Severity Score Research Articles

BEDROOM ENVIRONMENTAL QUALITY PARAMETERS ASSOCIATED WITH OLDER ADULTS’ BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS

Abstract Behavioral and psychological symptoms are common among older adults with apathy, depression and anxiety being the most prevalent. Identifying factors associated with such symptoms may help mitigate them. The study, Monitoring Apathy, Depression and Anxiety Using Technology Evaluations, aimed to identify indoor environmental quality factors that may trigger these symptoms. The study was a 9-month observational study in 12 participants’ personal residences. Participant mean age was 79.0 (6.4) years, 7 were males (58.3%), 7 had normal cognition, 4 had MCI and 1 had early-stage AD. The participants self-reported the severity of their apathy, depression and anxiety weekly online by answering standard surveys sent via email, which consisted of the 6-item Withdrawal-Apathy-Vigor subscale from the Geriatric Depression Scale for assessing apathy, and depression, and anxiety subscales from Patient-Reported Outcomes Measurement Information System for assessing depression and anxiety respectively. Bedroom environments were assessed with environmental sensors (Awair Omni, San Francisco) which measured light level, noise level, temperature, humidity and air quality every 5 minutes. Individual mixed-effect models were built with each symptom severity being the outcome, and each weekly mean bedroom environmental quality factor being the predictor, while controlling for age, sex and the week the data was collected. Lower light level in the bedroom was significantly associated with more severe depression scores (p< 0.01) and higher temperature was associated with more severe apathy scores (p< 0.05). Optimizing specific aspects of indoor environmental quality in older adults’ personal homes can potentially assist in improving management of behavioral and psychological symptoms.

Sudden gains in routine clinical care: application of a permutation test for trauma-focused cognitive behavioural therapy

ABSTRACT Background: Sudden gains, defined as large and stable improvements of psychopathological symptoms, are a ubiquitous phenomenon in psychotherapy. They have been shown to occur across several clinical contexts and to be associated with better short-term and long-term treatment outcome. However, the approach of sudden gains has been criticized for its tautological character: sudden gains are included in the computation of treatment outcomes, ultimately resulting in a circular conclusion. Furthermore, some authors criticize sudden gains as merely being random fluctuations. Objective: Use of efficient methods to evaluate whether the amount of sudden gains in a given sample lies above chance level. Method: We used permutation tests in a sample of 85 patients with posttraumatic stress disorder (PTSD) treated with trauma-focused cognitive behaviour therapy in routine clinical care. Scores of self-reported PTSD symptom severity were permuted 10.000 times within sessions and between participants to receive a random distribution. Results: Altogether, 18 participants showed a total of 24 sudden gains within the first 20 sessions. The permutation test yielded that the frequency of sudden gains was not beyond chance level. No significant predictors of sudden gains were identified and sudden gains in general were not predictive of treatment outcome. However, subjects with early sudden gains had a significantly lower symptom severity after treatment. Conclusions: Our data suggest that a significant proportion of sudden gains are due to chance. Further research is needed on the differential effects of early and late sudden gains.

언어행동기반의 조기집중행동중재(EIBI)가 자폐스펙트럼장애(ASD) 아동의 발달에 미치는 영향

This study examines the effects of Early Intensive Behavioral Intervention(EIBI) on the overall development of children with Autism Spectrum Disorder(ASD) and identifies predictive factors related to developmental improvements. The study involved 46 children diagnosed with ASD who underwent EIBI based on applied behavior analysis at a specialized institution for 12 months. Assessments of the children’s developmental levels were conducted before and after the intervention using the Ados-2 test, language assessments, educational diagnostic tests, the Vineland Adaptive Behavior Scales, and the Early Learner Curriculum and Achievement Record(ELCAR) curriculum evaluation. Data analysis was performed using paired sample t-tests and multiple regression analysis. The results show significant improvements in ASD symptom severity, language development, developmental age, adaptive behavior, and ELCAR curriculum scores following the EIBI intervention. Furthermore, ASD symptom severity was a significant predictor of improvement in developmental age, and developmental age was a predictor of ELCAR curriculum achievement. Within the developmental age subdomains, imitation emerged as an important predictor. These findings show the effectiveness and limitations of EIBI interventions for children with ASD in South Korea.

Effect of Pilates exercises on symptoms of irritable bowel syndrome in women: a randomized controlled trial.

The treatment of irritable bowel syndrome (IBS) is challenging, calling for therapeutic strategies other than pharmacological treatment. Therefore, this study aimed to investigate the effects of Pilates exercises on IBS symptoms and severity, frequency of complete spontaneous bowel movements, fatigue, anxiety, depression, and body weight in women with IBS. Sixty women with IBS, aged 20-45, completed this study. They were randomly assigned to two equal groups: a study group (n = 30) and a control group (n = 30). The study group received an 8-week Pilates exercise program (2 sessions per week) in addition to dietary advice, while the control group received dietary advice only. Inclusion criteria were women, IBS diagnosed based on Rome IV Diagnostic criteria, constipation-predominant IBS, and moderate to severe IBS. The outcome measures were the IBS severity scoring system (IBS-SSS), the frequency of complete spontaneous bowel movements, the modified fatigue impact scale (MFIS), hospital anxiety and depression (HADS) scale, and body weight (BW). The study group showed more significant improvements than the control group in total IBS-SSS score (Cohen d = 0.73, p < 0.001), frequency of complete spontaneous bowel movements (Cohen d = 0.50, p < 0.001), total MFIS score (Cohen d = 0.74, p < 0.001), anxiety (Cohen d = 0.56, p < 0.001), and depression (Cohen d = 0.64, p < 0.001). The study group also showed a significant reduction in body weight compared to baseline (p < 0.05). The control group showed significant improvements in all outcomes, except body weight, compared to baseline (p < 0.05). Pilates exercises, used in addition to dietary advice, may significantly improve IBS symptoms and severity, frequency of complete spontaneous bowel movements, and alleviate fatigue, anxiety, and depression moderately more than dietary advice alone in women with constipation-predominant IBS. Nevertheless, dietary advice alone may also significantly improve these outcomes in this cohort.

