Risk Of Morbidity Research Articles

Types of Road Traffic Accidents and Emergency Medical Care

Introduction: A traffic accident is when only material damage is caused to the vehicle and track environment, and there are no casualties. RTA represents a significant risk for morbidity and mortality in Kosovo, of which head injury and multiple-site injury increase injury severity. The anatomical site, mechanism of injury, time to reach an initial health facility, time of the day, patient condition at ED, type of treatment given, GCS at admission, and days spent in the hospital were among independent predictors of management outcome. Targeted approaches to improving the care of the injured victims may improve outcomes. Thus, the clinician should consider the clinical presentation of RTA and give due attention to the identified contributing factors in managing it. Law enforcers should also emphasize the identified types and mechanisms of accidents. The PubMed database was utilized for article selection, and papers were obtained and reviewed. The ATLS protocol has been developed to manage trauma patients systematically so as not to miss any condition that may kill the patient. Conclusions: Triage is essential in managing accidental situations and strengthening the primary, secondary, and tertiary health systems. To design clinical guidelines, algorithms, and triage protocols at the three levels of health care, all healthcare professionals should be educated and trained with continuing courses in triage, communication, and Basic Life Support -AED, ACLS, PHTLS, BTLS, and ATLS.

Onchocerciasis is not a major cause of blindness in two endemic villages in Sierra Leone

ObjectiveSierra Leone, a country where onchocerciasis is endemic in 14 of the 16 districts, was the focus of our investigation. Despite 17 rounds of annual ivermectin treatment since 2005, a report circulated by a local politician indicated an increase in cases of suspected onchocerciasis-related vision impairment in two villages (Mangobo and Petifu) in Tonkolili district. In response, the National Neglected Tropical Disease Program conducted a comprehensive investigation. Ophthalmological, parasitological, and serological tests were conducted using standard procedures to determine the relationship between self-reported vision loss and onchocerciasis in adults. In addition, serological tests were carried out on children aged 5 to 9 years to assess the recent status of exposure to onchocerciasis in the two villages.ResultsReported vision loss in 37 patients was mainly due to cataracts (35.1%), allergic conjunctivitis (18.9%), refractive error (10.8%), and other conditions not related to onchocerciasis. There were 40.7% of all adults (N = 54) tested and 29.0% of 31 persons with self-reported vision loss who were positive for Ov-16 IgG4 antibodies, suggesting a history of exposure to onchocerciasis. However, otoscopic eye examinations and microscopic skin snip tests were all negative for Onchocerca volvulus microfilariae, indicating no active or low-intensity infection among adults and a low or zero risk of serious ocular morbidity in the two villages. Onchocerciasis may no longer be a major cause of blindness in these two villages. Apparently, 4.6% of 153 children aged 5 to 9 years tested positive for Ov-16 IgG4 antibodies, suggesting that onchocerciasis transmission is likely still ongoing in the two villages. The data presented here suggest that more annual rounds of mass treatment with ivermectin with high coverage are needed to eliminate onchocerciasis transmission in this area.

Modeling of Disease Progression of Type 2 Diabetes Using Real-World Data: Quantifying Competing Risks of Morbidity and Mortality.

Type 2 diabetes (T2D) is a progressive metabolic disorder that could be an underlying cause of long-term complications that increase mortality. The assessment of the probability of such events could be essential for mortality risk management. This work aimed to establish a framework for risk predictions of macrovascular complications (MVC) and diabetic kidney disease (DKD) in patients with T2D, using real-world data from the Swedish National Diabetes Registry (NDR), in the presence of mortality as a competing risk. The study consisted of 41,517 patients with T2D registered in NDR between 2005 and 2013. At inclusion, patients were newly diagnosed (T2D < 1 year) and had no prior evidence of DKD or MVC. Using three-quarters of the data, a five-state multistate model was established to describe competing events of MVC, DKD, a combination thereof, and the terminal state, death. Two hypotheses were investigated: (1) the risk of MVC and DKD are mutually independent, and (2) mortality is independent of morbidities. At the end of the study, the majority of individuals remained in uncomplicated T2D; however, the probability of transition to complications and death increased over time. The mortality hazard depended on the presence of morbidities and was quantified as a life expectancy decreased by 5.0, 9.7, and 12.2 years for MVC, DKD, and the combined morbidity, respectively, compared to uncomplicated T2D. An established framework with a five-state model incorporating competing events was shown to be a useful tool for comorbidities risk assessment in newly diagnosed patients with T2D.

