Risk Factor For Negative Outcomes Research Articles

Half-life of serum alpha-fetoprotein in prepubertal testicular yolk sac tumors: an index significantly associated with prognosis.

To evaluate the association between serum alpha-fetoprotein (AFP) half-life (HL) and prognosis in prepubertal children with elevated AFP values 3 to 4 weeks after surgery for testicular yolk sac tumors (YST). Prepubertal patients with testicular YST treated with radical orchiectomy between January 2016 and December 2022 were retrospectively reviewed. Negative outcomes were defined as relapse, metastasis or death. Univariate and multivariate logistic regression analyses were conducted to select risk factors for negative outcomes. A total of 42 patients were eventually enrolled into the study. Patients were divided into non-negative and negative outcomes groups, consisting of 35 and 7 patients, respectively. Thirty-five patients were stage I, two cases were stage II, and five cases were stage IV, according to the Children's Oncology Group staging system. The overall survival (OS) rate was 100%. Average AFP values significantly decreased after resection (P < 0.001). A significant positive correlation was shown between pre- and postoperative AFP values (r = 0.60, P < 0.001). Long AFP HL was considered as an independent risk factor for negative outcomes in YST patients underwent radical orchiectomy (P = 0.04). The cut-off value for AFP HL was 5.78 days, regardless of age division. Testicular YST is a relatively rare disease in children with an OS of 100%, and salvage chemotherapy is effective even in grade IV patients. The postoperative AFP HL was significantly associated with prognosis in prepubertal patients with testicular YST. The cut-off value for AFP HL is 5.78 days regardless of the effect of physiological AFP elevation.

Long-term follow-up after incisional hernia repair: Dynamics of recurrence and patient-reported outcome.

Incisional hernia (IH) is common and recurrence rates remain high. Although the goal of treatment should be to improve quality of life, studies addressing this aspect are notably absent. We aimed to evaluate the long-term recurrence rate of open mesh repair of IH, investigate the burden of persisting discomfort, explore patient satisfaction, and identify risk factors for negative outcomes. A single-center, retrospective study was conducted on all open mesh repairs of IH performed between January 2002 and October 2013. Clinical data were gathered from medical records and operative reports, while patient-reported outcome measures (PROMs) were obtained through telephone interviews. Risk factors for recurrence were assessed by survival analysis. PROMs were analyzed across patient subgroups by clinical and demographic variables. This study included 271 patients undergoing medical record review, with 136 patients completing the telephone interview. Recurrence rates at 2, 5, 10, and 15years were 6%, 8%, 11%, and 12%, respectively. Risk factors for recurrence were obesity and an estimated mesh-defect overlap <7cm. Bridged repair posed no increased risk. For PROMs, the median follow-up time was 13.6years after which 78.7% of the patients reported no discomfort, and 89.0% were satisfied with their surgery. Patients <65years and females experienced more long-term discomfort. Recurrence rates were higher in obese patients and when the estimated mesh-defect overlap was <7cm, but not in bridged repairs. Young patients and females are at increased risk for long-term discomfort. High satisfaction levels were reported.

Morphological and clinical findings in placentas and newborns with a history of tobacco, alcohol, and other substance abuse during pregnancy.

Exposure to toxins during pregnancy is the main modifiable behavior that affects the placenta and, consequently, the fetus. In particular, smoking is a recognized risk factor for negative outcomes. Our study pretended to examine gross and microscopic placental features in women who reported exposure to tobacco, alcohol, or other psychoactive substances. In this observational case-control study, we collected 706 placentas to assess precise substance exposure histological-interaction features of in the placenta. We examined gross and microscopic placental features, and then recorded maternal and newborn clinical conditions. We found that 4.8% of mothers admitted to consumption of some type of (harmful) substance. The most common pre-existing maternal condition was obesity (20.3%); predominant complications included amniotic infection (32.3%), urinary tract infection (14.5%) and hypertensive disorders of pregnancy (14.5%). In newborns, we discovered positive associations as respiratory distress syndrome. Macroscopically, exposed mothers had heavier placentas, more true knots, and single umbilical artery; microscopically, they were more likely to exhibit fetal vascular malperfusion (FVM). Until our present study, no research linked umbilical cord defects to toxic substance exposure; our study results do confirm association with adverse outcomes in neonates and alterations in the neuro-cardio-placental circuit through FVM. The results are confirming the importance of this modifiable risk factor and how its presence may potentially affect the course of pregnancy, as well as the health of both mother and child.

Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder.

Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report, Family Assessment Device, and an in-house measure, respectively. Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.

Systemic inflammatory autoimmune disease before allogeneic hematopoietic stem cell transplantation is a risk factor for death in patients with myelodysplastic syndrome or chronic myelomonocytic leukemia.

Myelodysplastic syndrome (MDS) is well known to be complicated by systemic inflammatory autoimmune disease (SIADs). However, it remains unclear how the prognosis after allogenic hematopoietic stem cell transplantation (allo-HSCT) in patients with MDS is impacted by SIADs that occur before allo-HSCT. Therefore, we hypothesized that SIADs before allo-HSCT may be a risk factor for negative outcomes after allo-HSCT in patients with MDS. We conducted a single-center, retrospective, observational study of sixty-nine patients with MDS or chronic myelomonocytic leukemia who underwent their first allo-HCT. Fourteen of the patients had SIADs before allo-HSCT. In multivariate analysis, the presence of SIADs before allo-HSCT was an independent risk factor for overall survival (HR, 3.36, 95% confidence interval: 1.34-8.42, p = 0.009). Endothelial dysfunction syndrome was identified in five of 14 patients with SIADs who required immunosuppressive therapy or intensive chemotherapy, and notably, all patients with uncontrollable SIADs at allo-HSCT developed serious endothelial dysfunction syndrome and died in the early phase after allo-HSCT. The development of SIADs in the context of MDS is thought to reflect the degree of dysfunction of hematopoietic cells in MDS and suggests a higher risk of disease progression. In addition, MDS patients with SIADs before allo-HSCT are considered to be at higher risk of endothelial dysfunction syndrome because of preexisting vascular endothelial dysfunction due to SIADs. In conclusion, SIADs before allo-HSCT constitute an independent risk factor for death in MDS patients undergoing allo-HSCT.

Impact of SARS-CoV-2 infection on patients with hematological malignancies: a retrospective study

ABSTRACTObjectivesThis study aimed to evaluate the characteristics of patients with hematological malignancies (HM) and SARS-CoV-2 infection and analyze the risk factors of their severity and mortality.MethodsA retrospective study including inpatients diagnosed HM and SARS-CoV-2 infection between December 2022 and February 2023 were conducted. Demographic information, medical history, comorbidities, diagnosis, treatment related information and outcomes were extracted from electronic medical database. The primary outcome of this study were the severity of SARS-CoV-2 infection and case-fatality rate. The clinical characteristic and outcomes of the patients were summarized and analyzed.ResultsA total of 74 patients with HM and SARS-CoV-2 infection were included. Out of the total cases, 85.1% (63) had a mild /moderate SARS-CoV-2 infection, and 14.9% (11) were severe/ critical infection cases. A total of 8 deaths occurred in all cases for a case-fatality rate of 10.8%. Multivariate analysis identified patients with acute myeloid leukemia (AML) (P = 0.043, OR:5.274, 95%CI:1.053-26.407), primary hematological disease in active state (P = 0.005, OR:13.905, 95%CI:2.180-88.704) were independent risk factors for the severity of SARS-CoV-2 infection and patients with AML had 11.145-fold higher risk of non-survival (P = 0.020, OR:11.145, 95%CI:1.460-85.103) in comparison to the patients with other types of HM. There were no significant differences in the severity and case-fatality rate (P > 0.05) between the patients receiving chemotherapy drugs administration waiting <14 days and ≥14 days after negative SARS-CoV-2 testing.ConclusionThe primary hematological disease in active state may be the main risk factor for negative outcome of the patents. Waiting 14 days for chemotherapy initiation after negative SARS-CoV-2 testing is unnecessary.

