abstract Acute respiratory distress syndrome (ARDS) is a common and devastating consequence of SARS-CoV-2 infection in adults, however severe lung injury is a rare manifestation of COVID-19 in children. Aberrant local immune responses are known to drive lung pathology in adults, but little is known about localized immune responses in children with respiratory failure due to COVID-19. We obtained blood and respiratory tract samples from children (n=35, aged 1 month to 18 years) admitted to the hospital for COVID-19, stratifying by presence of respiratory failure (n=15). We defined the cytokine and chemokine profile of severe disease using a 71 analyte Luminex panel. Children with respiratory failure were found to have increased circulating levels of leukemia inhibitory factor (LIF), a growth factor upregulated during pulmonary inflammation. The local environment revealed significant inflammation with increased levels of pro-inflammatory cytokines including IL-6, IL-8, and IL-33 among others. Application of high dimensional flow cytometry to define immune cell subsets revealed elevated proportions of monocytes in both circulating and local environments. Monocytes demonstrated decreased expression of HLA-DR and CD86, suggesting an immunoparalysis phenotype, previously associated with severe COVID-19 in adults. Further, effector memory T cells in the airway exhibited an exhausted phenotype with high levels of PD-1 expression. Together this analysis reveals a highly inflammatory and dysregulated immune response underlies SARS-CoV-2 induced pediatric lung injury. These findings suggest a shared pathway with adult COVID-19 ARDS and provide new insights into the immune mechanisms associated with severe COVID-19 in children. Supported by grants from NIH (K23AI141686)

Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome.

Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia. A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality. The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009]. There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.

Ограничения индекса PESI в определении оптимальной лечебной тактики при тромбоэмболии легочной артерии: данные российского регистра СИРЕНА

Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals. Design: Registry, multicentre, prospective observational study. Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class). Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%). Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT. Keywords: Pulmonary Embolism Severity Index, pulmonary embolism, SIRENA registry, thrombolysis.

Paraquat – Boon or bane? A retrospective study of paraquat poisoning and outcomes in a tertiary care center in South India

Setting: Paraquat is a highly toxic, herbicide, extensively used in various parts of India. There is no effective treatment for paraquat poison and carries a very high mortality. In India, this compound can be misused for harmful purposes. Objective: A retrospective time-bound descriptive study of paraquat-consumed patients was conducted at Kasturba Hospital, Manipal, from January 1, 2014 to January 31, 2016. Materials and Methods: All the data were analyzed using the SPSS version 16. All the categorical data are expressed in terms of frequency and percentage. Continuous normal variables were expressed in terms of mean ± standard deviation, and skewed variables were expressed in terms of median and quartiles. Chi-square test was used to find the association between the categorical independent variables across the outcome in survivors, nonsurvivors, and those patients who were discharged from the hospital against medical advice. Similarly, Fisher's exact test was performed for those variables, for which 20% of the expected cell count was <5%. Kruskal–Wallis test was used to compare the relationship between the continuous skewed variables across the outcome. Results: A total of 55 paraquat-consumed patients were admitted, out of which 67.27% (n = 37) of patients were men. Only 32.7% (n = 18) of patients were farmers. Oral ulcers were seen in 43.6% (n = 24) of patients. About 65.5% (n = 36) of patients underwent hemoperfusion, 27.3% (n = 15) of patients survived, 47.3% (n = 26) of patients expired, and 25.5% (n = 14) of patients were discharged against medical advice in a critical condition. The presence of respiratory failure, hypotension, need for ventilator supportive therapy, the elevation of levels of blood urea, serum creatinine, and liver enzymes AST and ALT levels were statistically significant in three groups (P < 0.001). Conclusion: Paraquat poisoning is highly fatal. Treatment is expensive and available only in tertiary care hospitals in India. Central and state governments should ensure that it should not be readily accessible to ordinary people and it should be banned progressively.