Use of risk assessment tools in emergency general surgery: a cross-sectional survey of surgeons and trainees.

The applicability of risk assessment tools (RATs) for preoperative risk assessment (PRA) in Emergency General Surgery (EGS) is unclear. Limited knowledge of surgeons' approach to risk assessment is available. We investigated how Canadian surgeons approach PRA for EGS and their awareness of available RATs. Canadian Association of General Surgeons members were invited to complete an online cross-sectional survey. Descriptive statistics were reported. Of 278 respondents, 70% were attending surgeons (44% had 5-10years in practice, 43% > 10years), 5% fellows, and 25% residents. Most worked in medium-/large-volume centers (89%) and teaching hospitals (77%). During preoperative risk assessment, 2/3 of respondents reported applying clinical experience/instinct and referring to literature, while 55% used RATs. The best-known and used tools were the ACS-NSQIP calculator (68% and 59%) and the Emergency Surgery Acuity Score (ESAS, 66% and 47%, respectively). Surgeons were divided regarding the accuracy of RAT estimates, with 47% considering them generally accurate and 49% inaccurate. Trainees reported greater interest in major morbidity risk (86% vs. 65%) and probability of supported discharge (45% vs. 29%) than surgeons. Among participants not using RATs, 41% indicated they are scarcely accessible in the EGS context, while 33% found them cumbersome and time-consuming. RATs are underused in favor of personal judgment. The use of RATs may facilitate decision-making in elderly/complex patients and help reduce variability in practice, particularly for trainees and less-experienced surgeons. A greater effort in education is needed to spread the culture of RATs for PRA.

Stuck Prosthetic Valves: Clinical Implications of Pannus Formation and Gradient Measurement in Surgical Outcomes

Objective: Stuck prosthetic valves, often resulting from pannus formation or thrombus accumulation, represent a critical complication in prosthetic valve management, carrying significant risks for morbidity and mortality. This study aims to identify factors associated with stuck valve development and assess the effectiveness of interventions in restoring normal valve function. Methods: A total of 27 patients with stuck valves were analyzed, including mitral, aortic, and tricuspid valve cases. Metallic valves were initially implanted in all patients. Interventions included pannus cleaning in suitable cases and valve replacement when necessary, with the replacement being either metallic and biological based on clinical indications. Preoperative and postoperative ECG rhythms, left ventricular ejection fraction (LVEF) values, and gradient measurements were evaluated across patient groups. Results: No significant difference was found in time since initial surgery across valve types (p = 0.67), except in mitral valves, where time was longer in the replacement group (p = 0.02). Maximum gradients were higher in the pannus cleaning group for mitral valves (p = 0.03), while overall gradient values showed no significant differences. Postoperative left ventricular ejection fraction improved significantly in all groups (p &lt; 0.001). Conclusions: The findings highlight the importance of timely intervention in managing stuck prosthetic valves, which are associated with severe hemodynamic compromise and embolic risk. Pannus cleaning emerged as a viable alternative in selected cases where the obstruction was localized, with the valve structure otherwise intact. Biological valve replacements demonstrated superior rhythm stabilization in this study, although definitive conclusions are constrained by the minimal sample size (n = 2). Future research should focus on expanding sample sizes and incorporating comprehensive preoperative analyses to better inform surgical and clinical management strategies.

The role of skin microbiota in lichen planus from a Mendelian randomization perspective.

Lichen planus is a chronic skin lesion characterized by pruritic violaceous papules, which has a high risk of morbidity. Skin microbiota plays an important role in the maintenance of cutaneous mucosal barrier and human health and immune homeostasis. Studies have shown that skin microbiota may play a role in the pathogenesis of lichen planus, but it is not yet clear. MR studies have been performed to determine causal associations. Lichen planus samples from Finn database were extracted from published GWAS data, including 6,411 cases and 405,770 controls; skin microbiota samples were gathered from a meta-analysis of German population-based GWAS, which included 1,656 skin samples from two cohorts: KORA FF4 (n = 353) and PopGen (n = 294), comprising 4,685,714 SNPs. The IVW method was used as the main statistical method, supplemented by three methods: MR-Egger, weighted median and weighted mode. FDR correction and MR Steiger test were used to reduce false positives. IVW method revealed a negative correlation between Burkholderia in the moist anterior elbow and lichen planus (OR: 0.934, 95% CI: 0.910-0.986, P = 0.017). These associations remained stable following false discovery rate correction (P < 1e-5). Our study highlights a possible causal role of Burkholderia in the development of lichen planus and suggests that Burkholderia may reduce the occurrence of lichen planus by affecting macrophages.