Surgical oncological emergencies in octogenarian patients

BackgroundSurgical oncological emergencies represent a frequent challenge in acute settings, with postoperative courses characterized by high morbidity and mortality. An accurate selection of patients who could benefit from surgery is essential to avoid unnecessary invasive treatment. In this study, we tried to determine if advanced age (&amp;gt;80 years) represents a risk factor for negative short-term outcome in patients undergoing emergency surgery for acute abdominal oncological illness.MethodsWe retrospectively analyzed the records of patients who underwent emergency oncological surgery at the Department of Acute Care Surgery of Padua General Hospital from January 2018 to December 2022. One hundred two cancer patients were included in the study. Among them, 42 were aged ≥80 years (41%). Multiple preoperative and postoperative parameters were recorded, and the follow-up period was at least 90 days. Multivariate logistic regression analyses were used to identify factors associated with short-term postoperative outcomes.ResultsIn the octogenarian group, 30-day mortality was 11% vs. 9.5% in the younger group [p = not significant (ns)] and 90-day mortality was 17.6% in the octogenarian group vs. 20.5% in the younger group (p = ns). Postoperative morbidity and hospital length of stay were not significantly different in the two groups. Low albumin levels [odds ratio (OR) 30.6, 9.51–87.07] and elevated lactate dehydrogenase (LDH) levels (OR 26.4, 9.18–75.83) were predictive for short-term mortality in surgical oncological emergencies.ConclusionAdvanced age is not a risk factor for negative outcomes in surgical oncological emergencies. Therefore, surgical options should be considered in octogenarians with oncological emergencies and acceptable clinical conditions. Serum albumin levels and LDH can help predict the postoperative outcome after surgery for oncological emergencies.

What happens to endoscopic/arthroscopic tenotomies with iliopsoas impingement in the medium term? Review of a prospective cohort of 64 patients with a minimum follow-up of 5 years

IntroductionThe occurrence of iliopsoas impingement (IPI) after total hip arthroplasty (THA) is a proven risk factor for negative outcomes. Endoscopic or arthroscopic tenotomies of the iliopsoas offer a surgical solution with short-term results that have already been validated in prospective multicenter series. We carried out a review of the patients at more than 5 years of follow-up in order to assess the stability of the results over time. HypothesisOur main hypothesis was that endoscopic/arthroscopic tenotomies allow stable medium-term resolution of the painful symptoms of IPI. Our secondary hypothesis was that medium-term survival was satisfactory. Material and methodThis study is a continuation of a multicenter prospective series. Patients were contacted through multiple channels in order to: obtain an Oxford score, assess for satisfaction, psoas irritation, and daily pain on a visual analogue scale (VAS). ResultsOf 64 patients in the original study, 57 were contacted. The Oxford score at the last follow-up was 40.7±7.7 [12–48]. There was a significant difference between the Oxford scores preoperatively, at 8 months and at the last follow-up. The mean satisfaction out of 10 was 8.0±2.1 [1–10]. We found 84% satisfaction at 5 years against 83% at 8 months. The VAS was 2.1±2.3 [0–10]. A straight leg psoas sign was present in 19.6% (10/51) of patients at 5 years, compared to 15.6% (8/51) at 8 months. The sign disappeared in four cases, while it reappeared during the interval in six cases. Survival was 91.2% (95% CI: 80.2–96.3) at 5 years. ConclusionEndoscopic/arthroscopic iliopsoas tenotomies represent a permanent medium-term solution to treat IPI after THA. The existence of a force differential or an acetabular overhang does not seem, within a certain limit, to impact the results in the medium term. Level of evidenceIV; prospective series without control group.

Do low levels of alanine aminotransferase, a baseline marker of sarcopenia and frailty, associate with worse clinical outcomes among hospitalized COVID-19 patients? A Retrospective Cohort Study.

COVID-19 geoperdize lives. Not all the risk factors for negative outcomes are known. Sarcopenia and frailty are common, negatively affecting clinical outcomes. Studies have shown that sarcopenia and frailty are associated with worse outcomes. Our objective was to examine whether low ALT (Alanine-aminotranferase), a surrogate marker for sarcopenia, is associated with worse clinical outcomes among hospitalized COVID-19 patients. We reviewed cases of COVID-19 in a tertiary hospital, during three COVID-19 waves and examined correlations between ALT and mortality using crude, univariate and multivariate analysis for age, gender, hypertension, Chronic obstructive pulmonary disease and Congestive heart failure. 357 patients were included in this analysis. Median age was 69, 54% were males. Median ALT was 19 IU/L. During follow-up, 73 (20%) died. Patients with low ALT were more likely to die (HR 1.82, 95% CI 1.06-3.09, P=0.028). Other predictors for mortality were low albumin, background COPD, dyslipidemia, dementia, and malignancy. The multivariate analysis showed that low ALT was still an independent predictor of poor prognosis (HR 1.7, 95% CI 1.0-2.9, P=0.049). In our analysis of COVID-19 patients, low ALT levels were independently associated with increased risk of mortality, both as standalone and when incorporated into a multivariate analysis.

