Serum Hemoglobin Research Articles

Abstract 4135712: Mortality and Cardiovascular Complications Associated with Weight Loss Drugs among Breast Cancer Females Under Cardiotoxic Therapies: A Real-World Populational Study in the United States

Background: Obesity is an adverse prognostic factor for breast cancer (BC). While liraglutide and semaglutide, derived from antidiabetic glucagon-like peptide-1 receptor agonists (GLP1RA), are established weight loss drugs known for their cardiovascular safety in the general obese population, their safety in BC patients undergoing cardiotoxic antineoplastic therapies remains less understood. Objective: To investigate the mortality and cardiovascular outcomes related to GLP1RA used for weight loss among the highly susceptible BC females. Methods: This retrospective cohort study was based on the TrinetX network, comprising real-time health records from over 60 US healthcare organizations. The study population included obese females (≥18 years old) who received at least three prescriptions of either exclusive GLP1RA (liraglutide or semaglutide) or non-GLP1RA weight loss drugs (phentermine, bupropion-naltrexone, orlistat) upon BC diagnosis between 01/01/2015 and 01/01/2022. The index date was the initiation of systemic anti-cancer treatment, including chemotherapy (anthracycline, taxane, or cyclophosphamide), and/or anti-HER2 agents (trastuzumab, pertuzumab, or lapatinib). We used 1:1 propensity score-matching (PSM) to balance demographics, BMI, comorbidities, concurrent medications for cardiovascular diseases and metabolic disorders, BC receptor status and prior treatment, and levels of serum cholesterol (LDL, HDL) and hemoglobin A1c. Cox regression models were applied to compute hazard ratios (HR) and 95% confidence intervals (CIs). Follow-up continued until 05/24/2024, or until adverse cardiovascular events or death occurred. Results: Among 380 PSM-balanced pairs, the GLP1RA group (mean age: 57.6±11) showed significantly lower risks of all-cause mortality (HR 0.593, 95% CI 0.457-0.77), acute heart failure (HR 0.496, 95% CI 0.286-0.859), angina pectoris (HR 0.566, 95% CI 0.343-0.936), and acute stroke (HR 0.661, 95% CI 0.46-0.951) than the non-GLP1RA group (mean age: 57.5±12). Otherwise, no significant difference was shown in acute myocardial infarction (HR 0.787, 95% CI 0.495-1.251), pulmonary hypertension (HR 0.777, 95% CI 0.55-1.099), or arrhythmias (HR 0.829, 95% CI 0.566-1.215). Conclusion: Compared to non-GLP1RA weight loss agents, GLP1RA offers better survival and cardiovascular protection for BC patients undergoing cardiotoxic therapies. Future studies are warranted to validate the safety of these weight loss drugs during the BC treatment continuum.

Maternal iron nutrition during pregnancy and fetal intrauterine growth

BackgroundIron is critical for maternal and fetal health; however, the effect of iron nutrition on fetal intrauterine growth remains unclear. This study aimed to investigate the associations of maternal iron nutrition during pregnancy with fetal intrauterine growth parameters among the Chinese population.MethodsThis retrospective birth cohort study included 482 pregnant women. Maternal information was collected by standard questionnaires. Maternal concentrations of serum ferritin and hemoglobin were detected. Fetal ultrasound examinations in the second and third trimesters were conducted. Quantile regression or linear regression models were applied to assess the associations.ResultsParticipants took iron supplementation in early, mid, and late pregnancy accounted for 19.1%, 40.3%, and 37.8%, respectively. Iron supplementation in the first and second trimesters and total iron intake in pregnancy were positively associated with fetal intrauterine growth parameters at some percentiles. Compared with those without iron supplementation in the second trimester, women with iron supplementation in the second trimester had 0.37 (95%CI = 0.24–0.49), 0.37 (95%CI = 0.26–0.48), 0.15 (95%CI = 0.04–0.26), and 0.52 (95%CI = 0.42–0.61) higher z-scores in fetal biparietal diameter, femur length, abdominal circumference, and estimated fetal weight at the 50th percentile in the second trimester, respectively. Maternal serum ferritin and hemoglobin concentrations in the first and second trimesters were positively correlated with several fetal growth parameters.ConclusionsFetal intrauterine growth may benefit from maternal iron nutrition in the first and second trimesters.