Ранняя реабилитация дыхательной функции у пациентов, имеющих двусторонний парез голосовых складок

Therapeutic treatment of airway stenosis caused by vocal cord paralysis is a major challenge. Methodology, organization of research, treatment, and observation of such patients are necessary since the risk of developing respiratory failure and imposing a tracheotomy in the first months of the disease is especially high. Early diagnosis of impaired vocal fold mobility, the appointment of treatment, will contribute to the speedy rehabilitation of the respiratory function and reduce the number of complications. The purpose of the study is to develop a tactic for treatment and examination in patients with bilateral vocal fold paresis. The object of the study were 14 female patients with a diagnosis of bilateral vocal fold paresis caused by thyroid surgery. The following spirometry indicators were evaluated: FVC, FEV1, FEV/FVC, PEF, MEF75, MEF50, MEF25, which showed a significant impairment of air permeability at the level of the vocal folds, impaired ventilation of the bronchial tree, and a decrease in lung capacity. Endoscopic examination of the larynx also revealed a violation of the mobility of the vocal folds, which were in the paramedial position in 6 patients and in the median position in 6. The physical component of health and the psychological component were also assessed according to the standardized international questionnaire SF-36. The results obtained indicated an extreme degree of decrease in the patient’s psychological state on the verge of depression and also indicated the presence of respiratory failure. The information obtained as a result of such an examination can help in the choice of treatment tactics and further rehabilitation of patients.

Frequency of occurrence of cardiovascular risk factors in patients with anthracosilicosis in combination with arterial hypertension and coronary heart disease

Introduction. Clinical and experimental studies show the adverse effect of coal-rock dust not only on the bronchopulmonary, but also on the cardiovascular system. Coal mine workers have a high incidence of arterial hypertension and coronary heart disease. The key point in the prevention of the diseases of the circulatory system is the timely detection and correction of not only the main (non-occupational), but also occupational factors of cardiovascular risk. In this regard, the study of risk factors for arterial hypertension and coronary heart disease in coal mining workers is an urgent task. The study aims to explore the frequency and reveal the most significant non-occupational and occupational factors of cardiovascular risk in patients with anthracosilicosis in combination with arterial hypertension and coronary heart disease. Materials and methods. The study involved 269 coal mine workers: 139 miners with previously diagnosed anthracosilicosis and 130 miners in the control group without lung pathology. All of them underwent a comprehensive clinical, instrumental and laboratory examination to identify arterial hypertension, coronary artery disease and risk factors for the development of the diseases of the circulatory system. Results. According to the findings of the study, a significantly higher incidence of arterial hypertension and coronary heart disease was identified in the patients with anthracosilicosis compared with the miners who worked for a long time in harmful labour conditions but did not have occupational pulmonary pathology. The most significant non-occupational risk factors for arterial hypertension in the patients with anthracosilicosis were determined: age 50 years and older, the presence of fasting hyperglycemia, hyperhomocysteinemia, abdominal type of obesity, hypersthenic constitutional-morphological type according to the Rees-Eysenck index, blood group AB (IV). Occupational risk factors for the development of arterial hypertension in the patients with anthracosilicosis were also identified: work experience in hazardous working conditions of 25 years and more, the dust level in the working area exceeding the maximum permissible concentration by 10 times and more. In the patients with anthracosilicosis, the most significant risk factors for the development of coronary heart disease were: age 45 years and older, the presence of arterial hypertension, metabolic syndrome, andromorphic constitutional-morphological type according to the Tanner index, hyperhomocysteinemia, hyperfibrinogenemia, increased levels of soluble fibrin-monomer complexes and C-reactive protein. Occupational risk factors for the development of coronary heart disease in the patients with anthracosilicosis were also identified: work experience in hazardous working conditions of 20 years and more, the presence of respiratory failure (as a complication of an occupational disease). Limitations. This study is limited to a sample of workers in the main occupations of coal mines who are examined at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. The age group of workers from 40 to 54 years old, with a long work experience in underground dusty conditions (more than 15 years) was studied. The study did not include persons with proven occupational diseases other than anthracosilicosis. Conclusions. The identified significant markers of cardiovascular risk can be applied to elaborate prognostic methods. Timely detection and elimination of cardiovascular risk factors as primary preventive measures should be used to reduce the level of cardiovascular incidence rate among individuals working in hazardous labour conditions. Ethics. This medical research involving a human was carried out in accordance with the ethical principles presented in the latest version of the Declaration of Helsinki by the World Medical Association.

Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to severe acute pancreatitis

BackgroundThe importance of enteral nutrition (EN) in acute pancreatitis (AP) has been emphasised. Nasogastric (NG) feeding has been the preferred route for EN delivery in most AP patients intolerant to oral intake. However, gastric feeding intolerance (GFI) was frequently reported, especially in patients with more severe diseases. This study aimed to investigate the incidence and risk factors for GFI in moderately-severe to severe AP.MethodsThis is a single-centre, retrospective study. All the data were extracted from an electronic database from April 2020 to May 2021. Data were prospectively collected during hospitalisation. Patients diagnosed with moderately-severe to severe AP and admitted within seven days from the onset of abdominal pain were assessed for eligibility. Patients who showed signs of intolerance to gastric feeding and required switching to nasojejunal (NJ) feeding were deemed GFI. Multivariable logistic regression was performed to assess potential risk factors of GFI.ResultsA total of 93 patients were analysed, of whom 24 were deemed GFI (25.8%), and the rest tolerated NG feeding well (n = 69). In patients with GFI, the median time of switching to NJ feeding was five days (interquartile range: 4–7 days) after admission. The multivariable analysis showed that respiratory failure (odds ratio = 3.135, 95% CI: 1.111–8.848, P = 0.031) was an independent risk factor for GFI.The mean daily energy delivery in the following three days after switching to NJ feeding was significantly higher than the first three days after initiation of NG feeding in patients with GFI [920.83 (493.33–1326) vs. 465 (252.25–556.67) kcal, P < 0.001].ConclusionGFI is common in moderately-severe to severe AP patients with an incidence of 25.8%, and the presence of respiratory failure may increase the risk of GFI.

Prediction injury of the central nervous system in the neonatal period in preterm newborns

Objective: to develop a system for predicting the probability of developing damage of the central nervoussystem (CNS) in the neonatal period in children who was born prematurely. Materials and methods: the main group of the study is premature newborns with gestational age (GA) less than 36 weeks inclusive (n = 60), the control group – fullterm newborns (n = 35). In the process of dynamic observation, the main group was divided into subgroups depending on the diagnosed CNS injury in the neonatal period, according to the neurosonography (intraventricular hemorrhages (IVH), periventricular leukomalacia (PVL): subgroup 1 (prematurity babies with CNS injury) – 25 people, subgroup 2 (premature babies without CNS injury) – 35 people. we estimated clinical and anamnestic, laboratory and instrumental data of children at birth and in dynamics, indicators of antioxidant protection (manganese-containing superoxide dismutase (Mn-SOD), copper, zinc-containing superoxide dismutase (Cu, Zn-SOD), reduced glutathione (GSH), oxidized glutathione (GSSG), total antioxidant capacity of blood (TAS/TAC), oxidative stress (TOS/TOC), 4 polymorphisms of Mn-SOD gene. Results: we designed two prognostic models which can determine the probability of developing IVH and PVL in the neonatal period in premature newborns. This models are included GA, Apgar scores at 1 and 5 minutes of life, presence of respiratory failure at birth, invasive mechanical ventilation in the neonatal period, presence of intrauterine infection in the neonatal period and indicators of antioxidant protection (GSH, TAS/TAC; model 2). Conclusions: a comprehensive assessment of the clinical and anamnestic data of premature newborns at birth, as well as the determination of indicators that take into account the level of antioxidant protection, will make it possible to identify a premature baby at the risk for organic injury of the CNS and to correct the therapeutic strategies in the neonatal period.