A Cross-Sectional Study on the Associations between Economic, Social, and Political Resources and Subjective Caregiver Burden among Older Spousal Caregivers in Two Nordic Regions

Inspired by the caregiver stress process model emphasising the role of resources for caregiving outcomes, the aim of this study was to investigate the prevalence of subjective caregiver burden (SCB) and its associations with individual social, economic, and political resources among older spousal caregivers in a Nordic regional setting. Cross-sectional survey data collected in 2016 in the Bothnia region of Finland and Sweden were used, where 674 spousal caregivers were identified and included in the analyses. The descriptive results showed that about half of the respondents experienced SCB. SCB was more common among Finnish-speaking caregivers. Results from the multivariate logistic regression analysis showed that none of the assessed political resources were significantly associated with SCB when controlling for other variables. Experiencing financial strain was associated with SCB, while personal income was not. Frequent contact with family members was statistically significantly associated with SCB. Future research could use longitudinal data to determine causal relationships, and when data allow, test the full caregiver stress process model to investigate the role of mediating factors in different comparative settings. Accumulated evidence on risk factors for negative outcomes of informal caregiving can contribute to effective screening tools for identifying and supporting vulnerable caregivers, which is becoming increasingly important with the ageing population.

Difficulties in Adaptation of the Mother and Newborn via Cesarean Section versus Natural Birth—A Narrative Review

Birth is a physiological act that is part of the morpho-functional economy of the maternal body. Each stage in the act of birth has a predetermined pathway that is neurohormonally induced and morpho-functionally established through specific and characteristic adaptations. Like maternity, childbirth also has an important impact on the maternal body as a biological structure and psycho-emotional behavior. Cesarean section performed at the request of the mother with no medical underlying conditions besides the prolonged hospitalization risk can also cause breathing problems in children, delayed breastfeeding, and possible complications in a future pregnancy. Vaginal birth remains the path of choice for a physiological evolution pregnancy. Although erroneously considered safe and easy today, cesarean section delivery must remain an emergency procedure or a procedure recommended for pregnancies where birth is a risk to the mother and to the child, as cesarean section itself is a risk factor for negative outcomes for both mother and baby. This review summarizes the impact that both cesarean section and natural birth have on mother and newborn in their attempt to adapt to postpartum events and extrauterine life.

Risk Factors and Outcomes of Patients with Carbapenem-Resistant Pseudomonas aeruginosa Bloodstream Infection

The rising incidence of carbapenem-resistant Pseudomonas aeruginosa (PA) bloodstream infection (BSI) has made the selection of antibiotic therapy more difficult and caused high mortality. This study was aimed at exploring the risk factors for carbapenem-resistant Pseudomonas aeruginosa (CRPA) bloodstream infection and identifying the risk factors for the outcomes of patients with PA-BSI. We performed a retrospective cohort study of patients with PA-BSI in a tertiary hospital from January 2017 to December 2021 in China. Epidemiological, clinical, and microbiological characteristics were described. Risk factors for CRPA-BSI and the outcomes of PA-BSI inpatients were identified, using multivariate logistic regression analysis. A total of 198 PA-BSI inpatients were included. The negative outcome rate was significantly higher in patients infected with CRPA (15/34, 44.12%) than with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) (35/164, 21.34%), and the difference was statistically significant (P=0.005). Multivariate logistic regression analysis showed that previous exposure to carbapenem (OR 3.519, 95% CI 1.359-9.110, P=0.010) was an independent risk factor for CRPA-BSI. In addition, CRPA (OR 1.615, 95% CI 0.626-4.171, P=0.32) was not an independent risk factor for negative outcome among PA-BSI inpatients. Our study showed that previous exposure to carbapenem was an independent risk factor for CRPA-BSI. CRPA was not an independent risk factor for a negative outcome in PA-BSI inpatients.

Development of the prediction model for negative outcomes after primary laparoscopic pyeloplasty in children: a retrospective study of 535 patients.