Social Vulnerability and Biological Aging in New York City: An Electronic Health Records-Based Study.

Chronological age is not an accurate predictor of morbidity and mortality risk, as individuals' aging processes are diverse. Phenotypic age acceleration (PhenoAgeAccel) is a validated biological age measure incorporating chronological age and biomarkers from blood samples commonly used in clinical practice that can better reflect aging-related morbidity and mortality risk. The heterogeneity of age-related decline is not random, as environmental exposures can promote or impede healthy aging. Social Vulnerability Index (SVI) is a composite index accounting for different facets of the social, economic, and demographic environment grouped into four themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. We aim to assess the concurrent and combined associations of the four SVI themes on PhenoAgeAccel and the differential effects on disadvantaged groups. We use electronic health records data from 31,913 patients from the Mount Sinai Health System (116,952 person-years) and calculate PhenoAge for years with available laboratory results (2011-2022). PhenoAge is calculated as a weighted linear combination of lab results, and PhenoAgeAccel is the differential between PhenoAge and chronological age. A decile increase in the mixture of SVI dimensions was associated with an increase of 0.23years (95% CI 0.21, 0.25) in PhenoAgeAccel. The socioeconomic status dimension was the main driver of the association, accounting for 61% of the weight. Interaction models revealed a more substantial detrimental association for women and racial and ethnic minorities with differences in leading SVI themes. These findings suggest that neighborhood-level social vulnerability increases the biological age of its residents, increasing morbidity and mortality risks. Socioeconomic status has the larger detrimental role among the different facets of social environment.

An improved method of capture and immobilisation for medium to large-size macropods

Context Macropods are very susceptible to stress during capture. Capture methods for macropods fall into two categories: trapping and darting. Trapping by nets or a triggered trap mechanism is commonly used for small macropods. Darting is most often used for large macropods that are more prone to stress and capture myopathy when caught in traps. Aim To describe a modified ‘nylon drop-net’ technique for safely capturing medium to large macropods; and post-capture treatments that reduce stress and the potential for myopathy. Methods We used a drop-net to capture 40 agile wallabies (Notamacropus agilis) (24 females and 16 males), ranging in weight from 6 to 24 kg. For immobilisation, a single dose of intramuscular Diazepam (1 mg/kg) and Richtasol, a multivitamin, was administered to reduce the risk of capture myopathy. The longer-term effects of capture on animal condition were monitored in 34 radio-collared individuals for 2 months. Key results No deaths occurred during or as a result of capture or in the 8 weeks following capture. Conclusions Our modified drop-net and handling/treatment regime provides a cost-effective method for capturing medium and small-sized macropod species with very low risk of mortality or morbidity. Implications Our methods improve the welfare and safety of captured medium-sized macropods.

Effects of the Nonsteroidal MRA Finerenone With and Without Concomitant SGLT2 Inhibitor Use in Heart Failure.

Patients with heart failure (HF) with mildly reduced or preserved ejection fraction face heightened long-term risks of morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and the nonsteroidal mineralocorticoid receptor antagonist finerenone have both been shown to reduce the risk of cardiovascular events in this population, but the effects of their combined use are not known. FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) was a randomized, double-blind, placebo-controlled trial of finerenone in patients with HF and left ventricular ejection fraction ≥40%. Baseline SGLT2i use was a prespecified subgroup. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death. We first assessed for evidence of treatment heterogeneity on the basis of baseline SGLT2i use. We further examined SGLT2i uptake during the trial and evaluated the treatment effects of finerenone accounting for baseline and during-trial use of SGLT2i in time-varying analyses. Among 6001 participants, 817 (13.6%) were treated with an SGLT2i at baseline. During 2.6 years median follow-up, treatment with finerenone similarly reduced the risk of the primary outcome in participants treated with an SGLT2i (rate ratio, 0.83 [95% CI, 0.60-1.16]) and without an SGLT2i at baseline (rate ratio, 0.85 [95% CI, 0.74-0.98]; Pinteraction=0.76). In follow-up, 980 participants initiated SGLT2i, which was less frequent in the finerenone arm compared with placebo (17.7% versus 20.1%; hazard ratio, 0.86 [95% CI, 0.76-0.97]). Time-updated analyses accounting for baseline and subsequent use of SGLT2i did not meaningfully alter the treatment effects of finerenone on the primary end point. The treatment benefits of the nonsteroidal mineralocorticoid receptor antagonist finerenone were observed irrespective of concomitant use of an SGLT2i. These data suggest that the combined use of SGLT2i and a nonsteroidal mineralocorticoid receptor antagonist may provide additive protection against cardiovascular events in patients with HF with mildly reduced or preserved ejection fraction. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04435626.