Usefulness of lung ultrasound in the early identification of severe COVID-19: results from a prospective study.

There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound(LUS); however, its role in predicting the prognosis has yet to be explored. The aim of the study was to assess the relationshipbetween lung ultrasound findings with the degree of respiratory failure measured by the PaO2/FiO2 ratio (PaFi) andthe prognosis of these patients: need for non-invasive mechanical ventilation (NIMV), admission to the Intensive Care Unit(ICU) and mortality. Prospective, longitudinal and observational study performed in patients with confirmedCOVID-19 underwent a LUS examination and laboratory tests. A total of 107 patients were enrolled: 93.4%with bilateral involvement and 73.83% presented at least one consolidation. A good inverse correlation (Rho Spearman coefficient-0.897) between the ultrasound score and PaFi was obtained. The AUC for identification of patients with more severerespiratory failure, a moderate and severe ARDS, was 0.97 (CI 95%: 0.95-1) and a cut-off score of 34.5 showed a sensitivityof 0.94 and a specificity of 0.91. The Kappa index showed a high concordance (0.83) of the classification by ultrasound lunginvolvement and ARDS. The combination of the ultrasound score and the presence of respiratory failure caneasily identify patients with a higher risk to present complications.

Disease Severity and Risk Factors of 30-Day Hospital Readmission in Pediatric Hospitalizations for Pneumonia.

Pneumonia is the leading cause of hospitalization in pediatric patients. Disease severity greatly influences pneumonia progression and adverse health outcomes such as hospital readmission. Hospital readmissions have become a measure of healthcare quality to reduce excess expenditures. The aim of this study was to examine 30-day all-cause readmission rates and evaluate the association between pneumonia severity and readmission among pediatric pneumonia hospitalizations. Using 2018 Nationwide Readmissions Database (NRD), we conducted a cross-sectional study of pediatric hospitalizations for pneumonia. Pneumonia severity was defined by the presence of respiratory failure, sepsis, mechanical ventilation, dependence on long-term supplemental oxygen, and/or respiratory intubation. Outcomes of interest were 30-day all-cause readmission, length of stay, and cost. The rate of 30-day readmission for the total sample was 5.9%, 4.7% for non-severe pneumonia, and 8.7% for severe pneumonia (p < 0.01). Among those who were readmitted, hospitalizations for severe pneumonia had a longer length of stay (6.5 vs. 5.4 days, p < 0.01) and higher daily cost (USD 3246 vs. USD 2679, p < 0.01) than admissions for non-severe pneumonia. Factors associated with 30-day readmission were pneumonia severity, immunosuppressive conditions, length of stay, and hospital case volume. To reduce potentially preventable readmissions, clinical interventions to improve the disease course and hospital system interventions are necessary.

The prognostic value of diagnostic tools in patients with seropositive myasthenia gravis: a retrospective study of 31 cases