Laparoscopic pyeloplasty (LP) has been widely accepted as an effective method to treat ureteropelvic junction obstruction (UPJO) in pediatric patients. Limited studies focused on the relationship between risk factors and negative outcomes. Our study aimed to seek independent risk factors for negative outcomes and construct a prognostic nomogram to assist clinical decision-making and improve outcomes. A total of 535 patients with UPJO treated with primary LP between January 2016 and December 2020 were retrospectively reviewed. Negative outcomes were defined as restenosis requiring reoperation and grade III and IV complications based on the Clavien-Dindo grading system. Univariate and multivariate logistic regression analyses were used to select risk factors for negative outcomes after LP and developed the prediction model. The model was internally validated by the parametric bootstrapping method. Among the 535 patients, 33 (6.2%) developed negative outcomes. Ten patients developed ureteropelvic junction (UPJ) restenosis and underwent secondary surgery. UPJ leakage (two cases), difficulty of urinating after the removal of the Double-J (DJ) stent (two cases), and ileus (two cases) were the most common grade IIIa complications, while distal ureteral stricture (five cases), hernia formation (three cases), and delayed wound healing around the fistula (two cases) were the most common grade IIIb complications. After univariate and multivariate logistic analyses, the patient's weight, preoperative anteroposterior pelvic diameter (APD), and difficulty of DJ stent insertion were independent risk factors for negative outcomes, and they were used to fit the prediction model. The Brier score was 0.048. The model was relatively well-calibrated. The area under the receiver operating characteristic curve was 0.831 (95% CI: 0.756-0.906). Decision curve analysis illustrated good clinical utility. Primary LP is a safe and effective method for pediatric patients with UPJO. The patient's weight, preoperative APD, and difficulty of DJ stent insertion were independent risk factors for negative outcomes after LP. We established and validated a predictive model for negative outcomes after LP. With the help of this model, clinicians can make better decisions and improve patient outcomes.

A fragilidade é um fator de risco para desfechos negativos em idosos acometidos pela COVID-19

A fragilidade é um fator de risco para desfechos negativos em idosos acometidos pela COVID-19

Effect of modeling femoral version and head-neck offset correction on computed contact mechanics in dysplastic hips treated with periacetabular osteotomy

While correction of dysplastic acetabular deformity has been a focus of both clinical treatment and research, concurrent femoral deformities have only more recently received serious attention. The purpose of this study was to determine how including abnormalities in femoral head-neck offset and femoral version alter computationally derived contact stresses in patients with combined dysplasia and femoroacetabular impingement (FAI). Hip models with patient-specific bony anatomy were created from preoperative and postoperative CT scans of 20 hips treated with periacetabular osteotomy and femoral osteochondroplasty. To simulate performing only a PAO, a third model was created combining each patient’s postoperative pelvis and preoperative femur geometry. These three models were initialized with the femur in two starting orientations: (1) standardized template orientation, and (2) using patient-specific anatomic landmarks. Hip contact stresses were computed in all 6 model sets during an average dysplastic gait cycle, an average FAI gait cycle, and an average stand-to-sit activity using discrete element analysis. No significant differences in peak contact stress (p = 0.190 to 1), mean contact stress (p = 0.273 to 1), or mean contact area (p = 0.050 to 1) were identified during any loading activity based on femoral alignment technique or inclusion of femoral osteochondroplasty. These findings suggest that presence of abnormal femoral version and/or head-neck offset deformities are not themselves predominant factors in intra-articular contact mechanics during gait and stand-to-sit activities. Inclusion of modified movement patterns caused by these femoral deformities may be necessary for models to adequately capture the mechanical effects of these clinically recognized risk factors for negative outcomes.

It’s Not That They Are Big, It’s Just That They Are Black: The Impact of Body Mass Index, School Belonging, and Self Esteem on Black Boys’ School Suspension

The suspension of Black boys from school is a longstanding issue that places them at increased risk for negative academic and social–emotional outcomes. While risk factors for suspension are often documented, concurrently examining protective factors such as school belonging and self-esteem occurs infrequently. The purpose of this study was to examine the relationships between Body Mass Index (BMI), school belonging, self-esteem, race, gender, and school suspension. Results from the National Longitudinal Study of Adolescent to Adult Health (Add Health) indicated that BMI was a significant predictor of school suspension overall, but not for Black boys. Furthermore our hypotheses were not supported in that regardless of the levels of school belonging for Black boys, their levels of school suspension were not impacted as was the case with their peers. So it was not that they were big, just that they were Black as it relates to school suspension and Black boys. Implications are discussed in terms of the improving outcomes of Black boys. Impact Statement Black boys are suspended from school at higher rates than any group. Large body size is thought to be a risk factor for negative outcomes based on societal perceptions. For Black boys, body mass index does not predict school suspension.