Controlled fabrication of hierarchical porous carbon nanospheres with high doped nitrogen content for high-performance adsorbent of biomacromolecule

Constructing nitrogen-doped porous carbons with high specific surface area, rapid mass transfer channels, and positive charge is a crucial requirement for high-performance adsorbents. Herein, by the kinetic self-assembly synthesis strategy, we prepared nitrogen-doped hierarchical porous carbon spheres (N-HPCS) with adjustable pore structure, high specific surface area, and high nitrogen doping content (8.88 %). By using ethylenediamine as an assisted polymerization and assembly agent, the hydrolysis and condensation rate of tetraethyl orthosilicate (TEOS) as the silica source and the condensation rate of 3-aminophenol and formaldehyde as the phenolic resin precursor were controlled by adjusting ammonia volume as the alkaline catalyst to tune kinetic self-assembly of silica and phenolic resin components, thus achieving their simultaneous or sequential nucleus and growth. After carbonization and selective silica etching, three types of carbon nanospheres with center-radial pores, hollow center-radial pores and hollow structure were obtained. High nitrogen doping content endowed the nanospheres with positive charge. Through adsorption experiments on the bovine serum albumin (BSA) and Hemoglobin (Hb) as typical biological macromolecules, hollow carbon nanospheres with center-radial pores exhibited excellent adsorption performance for BSA(622.34 mg g−1) and Hb(759.96 mg g−1). Our fabricated N-HPCS may become a potential candidate for high-performance adsorption materials.

Nutritional Risk, Nutritional Status and Some Biochemical Parameters In Adult Burn Patients in Burn Intensive Care Unit: A Prospective Study

Nutritional therapy is very important in burn patients and plays a role in the prevention and treatment of malnutrition. Therefore, it is necessary to assess nutritional status, prevent or minimize nutritional problems, and monitor nutritional therapy. This study was conducted to determine the nutritional risk, nutritional status and biochemical parameters of adult burn patients in the burn intensive care unit. The 59 patients (women: 16, men: 43) between the ages of 19-64 were included in the study. Parameters such as NRS-2002 (admission and discharge), dietary intake, nutritional support status, serum albumin, and total protein (admission and discharge) were evaluated to determine the nutritional risk and nutritional status of the patients. In addition, body weight, mid-upper arm circumference, and triceps skinfold thickness were measured and body mass index was calculated (admission and discharge). The duration of hospitalization and burn percentage of men patients were higher than women (P < 0.05). A significant decreases were determined in the mean body weight, body mass index, and triceps skinfold thickness of men patients at discharge compared to admission (P < 0.05). In men patients, a statistically significant difference was found in serum albumin, hemoglobin, and hematocrit values between admission and discharge (P < 0.05). A statistically significant difference was found in NRS-2002 scores at admission and discharge in both genders, and the scores increased (P < 0.05). While a significant relationship was found between immunonutrition support and gender (P < 0.05), no relationship was found between genders in terms of the diet given and the consumption status of the diet intake (P > 0.05). No statistically significant difference was found between genders in terms of feeding duration with nutritional support products, energy intake with nutritional support products and diet, macronutrients, and total energy expenditure values (P > 0.05). Since burn injuries can cause serious metabolic disorders, impaired nutritional status was encountered during hospitalization. While the treatment process was positively affected by the increase in the NRS-2002 score during hospitalization, a decrease in parameters such as albumin, total protein, and anthropometric measurement values brought about by the catabolic process was encountered. Therefore, to prevent or treat malnutrition, the nutritional status of patients should be evaluated at the time of hospitalization and they should be able to receive the necessary nutritional support.

INVESTIGASI KADAR HEMOGLOBIN PASIEN CANCER PAYUDARA PRE DAN POST KEMOTERAPI

Anemia refers to a decrease in serum hemoglobin concentration to pathological levels where hemoglobin level in women is <12 g/dl and in men <14 g/dl. More than 40% of cancer patients undergoing chemotherapy are subjected to anemia. As chemotherapy drugs are unable to distinguish between normal and neoplastic cells, their destructive nature results in a reduced number of red blood cells through the hemolysis process. The principles of chemotherapy are required to maintain a number of normal cells to avoid unintended side effects. This study aimed to investigate the hemoglobin levels before and after chemotherapy. The method of this study was qualitative, using a case study approach. The study sample consisted of three individuals, and the hemoglobin levels were assessed using the EasyTouch hemoglobinometer. The data were processed using Colaizzi’s analysis method: reading, meaning formulation, and theming. The results of this study were presented in three themes: (1) anemia occurred due to oxidative stress, (2) a decrease in the number of red blood cells caused by lysis; and (3) PRC transfusion as a way to overcome anemia. It can be concluded that a decrease in the number of red blood cells is inevitable. Therefore, patients are advised to get sufficient rest, increase their intake of nutritious food, and consume iron vitamins.