A Bleed From the Distal Anastomosis Site of a Bypass Graft From the Left Common Iliac Artery to the Celiac Trunk Treated With a Surgeon-Modified Fenestrated Endograft.

The use of surgeon-modified fenestrated endograft to treat a bleeding complication in the common iliac artery. An Endurant limb graft was modified on back table in theater after planning the fenestration using a semi-automated centerline. The Endurant stent was planned to land flush at the aortic bifurcation. The Endurant limb was partially deployed until the fenestration opened facing the anastomosis to enable rotation and axial movement of the stent graft, if needed. By obtaining access from the contralateral common femoral artery, the fenestration was cannulated using up-and-over technique and bypass graft cannulated. The Endurant stent graft was then fully deployed. Through a separate puncture in the ipsilateral sheath, the fenestration was re-cannulated using a hydrophilic wire, and a balloon-expandable covered stent was introduced through a 7F sheath and then flared in a kissing fashion along with the Endurant stent. The distal part of the Endurant limb was extended with a bare metal stent into the external iliac artery. Control angiography was satisfactory, and bleeding was controlled. Surgeon-modified stent graft in the iliac arteries can be used even in the context of non-aneurysmal disease to treat patients in high-risk emergency situations and could be part of the armamentarium of the vascular surgeon. Physician-modified endografts are increasingly being used by vascular surgeons and interventional radiologists to treat patients with complex aorto-iliac aneurysms in whom custom-made endograft provided by the manufacturer is too expensive to produce and/or patient requires urgent surgery. Data on the use of physician-modified endografts to treat non-aneurysmal disease is lacking. This technical note highlights the use of physician-modified endograft to treat a patient with bleeding complication from the distal anastomosis of an iliac artery to coeliac trunk bypass graft in whom open surgery posed unacceptable high morbidity and mortality risks. This technical note continues to add more information and knowledge to the vascular surgery / interventional radiology communities on the use of physician-modified endografts and also adds another tool in the armamentarium of teams involved.

Kidney Injury Following Cardiac Surgery: A Review of Our Current Understanding.

Around one-quarter of all patients undergoing cardiac procedures, particularly those on cardiopulmonary bypass, develop cardiac surgery-associated acute kidney injury (CSA-AKI). This complication increases the risk of several serious morbidities and of mortality, representing a significant burden for both patients and the healthcare system. Patients with diminished kidney function before surgery, such as those with chronic kidney disease, are at heightened risk of developing CSA-AKI and have poorer outcomes than patients without preexisting kidney injury who develop CSA-AKI. Several mechanisms are involved in the development of CSA-AKI; injury is primarily thought to result from an amplification loop of inflammation and cell death, with complement and immune system activation, cardiopulmonary bypass, and ischemia-reperfusion injury all contributing to pathogenesis. At present there are no effective, targeted pharmacological therapies for the prevention or treatment of CSA-AKI, although several preclinical trials have shown promise, and clinical trials are under way. Progress in the understanding of the complex pathophysiology of CSA-AKI is needed to improve the development of successful strategies for its prevention, management, and treatment. In this review, we outline our current understanding of CSA-AKI development and management strategies and discuss potential future therapeutic targets under investigation.