To confirm the diagnosis of myasthenia gravis (MG), in addition to clinical observation of the muscle weakness dynamics, pharmacological and functional tests, Computed tomography/Magnetic resonance imaging (CT/MRI) of the mediastinum, detection of antibodies to acetylcholine receptors (AChR) and to muscle specific tyrosine kinase (MuSK)/; electrophysiological tests are used: rhythmic nerve stimulation (RNS)/decrement test and electro­myography of a single muscle fiber (single-fiber EMG (SF-EMG)/jitter). The aim of our study is to determine the possible relationship between the level of antibodies to AChR and the decrement test value, to verify a correlation between SF-EMG and the severity of MG seropositive to AChR. To evaluate the effectiveness of pathogenetic treatment and prediction of the duration of remission according to the results of the study. A total of 31 patients with myasthenia gravis seropositive to AChR were examined, among whom there were 19 (61.3%) women aged 19 to 74 years. The pattern of muscle weakness was evaluated by a score of the International Clinical Classification of Severity of Myasthenia gravis scale (MGFA). The presence of respiratory failure and its degree was assessed by spirography. The number of antibodies to AChR was determined using enzyme-linked immunosorbent assay (ELISA). The criteria for inclusion in the study were the confirmed diagnosis of seropositive myasthenia gravis with an AChR antibody level of more than 0.5 nmol/L. All patients underwent electrophysiological studies. Patients were examined three times: 1) at the time of visiting the doctor (in the hospital or on an outpatient basis); 2) in 16 and 3) in 24 weeks from the start of the study. Depending on the clinical condition of the patients the following treatment was prescribed: pyridostigmine, methylprednisolone, azathioprine. Statistical analyses were performed using the statistical computing environment R (R Core Team). In the dynamics of observation, a decrease in the level of antibodies to AChR and an improvement in the condition of patients according to the MGFA classification were generally observed but no correlation was found between the severity of MG and the level of antibodies to AChR during the first visit (Kruskal-Wallis test: H (4, N=31)=2.23 p=0.69); during the second visit (Kruskal-Wallis test: H (5, N=31)=9.44 p=0.09), as well as during the third visit (Kruskal-Wallis test: H (2, N=30)=2.74 p=0.25). A correlation was found between the concentration of antibodies to AChR and a thymectomy in the clinical history (Kruskal-Wallistest: H (1, N=7)=3.153752 p=0.07): over time, the level of antibodies decreased. Decrement test deviations were detected in 23 (74.2%) of the 31 patients, SF-EMG – in 20 (95%) of 21 patients. Abnormal jitter was recorded in 100% of cases with a generalized form of myasthenia gravis. During all three visits, a correlation was determined between the highest decrement test of symptomatic muscle and MG severity according to MGFA (r=0.39; p=0.042), (r=0.35; p=0.048), (r=0.41; p=0.039); and also between the jitter value and MG severity (r=0.54; p=0.032) (r=0.35; p=0.048), (r=0.61; p=0.034 respectively). Analysis of the contingency tables using the exact Fisher test provided information on the best method of treating patients. We consider that the most effective prognostic test that may affect the choice of further treatment is SF-EMG. However, due to the difficulties of using this method in routine practice, rhythmic nerve stimulation (RNS) test in clinically weak muscles should be recommended. It is not recommended to monitor antibodies to AChR in order to predict the course of the disease, it is better to use this test only for the diagnosis of seropositive myasthenia gravis.

Essentials of cerebral fat embolism syndrome

Fat embolism syndrome typically appears after an asymptomatic period of 24 to 72 hours and is typically manifested by the clinical triad of respiratory failure, neurological manifestations and petechiae, together with analytical alterations such as anaemia and thrombopenia. Respiratory distress is the most common symptom. Cerebral fat embolism is an incomplete form of fat embolism, which does not meet all the diagnostic criteria; in fact, it may appear without the presence of respiratory failure; Therefore, its early diagnosis is a challenge in the trauma patient

Экспресс-метод для определения вероятности развития врожденной пневмонии у доношенных новорожденных