Relationship Between Vitamin D Insufficiency and Anemia in Older Adults: An Approach Considering Clinical Aspects and Food Insecurity

Background/Objectives: Studies have shown a high prevalence of anemia and vitamin D insufficiency in older adults, and the literature suggests a relationship between these two conditions, as vitamin D insufficiency may impair erythrocyte synthesis. Food insecurity refers to the lack of regular access to sufficient and nutritious food, which can directly affect health by worsening conditions such as anemia and vitamin D insufficiency. This study evaluated the association between vitamin D insufficiency and anemia in older adults. Methods: We conducted a cross-sectional study with 430 individuals aged 60 and older, using personal interviews and blood tests for data collection. Anemia was identified with serum hemoglobin levels of <12 g/dL for women and <13 g/dL for men, while vitamin D insufficiency was defined as serum levels <30 ng/mL. We used multiple logistic regression to analyze associations through Stata version 17.0 software. Results: The prevalence of anemia was identified in 14.7% of the sample, and vitamin D insufficiency was observed in 63.5%. We found an association between vitamin D insufficiency and anemia (OR = 2.4; 95% CI = 1.2–4.7). In the final model, factors such as male sex (OR = 2.7; 95% CI = 1.5–4.9) and polypharmacy use (OR = 2.0; 95% CI = 1.0–3.9) were also associated, regardless of age group, food insecurity, and multimorbidity. Conclusions: Vitamin D insufficiency increased the likelihood of anemia among the older adults evaluated, suggesting that prevention and treatment strategies for anemia should consider vitamin D serum levels.

Impact of malnutrition on postoperative outcomes in total knee arthroplasty: a comprehensive analysis

Introduction: Malnutrition has been shown to cause perioperative complications, which can be particularly detrimental following total knee arthroplasty (TKA). These complications can lead to increased morbidity, extended hospital stays, and significant financial burdens on both patients and healthcare systems. To evaluate the nutritional status and body mass index (BMI) of patients undergoing TKA and monitor them for complications immediately postoperatively, at one week, and three months after surgery. Methods: This prospective study included 88 patients who underwent TKA at government medical college Kozhikode, Kerala, India. Nutritional status was assessed using serum albumin, ferritin, haemoglobin, and BMI (body mass index) levels. Patients were followed up for three months postoperatively to identify any complications. Data analysis was conducted to determine the relationship between malnutrition and postoperative complications. Results: Of the 88 patients, 5 developed major wound complications, with 4 of these patients exhibiting hypoalbuminemia. Hypoalbuminemia was found to have a statistically significant association with major wound complications (p<0.001). Malnutrition was associated with higher rates of major wound complications, increased need for postoperative blood transfusions, and longer hospital stays. Conclusion: Identifying modifiable risk factors such as malnutrition in patients undergoing TKA is crucial for reducing the risk of postoperative complications, which can otherwise lead to disastrous outcomes. Preoperative optimization of nutritional status can significantly improve surgical outcomes and reduce complications.

Factors associated with dysfunction of autogenous arteriovenous fistula in patients with secondary hyperparathyroidism after parathyroidectomy

Background Secondary hyperparathyroidism (SHPT) is a prevalent chronic complication in patients undergoing hemodialysis. Parathyroidectomy (PTX) is crucial for reducing mortality and improving the prognosis in the treatment of refractory hyperparathyroidism. However, it is often associated with a number of postoperative complications such as postoperative hypotension, hyperkalemia, and hungry bone syndrome. A previous study demonstrated that low blood pressure influences the patency of autogenous arteriovenous fistulas (AVF). Few studies have examined AVF dysfunction following PTX. This study aimed to identify and describe the risk variables associated with AVF dysfunction after PTX. Methods Cases of AVF dysfunction after PTX between 2015 and 2021 were studied. Four controls were identified for each patient and were matched for sex and age. Biochemical parameters and blood pressure of the patients before and after PTX were recorded. Risk factors for AVF dysfunction after PTX were identified using conditional logistic regression analysis. Results Sixteen patients and 64 controls were included in this study. Baseline demographic and laboratory data were compared. Patients in the AVF dysfunction group had lower levels of postoperative calcium than the controls. After surgery, calcium levels decreased more in patients with AVF dysfunction than in the control group. The decrease in systolic blood pressure (ΔSBP) after PTX was greater in the AVF dysfunction group than that in the control group. For each 1 mmHg increment in ΔSBP, the risk of AVF dysfunction after surgery increased by 11.6% (OR = 1.116, 95% CI, 1.005–1.239, p = .040). The likelihood of developing AVF dysfunction after surgery was twelvefold higher in diabetic patients than in non-diabetic patients (OR = 12.506, 95% CI, 1.113–140.492, p = .041). Among patients with ΔSBP > 5.8 mmHg after PTX, the AVF failure rate was significantly greater in patients with diabetes than in those without diabetes. Patients with a history of AVF failure had a nine-fold higher risk of developing AVF dysfunction (OR = 9.143, 95% CI, 1.151–72.627, p = .036). Serum albumin, hemoglobin, ΔiPTH, and age were not independent predictors of AVF dysfunction. The cutoff value for SBP was 5.8 mmHg, as determined by the Youden index of the receiver operating characteristic curve. Conclusion Decreased systolic blood pressure (ΔSBP) after PTX, diabetes, and AVF failure history were risk factors for AVF dysfunction following PTX in patients with SHPT. Diabetes patients with ΔSBP > 5.8 mmHg were more prone to AVF dysfunction after PTX.

Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients.

Given the high prevalence and significant challenges of frailty, a state of increased vulnerability to adverse health outcomes, among maintenance hemodialysis (MHD) patients, this cross-sectional study aimed to investigate its prevalence and explore its association with nutritional status and other relevant factors. The study involved 290 MHD patients with an average age of 52.98 ± 13.65 years. Frailty assessments, nutritional evaluations, and medical status measurements were performed. Data analysis involved descriptive statistics, correlation analyses, and multivariate logistic regression. Among the patients, 70.3% were identified with frailty (16.9% frail, 53.4% pre-frail). Frailty was more prevalent in female patients compared to males and correlated positively with age, marital status, caregiving needs, comorbidities, dialysis duration, and higher nutritional risk scores. Negative correlations were observed with serum albumin, hemoglobin, body weight, and height. A significant prevalence of frailty was found in MHD patients, with notable associations to various demographic, clinical, and nutritional factors.

Association of regular plasmapheresis donation with serum protein and electrolyte levels: a multicentre cross-sectional study in China

BackgroundChina’s plasmapheresis donation policy differs from that of Western countries. The association between regular plasmapheresis donation and donor health in China is still unknown.ObjectivesTo investigate the association of regular plasmapheresis...

Impact of enhanced recovery after surgery (ERAS) on surgical site infection and postoperative recovery outcomes: a retrospective study of 1276 cases

This retrospective observational study aimed to evaluate the incidence of surgical site infection (SSI) in the era of enhanced recovery after surgery (ERAS) and the effect of ERAS on postoperative outcomes. Totally 1,276 patients (565 in ERAS group and 711 in non-ERAS group) who underwent operations at the department of general surgery during 2017–2021 were included. Risk factors were identified via logistic regression analysis and meta-analysis of all relevant published studies was performed. Subsequently, propensity score matching was used to match different risk factors. Overall, 40 patients were diagnosed with SSI, and the pooled incidence of SSI was 3.13%. In total, 14 (2.48%) and 26 (3.66%) patients in the ERAS and non-ERAS groups, respectively, were diagnosed with SSI (P = 0.230). Among patients for whom the ERAS protocol was adopted, 7 independent risk factors of SSI were identified. After propensity score matching, in patients without SSI, the number of hospital days was significantly lower in the ERAS group than in the non-ERAS group (2 [2, 5] vs. 3 [2, 7], P = 0.005), whereas in patients with SSI, the number of hospital days was similar between the ERAS and non-ERAS groups. ERAS had no effect on the incidence of SSI but could significantly accelerate the discharge of uninfected patients. In the era of ERAS, SSI incidence was affected by the type of surgery; number of postoperative hospital days; type of incision; serum hemoglobin, total protein, and albumin levels; and antibiotic prophylaxis. Furthermore, these results will significantly affect the implementation of the ERAS protocol and optimal preoperative management.