Effect of acute kidney injury care bundle on kidney outcomes in cardiac patients receiving critical care: a systematic review and meta-analysis

BackgroundCardiac surgery is a major contributor to acute kidney injury (AKI); approximately 22% of patients who undergo cardiac surgery develop AKI, and among them, 2% will require renal replacement therapy (RRT). AKI is also associated with heightened risks of mortality and morbidity, longer intensive care stays, and increased treatment costs. Due to the challenges of treating AKI, prevention through the use of care bundles is suggested as an effective approach. This review aimed to assess the impact of care bundles on kidney outcomes, mortality, and hospital stay for cardiac patients in critical care.MethodsPubMed, Scopus, Web of Science, and EMBASE were searched up to November 2024. Inclusion criteria were studies on individuals with cardiac diseases receiving critical care, that used AKI care bundle as the intervention, and reported outcomes related to AKI, mortality, and other kidney-related events. We used the Cochrane Collaboration’s risk of bias tool 2 and the Newcastle-Ottawa scale for quality assessment. Pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.ResultsSeven studies on total 5045 subjects, including five observational and two randomized controlled trials (RCTs) were included. The implementation of care bundles significantly reduced the incidence of all-stage AKI (OR: 0.78; 95%CI: 0.61–0.99) and moderate-severe AKI (OR: 0.56; 95%CI: 0.43–0.72). Also, the implementation of care bundle increased the incidence of persistent renal dysfunction after 30 days by 2.39 times. However, there were no significant changes in RRT, major adverse kidney events, or mortality between the groups. The mean quality assessment score for observational studies was 7.2 out of ten, while there were noted concerns in the risk of bias assessment of the RCTs.ConclusionsThe application of care bundles in patients, including those undergoing cardiac surgeries as well as non-cardiac critical illness, appears to be effective in reducing AKI, particularly in moderate and severe stages. However, given the inclusion of non-cardiac patients in some studies, the observed effect may not be solely attributable to cardiac surgery cases. Future large-scale RCTs focusing specifically on cardiac surgery patients are recommended to clarify the impact of care bundles within this subgroup.Registration ID in PROSPEROCRD42024498972.

Periaortic fat thickness and cardiovascular risk factors in children with congenital adrenal hyperplasia.

Children with congenital adrenal hyperplasia are considered to be at an elevated risk for cardiovascular morbidity and mortality. The objective of this study was to evaluate the association between periaortic fat thickness and the cardiometabolic profile in children diagnosed with congenital adrenal hyperplasia. A total of 20 children and adolescents with congenital adrenal hyperplasia and 20 healthy control subjects were enrolled in the study. We investigated metabolic and anthropometric parameters, comparing these values to those of the control group. Periaortic fat thickness was assessed using an echocardiographic method that has not previously been applied to paediatric patients with congenital adrenal hyperplasia. The subjects in the congenital adrenal hyperplasia group were significantly shorter than the control subjects (p = 0.021) and exhibited a higher body mass index (p = 0.044) and diastolic blood pressure (p = 0.046). No significant differences were observed between the congenital adrenal hyperplasia group and control subjects concerning age, weight, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels. Additionally, dyslipidemia was identified in 5% (N = 1) of the congenital adrenal hyperplasia group. The mean fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance, and fasting glucose-to-fasting insulin ratio were similar between the congenital adrenal hyperplasia group and the control subjects. However, 15% (n = 3) of the congenital adrenal hyperplasia group had insulin resistance. Two children with congenital adrenal hyperplasia (10%) were diagnosed with hypertension.Periaortic fat thickness was significantly greater in the congenital adrenal hyperplasia group compared to the control group (p = 0.000), with measurements of 0.2039 ± 0.045 mm in the congenital adrenal hyperplasia group and 0.1304 ± 0.022 mm in the control group. In children with congenital adrenal hyperplasia, periaortic fat thickness exhibited a negative correlation with high-density lipoprotein cholesterol (r = -0.549, p = 0.034) and a positive correlation with the dose of hydrocortisone (r = 0.688, p = 0.001). Our results provide further evidence of subclinical cardiovascular disease in children with congenital adrenal hyperplasia. It is crucial to regularly assess cardiometabolic risk in children with congenital adrenal hyperplasia. The measurement of periaortic fat thickness in this population may serve as a valuable tool for identifying individuals at high risk for developing early atherosclerosis.

Circulating metabolomic biomarkers of 5-year body weight and composition change in a biracial cohort of community-dwelling older adults.