По данным Всемирной организации здравоохранения, в 2017 году во всем мире от пневмонии умерло 15 % детей в возрасте младше пяти лет. Цель исследования: разработка математической модели для определения вероятности развития врожденной пневмонии у доношенных новорожденных экспресс-методом. Проведено комплексное обследование 116 доношенных новорожденных, находившихся в педиатрическом отделении для новорожденных детей и родильном физиологическом отделении Государственного учреждения «Республиканский научно-практический центр «Мать и дитя» в период с 2017 по 2019 год. Произведен сравнительный анализ 174 данных анамнеза жизни, исходов предыдущих беременностей, осложнений настоящей беременности у матерей, клинических и рутинных лабораторных методов исследования у новорожденных на 1–2-е сутки жизни. В последующем определены наиболее значимые факторы, ассоциированные с развитием врожденной пневмонии у доношенных новорожденных. На основании бинарной логистической регрессии и ROC-анализа проведен математический анализ 387,4 млн связей переменных. В результате проведенного обследования установлены наиболее значимые факторы, ассоциированные с развитием врожденной пневмонии у доношенных новорожденных: из акушерско-гинекологического и соматического анамнеза жизни матери — самопроизвольный выкидыш; из осложнений беременности — хроническая внутриматочная гипоксия плода и хроническая фетоплацентарная недостаточность; по результатам клинических проявлений в первые сутки жизни — наличие дыхательной недостаточности. На основании полученных данных разработана модель с чувствительностью, равной 90,6 %, специфичностью — 92,1 % и площадью под ROC-кривой — AUC = 0,93 ± 0,054; р &lt; 0,001 (95% доверительный интервал 0,88–0,98). С помощью прогностической модели рассчитаны пороговые значения: для самопроизвольного ± выкидыша — 0,836; хронической внутриматочной гипоксии плода — 0,537; хронической фетоплацентарной недостаточности — 0,533; наличия дыхательной недостаточности — 0,939, что при пороговых значениях ≥ 0,53 ROC-кривой позволяет выделить группу высокого риска по развитию врожденной пневмонии среди доношенных новорожденных. С действующей математической моделью для определения вероятности развития врожденной пневмонии у доношенных новорожденных экспресс-методом можно ознакомиться на сайте http://pneu.bsmu.by или https://www.bsmu.by (внизу страницы меню «Врач/провизор: диагностика врожденной пневмонии»).

Prognostic model for determining the probability of congenital pneumonia in full-term newborns

According to the data of the World Health Organization, pneumonia is one of the leading causes of death in children under five years of age. Objective: to develop a prognostic model to determine the factors associated with the development of congenital pneumonia in full-term newborns. A comprehensive survey of 116 full-term newborns who were in the pediatric Department for newborn children and the Maternity Physiological Department of the State Institution “Republican Scientific and Practical Center “Mother and Child” in the period from 2017 to 2019 was conducted. The study group consisted of 53 healthy full-term newborns with congenital pneumonia, born at the gestational age of 39.50 ± 0.69 weeks, body weight 3337.50 ± 354.42 g and a body length of 52.20 ± 2.13 cm. The control group consisted of 63 healthy full-term babies born at gestational age of 39.30 ± 0.63 weeks, body weight 3417.30 ± 253.82 g and a body length of 52.50 ± 1.57 cm. The survey revealed the most significant factors associated with the development of congenital pneumonia in full-term newborns: from the obstetric-gynecological and somatic history of the mother’s life — spontaneous miscarriage; from the complications of pregnancy — chronic intrauterine fetal hypoxia; the placenta study determined the presence of inflammatory changes in the placenta; clinical manifestations within the first 72 hours of life included respiratory failure. Based on the data obtained, a model with sensitivity equal to 92.5 %, specifi­city 92.1 % and an area under ROC-curve (AUC) 0.94 ± 0.054, p &lt; 0.001 (95% CI 0.90–0.99). Using a prognostic model, thre­shold values were calculated: for spontaneous miscarriage — 0.810; chronic intrauterine fetal hypoxia — 0.289; inflammatory changes in the placenta — 0.565; the presence of respiratory failure — 0.928, which at threshold values ≥ 0.56 ROC-curve allows identify a high risk group for the development of congenital pneumonia among full-term newborns.

Modified ICH score was superior to original ICH score for assessment of 30-day mortality and good outcome of non-traumatic intracerebral hemorrhage