The Effectiveness of Anemia Treatment with Injectable Iron within 48 to 72 Hours before Coronary Artery Bypass Surgery on Cardiac Function and Postoperative Outcome: A Randomized Clinical Trial

Background: Anemia is considered as one of the risk factors affecting the outcomes after cardiac surgery. Accordingly, the improvement of iron deficiency anemia through injection or oral may be associated with the improvement of post-procedure results, especially the improvement of cardiovascular function. This study was aimed at investigating the effectiveness of iron treatment shortly before surgery in reducing the need for blood transfusion and improving myocardial performance parameters (left ventricular ejection fraction) in coronary bypass surgery patients. Methods: This study was a single-blind randomized clinical trial. In total, 60 candidates for coronary bypass surgery having iron deficiency anemia before the operation were randomly divided into two groups treated with injectable iron supplement (iron sucrose at a dose of 200 mg/200 ml of normal saline injected in 30 minutes) 48 to 72 hours before surgery or without therapeutic intervention. The patients were examined during and after the operation in terms of surgical outcomes. Results: Treatment with injectable iron before surgery was associated with improvement in serum hemoglobin level after surgery and a significant reduction in the need for intraoperative and postoperative transfusions. Preoperative treatment of iron deficiency was associated with a reduction in the length of hospitalization of the patients after surgery. Conclusion: Treatment of iron deficiency anemia within 48 to 72 hours before surgery will improve the condition of patients’ anemia and compensate serum hemoglobin, reduce the need for blood transfusion during surgery and the length of hospitalization of the patients after surgery.

Application of serum tumor specific protein 70 for prognostic stratification in acute myeloid leukemia

Objective: To assess the value of serum tumor specific protein 70 (SP70) for prognostic stratification in acute myeloid leukemia (AML). Methods: A cohort study design was adopted. 129 newly diagnosed AML patients from September 2022 to January 2024 at the Hematology Department of the First Affiliated Hospital of Nanjing Medical University were included, as well as a control group consisted of 120 healthy individuals and 7 cases with benign hematologic diseases during the same period (total 127 cases). Clinical data were collected from Electronic Medical Records. According to the 2023 edition of the Chinese Leukemia Diagnosis and Treatment Guidelines, AML patients with good or moderate prognosis were categorized as low-to-intermediate risk, while those with poor prognosis were high-risk group. Univariate and multivariate logistic regression analyses were used to identify variables significantly associated with AML prognostic risk. ROC analysis was used to evaluate diagnostic performance. A nomogram for predicting patient prognostic risk was constructed by R 4.0.2 software, and the internal validation was performed using bootstrapping. Results: Among 129 AML patients, there were 71 males (55.0%) and 58 females (45.0%), with 42 (32.6%) classified as high-risk and 87 (67.4%) as low-intermediate risk. The high-risk group had a significantly higher median age [62 (48, 67) years] compared to the low-intermediate risk group [50 (35, 63) years, Z=-2.381, P=0.017], and a significantly higher proportion of males (30 patients, 71.4%) compared to the low-intermediate risk group (41 patients, 47.1%, χ2=6.760, P=0.009). Multivariate logistic regression analysis indicated that serum SP70 (OR=2.54, 95%CI: 1.68-3.84, P<0.001), hemoglobin (HB) (OR=0.96, 95%CI: 0.93-0.99, P<0.05), and bone marrow blast (BM blast) (OR=1.07, 95%CI: 1.02-1.13, P<0.05) were independent risk factors for high-risk prognosis in AML patients. ROC analysis showed that the area under the curve (AUC) for SP70 predicting high-risk patients was 0.908 (cut-off value of 5.74 ng/ml, 95%CI: 0.845-0.952, sensitivity 90.5%, specificity 82.8%). The combined model of serum SP70, HB, and BM blasts had an AUC of 0.931 (95%CI: 0.890-0.973); C-index=0.925 (95%CI: 0.876-0.963),with no statistically significant difference compared to serum SP70 alone (Z=1.693,P>0.05). Conclusion: Serum SP70 may be a promising non-invasive molecular biomarker for prognostic stratification in AML.

Influence of preoperative HbA1c levels on the occurrence of postoperative complications in patients undergoing coronary artery bypass grafting.

To explore the impact of preoperative HbA1c levels on postoperative complications in coronary heart disease patients undergoing coronary artery bypass grafting (CABG). From September 2020 to November 2022, 98 patients with coronary heart disease who were preparing to receive CABG treatment in a cardiac surgery department of a certain hospital were included in the study using the retrospective analysis. According to the preoperative serum hemoglobin A1C (HbA1c) test results, patients were divided into a low-level group (HbA1c < 5.7%, 20 cases), a medium level group (HbA1c: 5.7% ~ 7.0%, 59 cases), and a high level group (> 7%, 19 cases). The surgical outcomes and postoperative complications among the three groups were compared. There was no statistically significant difference in the number of bypass grafts, mechanical ventilation time, and hospitalization time among the three groups of patients (P > 0.05). The high-level group stayed in the ICU longer than the other two groups, while the middle level group had a longer stay than the low-level group (P < 0.05). Within one year of postoperative follow-up, the occurrence of postoperative complications was 20.00%, 32.20%, and 47.37%, respectively, with no statistically significant difference (P > 0.05). Among them, the incidence of acute kidney injury in the high-level group was higher than that in the other groups (P < 0.05), but the correlation difference between the middle and low level groups is P > 0.05. The incidence of infection in the middle level group was higher than that in the low level group (P < 0.05), but the incidence of infection in the high and low level groups was P > 0.05 compared to the medium level group. For patients with coronary heart disease undergoing CABG, the higher the preoperative HbA1c level, the longer their postoperative stay in the ICU, and the higher the risk of acute renal function damage.