Unintentional weight loss in older populations is linked to greater mortality and morbidity risks. This study aims to understand the metabolic mechanisms of unintentional weight loss and their relationship with body composition changes in older adults. We investigated plasma metabolite associations with weight and body composition changes over 5years in 1335 participants (mean age 73.4years at Year 1, 51% women, and 33% Black) from the Health, Aging and Body Composition (Health ABC) study. Multinomial logistic regressions were used to examine associations of the 442 metabolites with weight loss > 5% over 5years with/without an intention, weight gain > 5%, and fluctuating weight relative to weight stability. Metabolite associations with unintentional weight loss differed from other weight change patterns. Lower levels of essential amino acids, phospholipids, long-chain polyunsaturated triglycerides, cholesterol esters, and uridine were associated with higher odds of unintentional weight loss versus weight stability after adjusting for age, sex, race, and Year 1 BMI categories. Losses in fat mass and muscle mass each attenuated > 20% of the associations between many metabolites, such as phospholipids and essential amino acids, and unintentional weight loss. DXA whole-body fat mass loss (mean 3% annually) further attenuated 9 metabolite associations by > 50% after CT muscle loss (mean 2% annually) adjustment. Lipids and amino acids related to energy and protein balance were associated with unintentional weight loss in older adults. Fat and muscle mass losses partially attenuated these associations, suggesting connections of these metabolic pathways with muscle, and particularly adiposity dynamics.

Associations of short-term exposure to air pollution with risk of pulmonary space-occupying lesions morbidity based on a time-series study

BackgroundPulmonary space-occupying lesions are typical chronic pulmonary diseases that contribute significantly to healthcare resource use and impose a large disease burden in China. A time-series ecological trend study was conducted to investigate the associations between environmental factors and hospitalizations for pulmonary space-occupying lesions in North of China from 2014 to 2022.MethodsThe DLNM was used to quantify the association of environmental factors with lung cancer admissions. The heating-, age-, gender-, malignancy-specific effects were further estimated to identify the susceptible groups.ResultsDuring the study period, fluctuations in air pollutants and climate conditions closely mirrored changes in hospitalizations for pulmonary space-occupying lesions. Totally, the distributed lag surface showed clear positive associations between pulmonary tumor hospitalization and PM2.5 (RRlag30: 1.000912; 95%CI: 1.000076, 1.00175), PM10 (RRlag30: 1.002246; 95%CI: 1.000474, 1.004021), SO2 (RRlag30: 1.002714; 95%CI: 1.001071, 1.004414), CO (RRlag30: 1.002231; 95%CI: 1.000592, 1.003873). Additionally, the associations between air pollutants and hospitalizations for pulmonary space-occupying lesions were significantly stronger during the heating season. Population aged 65 or older, females and those diagnosed with malignancies were more vulnerable for the risk of pulmonary space-occupying lesions diseases due to air pollution exposure.ConclusionsThe present study illustrated risk and burden for pulmonary space-occupying lesions hospitalization associated with air pollution, especially among population aged ≥ 65, or female.

Deep learning MRI models for the differential diagnosis of tumefactive demyelination versus IDH-wildtype glioblastoma.