Psychopathic personality, and its dimensions in the prediction of negative outcomes: Do they offer incremental value above and beyond common risk factors? Introduction to the special section

A total of nine studies put the psychopathy construct to a stringent test by examining the predictive ability while controlling for common risk factors for negative outcomes. In this way, the special section studies shed light on the important issue as to whether psychopathy as a construct offers something above and beyond common risk factors. Eight of the nine studies showed in different ways, in different countries, with different developmental/age periods, and with different measures and conceptualizations that psychopathic personality often was predictive of negative outcomes after adjusting for common risk variables. Five studies examined the association between psychopathic personality and negative outcomes in young children. All five of these studies found psychopathic personality to be predictive above and beyond common risk factors. Three studies examined psychopathy and its relation to negative outcomes from adolescence forward. Two of the three studies in this age band found psychopathy to be predictive of negative outcomes after controlling for common risk factors. Finally, one study examined psychopathy from adulthood forward in a specialized population and found that Factor 2 of the PCL-R was predictive of recidivism above and beyond the commonly used DSM diagnosis of ASPD. These findings support the notion that individuals with psychopathic personality follow a hazardous course impacting their own well-being as well as negatively impacting society. The implications of the findings are discussed in further detail and directions for future research are considered.

A customized adherence enhancement program for adolescents and young adults with suboptimal adherence and bipolar disorder: Trial design and methodological report

BackgroundThe onset of bipolar disorder (BD) is common during late adolescence and young adulthood (AYA). Suboptimal medication adherence is a critical yet modifiable risk factor for negative outcomes among AYAs with BD. MethodsThis research used an iterative process (e.g., focus groups, advisory board, cognitive interviews) to modify an existing adherence intervention to address suboptimal adherence in AYAs with BD. The modified version of Customized Adherence Enhancement for Adolescents and Young Adults (CAE-AYA) will be compared to an Enhanced Treatment as Usual condition (ETAU) in 40 AYAs intervention using a 6-month prospective, randomized controlled trial (RCT) in a high-risk group of 16–21 year old AYAs with BD with demonstrated non-adherence to their prescribed BD medications. ConclusionsThis report describes the methodology and design of the ImprovinG adhereNce In adolescenTs with bipolar disordEr (IGNITE) study. If successful, the CAE-AYA approach has the potential to advance care for vulnerable youth with BD.

Frailty in elderly patients with acute appendicitis

PurposeAcute appendicitis in the elderly is becoming increasingly recognized for its often severe course. For various elective and urgent operations in older patients, frailty is a risk factor for poor outcomes. However, there is a lack of data on frailty in elderly patients with acute appendicitis.MethodsPatients over 65 years old who underwent surgery for acute appendicitis in three hospitals between January 2015 and September 2020 were assessed with the Hospital Frailty Risk Score (HFRS) and the modified Frailty Index (mFI). Outcomes of interest, including morbidity, mortality, and length of stay, were recorded.ResultsWhile frailty can be measured with both tests, the mFI has better applicability and takes significantly less time to implement compared to the HFRS (21.6 s vs. 80.3 s, p < 0.0001) while providing the same information value.Patients who exhibited frailty according to either assessment had a significantly higher rate of milder (OR 5.85/2.87, p < 0.0001/0.009) and serious (OR 4.92/3.61, p < 0.011/0.029) complications, more admissions to the intensive care unit (OR 5.16/7.36, p < 0.0001), and an almost doubled length of stay (12.7 days vs. 6.6 days, p < 0.005). Up to 31% of these patients required institutional care after discharge, which is significantly more than those without frailty (p < 0.0001). Furthermore, the mortality rate in frail patients was significantly elevated to 17%, compared to less than 1% in non-frail patients (p = 0.018).ConclusionIn elderly patients, frailty is a significant risk factor for negative outcomes. Frailty can be assessed more quickly and reliably with the mFI compared to the HFRS.

Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2.

Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.