Study of malnutrition in patients with idiopathic pulmonary fibrosis

Background Although the interest in Idiopathic Pulmonary Fibrosis (IPF) has increased in recent years due to the appearance of new therapies however the interest has focused on pulmonary involvement with little concern for systemic manifestations such as the nutritional status abnormalities. Thus, our study assessed the malnutrition prevalence in patients with IPF and the best indicators for the assessment of malnutrition among them. Patients and methods This work was conducted on 110 stable IPF patients who attended the outpatient clinic of Ain Shams University Hospitals from October 2020 to July 2021. Data about the detailed history and nutritional assessment was collected. Results 22.7% and 20.9% were malnourished according to the definition of fat-free mass index (FFMI) and body mass index (BMI), respectively. Most malnourished patients according to low FFMI were female; not using PPI was a significant independent predictors of malnutrition. There was a statistically significant relation between low FFMI and low serum albumin, hemoglobin, and oxygen saturation. Our findings also revealed that measuring BMI and being less than or equal to 22.1 kg/m2 and mid-arm circumference (MAC) less than or equal 28.5 cm is significantly related to low free fat mass index (malnutrition) and increases that risk by 31.63 folds. Conclusion Nearly one-quarter of IPF patients were malnourished and it was found that measuring BMI less than or equal to 22.1 kg/m2 together with MAC less than or equal to 28.5 cm can predict low FFMI and that can be used in our clinical approach.

Assessment of machine learning classifiers for predicting intraoperative blood transfusion in non-cardiac surgery

BackgroundThis study aimed to develop a machine learning classifier for predicting intraoperative blood transfusion in non-cardiac surgeries. MethodsPreoperative data from 6255 patients were extracted from the VitalDB database, an open-source registry. The primary outcome was the area under the receiver operating characteristic (AUROC) curve of ML classifiers in predicting intraoperative blood transfusion, defined as the receipt of at least one unit of packed red blood cells. Five different machine learning algorithms including logistic regression, random forest, adaptive boosting, gradient boosting, and the extremely gradient boosting classifiers were used to construct a binary classifier for intraoperative blood transfusion, and their predictive abilities were compared. Results337 (5%) patients received intraoperative blood transfusion. In the test-set, the logistic regression classifier demonstrated the highest AUROC (0.836, 95% CI, 0.795-0.876), followed by the gradient boosting classifier (0.810, 95% CI, 0.750-0.868), AdaBoost classifier (0.776, 95% CI, 0.722-0.829), random forest classifier (0.735, 95% CI, 0.698-0.771), and XGBoost classifier (0.721, 95% CI, 0.695-0.747). The logistic regression classifier showed a higher AUROC compared to that of a multivariable logistic regression model (0.836 vs. 0.623, P < 0.001). Among various parameters used to construct the logistic regression classifier, the top three most important features were operation time (0.999), preoperative serum hemoglobin level (0.785), and open surgery (0.530). ConclusionWe successfully developed various ML classifiers using readily available preoperative data to predict intraoperative transfusion in patients undergoing non-cardiac surgeries. In particular, the logistic regression classifier demonstrated the best performance in predicting intraoperative transfusion.