Diagnosis of tumefactive demyelination can be challenging. The diagnosis of indeterminate brain lesions on MRI often requires tissue confirmation via brain biopsy. Noninvasive methods for accurate diagnosis of tumor and non-tumor etiologies allows for tailored therapy, optimal tumor control, and a reduced risk of iatrogenic morbidity and mortality. Tumefactive demyelination has imaging features that mimic isocitrate dehydrogenase-wildtype glioblastoma (IDHwt GBM). We hypothesized that deep learning applied to postcontrast T1-weighted (T1C) and T2-weighted (T2) MRI images can discriminate tumefactive demyelination from IDHwt GBM. Patients with tumefactive demyelination (n=144) and IDHwt GBM (n=455) were identified by clinical registries. A 3D DenseNet121 architecture was used to develop models to differentiate tumefactive demyelination and IDHwt GBM using both T1C and T2 MRI images, as well as only T1C and only T2 images. A three-stage design was used: (i) model development and internal validation via five-fold cross validation using a sex-, age-, and MRI technology-matched set of tumefactive demyelination and IDHwt GBM, (ii) validation of model specificity on independent IDHwt GBM, and (iii) prospective validation on tumefactive demyelination and IDHwt GBM. Stratified AUCs were used to evaluate model performance stratified by sex, age at diagnosis, MRI scanner strength, and MRI acquisition. The deep learning model developed using both T1C and T2 images had a prospective validation area under the receiver operator characteristic curve (AUC) of 88% (95% CI: 0.82 - 0.95). In the prospective validation stage, a model score threshold of 0.28 resulted in 91% sensitivity of correctly classifying tumefactive demyelination and 80% specificity (correctly classifying IDHwt GBM). Stratified AUCs demonstrated that model performance may be improved if thresholds were chosen stratified by age and MRI acquisition. MRI images can provide the basis for applying deep learning models to aid in the differential diagnosis of brain lesions. Further validation is needed to evaluate how well the model generalizes across institutions, patient populations, and technology, and to evaluate optimal thresholds for classification. Next steps also should incorporate additional tumor etiologies such as CNS lymphoma and brain metastases. AUC = area under the receiver operator characteristic curve; CNS = central nervous system; CNSIDD = central nervous system inflammatory demyelinating disease; FeTS = federated tumor segmentation; GBM = glioblastoma; IDHwt = isocitrate dehydrogenase wildtype; IHC = immunohistochemistry; MOGAD = myelin oligodendrocyte glycoprotein antibody associated disorder; MS = multiple sclerosis; NMOSD = neuromyelitis optica spectrum disorder; wt = wildtype.

Gut microbes of the cecum versus the colon drive more severe lethality and multi-organ damage.

Intestinal perforations lead to a high risk of sepsis-associated morbidity and multi-organ dysfunctions. A perforation allows intestinal contents (IC) to enter the peritoneal cavity, causing abdominal infections. Right- and left-sided perforations have different prognoses in humans, but the mechanisms associated with different cecum and colon perforations remain unclear. This study investigates how gut flora influences outcomes from perforations at different sites in mice. Using fecal-induced peritonitis mouse model, isolated IC from the cecum or colon was injected peritoneally at 2mg/kg. Bacterial burden was quantified with quantitative PCR, and microbial communities were analyzed using 16S rRNA gene sequencing. Survival rates were monitored, and blood biochemical indices, histological changes, cytokines expression, immunological signaling and multiple-organ damage were assessed at 16h post-injections. The results showed cecum IC developed more severe sepsis than colon IC, with shorter median survival time and greater multi-organ damage. Mice treated with cecum IC displayed elevated tissue damage markers in the liver, heart, and kidneys, contributing to worsened pathology. This was likely driven by systematic inflammatory cytokines production and lung inflammation. Mechanistically, cecum IC triggered stronger cGAS-STING and TBK1-NF-κB signaling, promoting systemic inflammation compared to the colon IC. Moreover, bacterial analysis demonstrated that cecum IC carry a higher bacterial burden than colon IC and exhibit a different microbial community. A detailed microbiome comparison revealed an increased abundance of potentially pathogenic bacteria in the cecum IC. These findings suggest that the site of intestinal perforation influences sepsis severity, with the cecum being associated with a higher bacterial burden and a relatively increased abundance of potentially pathogenic bacteria compared to the colon. Our findings first compared the lethality associated with the microbial composition of the cecum and colon, indicating the perforation site could help providers predict the severity of sepsis, thereby introducing a novel perspective to microbiology and sepsis research.

Intra-articular procedures and associated septic arthritis: A mini-review.

Native joint septic arthritis (SA) is a severe, potentially life-threatening condition characterized by the invasion of synovial fluid and membrane by pathogens, most commonly bacteria. The rising frequency of intra-articular procedures such as joint aspirations and injections has led to increased concern regarding iatrogenic septic arthritis. This mini-review aims to summarize current understanding of the incidence, risk factors, bacterial etiology, and strategies for preventing SA associated with intra-articular procedures. Recent studies report that while iatrogenic SA incidence remains low, ranging between 0.002% and 0.008% following injections, it is higher following arthroscopy (0.14%). Risk factors for iatrogenic SA mirror those of hematogenous SA, comprising older age, male gender, comorbidities such as diabetes mellitus, and systemic corticosteroid therapy. Staphylococcus aureus remains the most frequently implicated pathogen, followed by coagulase-negative staphylococci and streptococci. Preventive measures, including hand antisepsis, patient skin disinfection, and the wearing of surgical masks, are essential to reducing the risk of SA during intra-articular procedures. Despite low incidence, SA poses significant morbidity and mortality risks, underscoring the need for adherence to infection control protocols. This review highlights the importance of standardized preventive measures and further research into optimized aseptic techniques, the objective being to mitigate the risk of iatrogenic infections in clinical practice.