IntroductionIntracerebral hemorrhage (ICH) score has been widely used as a consistent and reliable clinical grading scale for predicting mortality. However, ICH score had not been used to predict good outcome or significant disability for those who were alive. We intended to address whether any modifications would increase prediction accuracy for mortality as well as the extent of morbidity for those who survived. MethodsWe conducted a retrospective cohort study, involving all non-traumatic ICH patients admitted to our hospital between September 2018 and July 2020. All non-traumatic ICH patients who were admitted to the stroke unit and registered in our stroke database had their medical records, neuroimaging, and laboratory test results reviewed. Only patients with complete medical records and available CT imaging and laboratory test results were included in our study. Independent predictors of mortality (modified Rankin scale/mRS of 6) or good outcome vs. significant disability (mRS≤2 vs. mRS 3–5, respectively) were identified by logistic regression. A modified ICH (mICH) score was compared with the original ICH (oICH) score for its diagnostic performance (DP). Overall DPs were graded and ranked according to Youden Index (YI). ResultsAs many as 311 patients were eligible with both 39.9% rate of 30-day mortality and good outcome. Factors independently associated with mortality were low GCS and high NIHSS on admission (P = 0.002, <0.001, respectively), and presence of respiratory failure (P < 0.001). Independent factors for good outcome were low NIHSS on admission and mass effect (midline shift > 5 mm) [both P < 0.001]. A modification of ICH score from the original was made by substituting GCS with NIHSS (0 –10 = 1; 11 – 20 = 2; >20 = 3), changing age cut-off point to > 55 years old (= 1), and adding respiratory failure (= 1), and mass effect (= 1). Overall, mICH scored better over oICH score with respect to sensitivity and had comparable specificity for both 30-day mortality and good outcome (sensitivity 80.6% vs. 50.8%; specificity 88.7% vs. 89.3%; YI 0.69 vs. 0.40, respectively) and good outcome (sensitivity 86.3% vs. 77.4%; specificity 74.6% vs. 77.8%; YI of 0.61 vs. 0.55, respectively). There was only one patient with oICH and none on mICH score of 0, who died and none survived with oICH and mICH score of ≥ 5 and ≥ 7, respectively. The proportion of 30-day mortality and good outcome increased in a more linear fashion with mICH score. ConclusionsThe mICH score was proven to be reliable and consistent as a risk grading assessment for non-traumatic ICH patients. The mICH was statistically superior to oICH score in predicting 30-day mortality and good outcome.

The significance of myositis autoantibodies in idiopathic inflammatory myopathy concomitant with interstitial lung disease.

This study identified factors associated with interstitial lung disease (ILD) in patients with idiopathic inflammatory myopathy (IIM) based on the latest classification and recent advances in autoantibody serology. We retrospectively analyzed data of 173 patients who underwent complete myositis autoantibody serology examination in a medical center in Taiwan from July 2018 to February 2020. After exclusion of patients who did not receive a final diagnosis of IIM, clinical features, serology data, concomitant diseases, treatment, presence of respiratory failure, and mortality rate of the remaining 97 patients were analyzed. Of IIM patients in our cohort, 47.4% had ILD. ILD was significantly associated with subtypes of IIM, older age of onset, presence of mechanic's hand, and presence of anti-Jo-1 and anti-Ro52 antibodies. Among five IIM subtypes, overlap myositis (OM) and dermatomyositis (DM) were significantly associated with a higher prevalence rate of ILD (67.5% in OM and 53.3% in DM). Among patients with OM, the presence of anti-Jo-1 (100%), anti-PL-7 (100%), and anti-EJ antibodies (77.8%) was most significantly associated with ILD. The latest classification of IIM, older age of onset, presence of mechanic's hand, and presence of anti-Jo-1 and anti-Ro52 antibodies were significantly associated with ILD. Among five IIM subtypes, OM and DM had higher prevalence rate of ILD. Among OM patients, the presence of anti-Jo-1, anti-EJ, and anti-PL-7 antibodies was significantly associated with ILD. The study results may help physicians to timely screen and monitor pulmonary function in high-risk groups.

Venous thromboembolism in patients with COVID-19 and correlation with D-dimers: a single-centre experience

ObjectiveTo study the frequency of venous thromboembolism in hospitalised patients with COVID-19 and correlation with the D-dimers and thromboprophylaxis.DesignCross-sectional descriptive study.Place and duration of studyQueen Elizabeth Hospital, 20 April 2020–13...