Recurrent Urinary Tract Infection- Etiology, Risk Factors and Outcome in a Tertiary Care Hospital of Bangladesh

Background: Urinary tract infections (UTIs) are one of the major causes of morbidity and comorbidities in patients with underlying conditions, and it accounts for the majority of the reasons for hospital visit globally. The high prevalence of recurrent UTIs represents a modifiable determinant for both societal and personal burdens, hence the importance of disease prophylaxis. Consultations for UTIs represent between 1% and 6% of all medical visits (~7 million visits and ~US$1.6 billion annually). They are associated with a significant burden of morbidity and mortality in the elderly, among whom UTIs are most prevalent. Methods: This cross-sectional descriptive type of observational study was conducted in the Department of Nephrology in Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh from January 2023, to December 2023. A total no of 93 patients were included in the study. Inpatients, age range 21-85 years, presenting or highly suspicious of having UTIs and the occurrence of ≥2 symptomatic episodes within 6 months or ≥3symptomatic episodes within 12 months were recruited in the study. Any patient who was terminally ill, who fails to give urine samples, with a history of antibiotic administration in the last two weeks and any female who was in their menstruation period were excluded from the study. Results: Among them 79 were female and 14 were male. Female to male ratio was 5.64:1. Mean age of the patients was 58.61±17.51 (Mean±SD). Most of the patients were of 61-70 years age group 23/93 (24.73%) and after that41-50 years 19/93 (20.43%). 92.47% (86/93) were married and 7.53% (7/93) were unmarried. Most of the patients were of Diabetes mellitus (DM) 57/93 (61.29%). After that Hypertension, Chronic Kidney Disease (CKD) and CKD + DM about 51/93 (54.84%), 39/93 (41.94%) and 36/93 (38.71%) respectively. 54/79 (68.35%) were of menopause and 24/79 (30.38%) women had regular menstrual cycle. 1/79 (1.27%) was pregnant.Escherichia coli(E coli) was the most prevalent uropathogens with 47/93 (50.54%) followed by Klebsiella pneumoniae 12/93 (12.90%), Pseudomonas aeruginosa 10/93 (10.75%), Streptococcus pyogenes 8/93 (8.60%), Staphylococcus aureus 6/43 (6.45%), Enterococcus faecalis 5/93 (5.38%) and others 5/93 (5.38%). 77.42% were of relapse and 22.52% were of reinfection. The Mean±SD of HbA1c was 7.83±2.15% and that of Serum creatinine and Hemoglobin were 2.17±1.18 mg/dl and 9.82±2.60gm%. On routine examination of urine, 39/93 (41.94%) patient had trace albumin present in urine and 57/93 (61.29%) had reducing sugar. 71/93 (76.34%) had1-2 pus cell in urine and 22/93 (23.66%) presented with plenty of pus cell with 19/93 (20.43%) had 0-4 RBC’s (Red blood cell). Factors associated with recurrent UTI were Age &gt;50 years (56.99%), Female gender (84.95%), Married (92.47%), Menopause (58.06%), Diabetes mellitus (61.29%), Indwelling catheter &gt;6 days (25.81%) and Genitourinary abnormalities (15.05%). Conclusion: This study has demonstrated that hospitalization, married individuals, duration of catheter, diabetes mellitus, genitourinary tract abnormalities, female gender and menopause are the most important factors associated with UTIs. Appropriate measures may help to reduce UTIs due to these associated factors. We recommend routine UTIs screening of patients of the following category: hospitalized, genitourinary tract abnormalities, indwelling catheter, diabetic, female gender, menopause and married individuals. If these routine checks are put in place, prevention of UTI can be realized at lower cost. Bangladesh J Medicine 2024; 35: 173-179

Impact of Serum Phosphate on Hemoglobin Level: A Longitudinal Analysis on a Large Cohort of Dialysis Patients

Background/Objectives: Phosphate is a macro-element involved in all cellular energetic processes. As about 90% of the phosphate filtered by the glomerulus is excreted by kidneys, the impairment of renal function and the consequent over-secretion of parathyroid hormone and fibroblast growth factor 23 results in the increase in the serum phosphate levels. The association between phosphate and hemoglobin is controversial, as both direct and indirect relationships have been reported. The present study aims to investigate the relationship between phosphate and hemoglobin in a large prospective, longitudinal cohort including dialysis patients from the Sicilian Registry of Nephrology, Dialysis, and Transplantation. Methods: In this prospective cohort study, we included 6263 hemodialysis patients to achieve a total of 120,462 repeated measurements of serum phosphate and hemoglobin over time. The longitudinal association between phosphate and hemoglobin was analyzed by univariate and multivariate Linear Mixed Models. Results: The mean age was 66 ± 16 years and the median dialysis vintage was 5 months [IQR: 2–16]. Mean and median values of hemoglobin and phosphate were 10.7 g/dL (SD 1.3 g/dL) and 4.6 mg/dL [IQR 3.9–5.5 mg/dL], respectively. The multivariate model, adjusted for potential confounders, confirmed the positive association between serum phosphate and hemoglobin [adjβ = 0.13, 95%CI 0.03–0.23, p = 0.01)]. These results were confirmed in analyses stratified for the use of phosphate binders. Conclusions: In our large cohort of dialysis patients, we found a linear, direct relationship between phosphate and hemoglobin levels. As a reduction in phosphate is associated with a parallel reduction in hemoglobin levels, hypophosphatemia can accentuate anemia in dialysis patients. Our results generate the hypothesis that monitoring serum phosphate in clinical practice might provide a better management of anemia.