Echocardiographic predictors of surgical outcomes in pulmonary atresia with intact ventricular septum and development of a discriminatory calculator: an Australian tertiary institution experience.

Pulmonary atresia with intact ventricular septum is a rare congenital cardiac lesion with significant anatomical heterogeneity. Surgical planning of borderline cases remains challenging and is primarily based on echocardiography. The aim was to identify echocardiographic parameters that correlate with surgical outcome and to develop a discriminatory calculator. Retrospective review of all pulmonary atresia with intact ventricular septum cases at a statewide tertiary paediatric cardiac centre was performed between 2004 and 2020. Demographic, clinical, and echocardiographic data were collected. Logistic regression was used to develop a discriminatory tool for prediction of biventricular repair. Forty patients were included. Overall mortality was 27.5% (n = 11) and confined to patients managed as univentricular (11 vs 0, p = 0.027). Patients who underwent univentricular palliation were more likely to have an associated coronary artery abnormality (17 vs 3, p = 0.001). Fifteen surviving patients (51.7%) achieved biventricular circulation while 14 (48.3%) required one-and-a-half or univentricular palliation. Nineteen patients (47.5%) underwent percutaneous pulmonary valve perforation. No patients without tricuspid regurgitation achieved biventricular repair. The combination of tricuspid valve/mitral valve annulus dimension ratio and right ventricle/left ventricle length ratio identified biventricular management with a sensitivity of 93% and specificity of 96%. An online calculator has been made available. Pulmonary atresia with intact ventricular septum is a challenging condition with significant early and interstage morbidity and mortality risk. Patient outcomes were comparable to internationally reported data. Right ventricle/left ventricle length and tricuspid valve/mitral valve annulus dimension ratios identified a biventricular pathway with a high level of sensitivity and specificity. Absent tricuspid regurgitation was associated with a univentricular outcome.

Recommencing anticoagulation treatment in surgically managed patients with intracerebral haemorrhage and mechanical heart valves: An Aotearoa-New Zealand analysis.

Intracerebral haemorrhage (ICH) is an absolute contraindication for therapeutic oral anticoagulation therapy (OAT). Re-bleeding carries significant risk of morbidity and mortality. Patients with prosthetic heart valves are at higher risk of thromboembolic complications when OAT is withheld. The aim of our study is to establish the safe time periods where OAT can recommence, and assess the complication rates of re-introduction and associated risk factors. New Zealand-wide, retrospective (2005-2021) and prospective (2021-2023) data was collected from patients with prosthetic heart valves, aged 18years or older who underwent surgical management of ICH. The time to re-bleeding or thromboembolic event was recorded and the time period that balances the risks was examined. Primary outcomes included rate of re-bleeding and thromboembolic events. Associated medical, radiological, surgical and valve risk factors were examined. Thirty patients were identified and included in the analysis. Average time to therapeutic anticoagulation was 12.2days post-op (95% CI 6.9 - 17.5days), 62.5% recommenced OAT at or before day 14 (Range 3-13days). Four patients (13.3%) sustained a re-bleeding event after recommencing OAT. Three of the 4 re-bleeding events were observed in the group recommencing prior day 14, without reaching statistical significance. Of these, two patients died following the event. Group mortality was 30%. One patient had a thromboembolic complication at day 14 post OAT, age of valve was 2months. No thromboembolic complications were observed in patients recommencing after day 14. Maori and Pasifika patients were disproportionately represented and their condition was associated with a background of Rheumatic Heart Disease in 10 out of 11 cases. Early re-commencing of OAT is effective in preventing thromboembolic complications associated to prosthetic heart valves. There is a tendency for re-bleeding to occur when OAT is recommenced prior to day 14 (not significant). These data suggest that in this New Zealand cohort, the thromboembolic risks of withholding OAT may be overestimated at the expense of early anticoagulation, with an increased risk of re-bleeding in this surgically managed cohort. Further prospective studies are warranted to definitively examine the risks of early therapeutic anticoagulation in this group.