Predicting blood transfusion needs in colorectal surgery at a university hospital in Saudi Arabia: insights into anemia, malnutrition, and surgical factors

BackgroundIn Saudi Arabia, nearly a quarter of a hospital’s blood supply is consumed in operating rooms. However, blood is a scarce resource, and its unavailability has led to the cancellation of many surgeries. This study aims to identify risk factors for perioperative blood transfusion in colorectal surgery, thus providing valuable insights for better blood management and transfusion planning.MethodsWe conducted a retrospective cohort study of patients who underwent colorectal surgery at King Abdulaziz University Hospital from 2013 to 2022. Data on patient demographics, comorbidities, surgical details, and transfusion outcomes were collected and analyzed. Statistical analyses included logistic regression to identify predictors of transfusion and over-transfusion.ResultsWe collected data from 434 patients. Women were almost twice as likely (OR = 1.98; 95%CI = 1.35–2.90) as men to receive one or more units of RBCs. Also more likely to be transfused were patients with a higher ASA score; a lower pre-operative serum hemoglobin (Hgb) level; and malignant disease as the reason for surgery (all p < 0.001). On multivariable analysis, receiving a transfusion of packed blood cells (RBCs) was statistically linked to volume of intra-operative blood loss and Hgb level (both p < 0.001); as well as to pre-operative body mass index (BMI), with patients who were under-weight and of normal weight most at risk, and patients with a BMI between 25 and 35 less likely to be transfused. Patients whose pre-operative serum Hgb level was 12 g/dL or higher were more than twice as likely to not receive a transfusion, while those with pre-operative Hgb levels from 8.0 to 9.9 g/dL were three times more likely than not to receive blood, and those with a pre-operative Hgb under 8.0 g/dL almost five times as likely as not.ConclusionsKey risk factors for perioperative blood transfusion in colorectal surgery are preoperative anemia, diabetes, low BMI, and significant blood loss. Addressing these through a multidisciplinary approach and the development of perioperative protocols may reduce transfusion needs. Future prospective studies are needed to validate these findings and refine transfusion risk assessments.

Correlation between serum hemoglobin levels and bone mineral density in adults: A cross-sectional study.

Serum hemoglobin plays an important role in bone metabolism. However, the association between serum hemoglobin levels and bone mineral density (BMD) remains unclear. Therefore, this study aimed to explore the relationship between serum hemoglobin levels and lumbar spine BMD in adults. We conducted a cross-sectional study by utilizing data from the National Health and Nutrition Examination Survey from 2011 to 2018. The serum hemoglobin level was examined as an independent variable, while the lumbar spine BMD was utilized as the dependent variable. Weighted multivariate linear regression models and stratified analysis by age, sex, and race/ethnicity were applied after controlling for confounding factors to assess the relationship between serum hemoglobin levels and the lumbar spine BMD. Additionally, smooth curve fitting and threshold effect analyses were utilized to depict the nonlinear relationship between the 2 variables. A total of 11,658 participants (6004 men and 5654 women) aged ≥ 18 years were included in this study. When the serum hemoglobin level was represented as a continuous variable and fully adjusted in the regression model, the hemoglobin level was significantly negatively correlated with the lumbar spine BMD (β = -0.0035, 95% confidence interval: -0.0065 to -0.0004, P = .024555); this significant negative correlation persisted when the serum hemoglobin level was transformed into a categorical variable, except in the Q2 group (β = -0.0046, 95% confidence interval: -0.0142 to -0.0050, P = .348413). When different confounding factors were used including sex, age, and race/ethnicity, the stratified subgroups exhibited a negative correlation between the serum hemoglobin level and the lumbar spine BMD. Additionally, smooth curve fitting and threshold effect analyses showed a negative correlation between the serum hemoglobin level and the lumbar spine BMD, with a saturation effect at 15 g/dL. Our findings demonstrated an association between hemoglobin levels and the lumbar spine BMD in adults, characterized by a nonlinear relationship. Thus, monitoring the serum hemoglobin level could aid in the early detection of risks associated with bone metabolic disorders such as osteoporosis.