IMPLEMENTING ISUPPORT IN UGANDA: A PILOT RCT FOR REDUCING CAREGIVER STRESS

Abstract Background: Dementia is a significant public health issue in low- and middle-income countries, and Uganda has seen a notable increase in cases. The iSUPPORT program, adapted into AiSUPPORT, provides tailored interventions that address the sociocultural and economic context of Uganda, aiming to alleviate psychological distress among caregivers of patients with AD and dementia. Methods: This pilot randomized controlled trial (RCT) was conducted in the Wakiso District, enrolling 65 caregivers of Alzheimer’s disease and related dementia (ADRD) patients. Participants were randomly assigned to either an intervention group that received AiSUPPORT sessions, or a control group that received standard care. This study aimed to assess the feasibility, fidelity, acceptability, and impact of the intervention on caregivers’ psychological distress, quality of life, and depression severity, as measured using the Kessler Psychological Distress Scale and other tools. Results: In the intervention group, psychological distress scores reduced significantly, averaging 29.2 to 23.7 (p&amp;lt; 0.001), and depression severity scores dropped from 33.4 to 25.6 (p&amp;lt; 0.001). Quality of life scores improved substantially, from an average of 81.1 to 89.4 (p&amp;lt; 0.001), compared with the control group. The AiSUPPORT program demonstrated effectiveness and cultural appropriateness, with a 95% retention rate and high engagement. Conclusion: The AiSUPPORT program for dementia caregivers in Uganda’s successful implementation in low-resource settings demonstrates its potential. The program’s effectiveness, feasibility, and cultural sensitivity underscore the importance of cultural considerations in intervention design, supporting the integration of culturally adapted evidence-based interventions in national health systems to address the complex needs of dementia caregivers.

Screening assessment of psycho-emotional state and cardiometabolic risk factors in combatants and civilians during the war in Ukraine

Objective — to conduct the screening assessment of symptoms of psycho‑emotional disorders (post‑traumatic stress disorder (PTSD), general anxiety, perceived stress) and their relationships with metabolic disorders and body composition indicators in combatants and civilians during the war in Ukraine. Materials and methods. 21 combatants with the duration of participation in active hostilities up to 6 months and 20 civilians of the comparison group who permanently resided in Kharkiv and the unoccupied part of Kharkiv region since the beginning of the war were examined. The study included men aged 25 to 55 years without cardiovascular diseases and diabetes. Questionnaires were surveyed using the Post Traumatic Stress Disorder (PTSD) Checklist Scale‑5 (PCL‑5), the Generalized Anxiety Disorder 7 (GAD‑7), and the Perceived Stress Scale 10 (PSS‑10). The body mass index was determined, visceral fat level, percentage of total body fat mass, and muscle mass were measured by bioimpedance. The levels of lipids, blood glucose, glycated hemoglobin were determined, and the triglyceride‑glucose index (TyG) was calculated. Results. Combatants’ PCL‑5 severity scores were only numerically higher than civilians’, and the GAD‑7 severity score was higher (p=0.028). Perceived stress in civilians corresponded to the low level, in combatants — to the moderate level. The PSS‑10 scale scores in combatants was significantly higher than in the comparison group (p=0.018). Among combatants the proportion of individuals with signs of probable PTSD (33.33%) was significantly higher than in civilians (5.00%, p=0.022). Compared to the civilians among the combatants there were also significantly more individuals with moderate and severe general anxiety (28.6% versus 5.0%, respectively, p=0.045). The combatants had higher systolic blood pressure, lower body fat percentage and greater skeletal muscle percentage than the civilians. Metabolic changes in military personnel were characterized by elevated triglyceride levels and lower glycemic indices in comparison to the civilians. In the cоmbatants the assessed severity of PTSD symptoms and perceived stress level were positively correlated with skeletal muscle mass. There were negative correlations between the general anxiety level and fasting glucose, and between the perceived stress level and body fat mass. In the civilians, the severity of symptoms of probable PTSD was positively correlated with body mass index, body fat and visceral fat accumulation, and the triglyceride‑glucose index. The increase in general anxiety and perceived stress levels were associated with the increase in glycemic indices. In addition, the level of general anxiety was inversely correlated with high density lipoprotein cholesterol. Conclusions. In the conditions of ongoing war, the higher proportion of individuals with signs of probable PTSD were found among combatants than among civilians. Compared with civilians, military personnel had higher levels of general anxiety and perceived stress. In civilians, the increase in psycho‑emotional disorders was associated with adverse changes in metabolic parameters and body composition, while in military personnel the accumulation of stressful experiences was correlated with the increase in skeletal muscle mass, the decrease in fat body mass and in glycemia levels.

COMPARING THE EFFICACY OF 35% TRICHLOROACETIC ACID (TCA) PEEL WITH TOPICAL 0.1% ADAPALENE GEL IN THE TREATMENT OF COMEDONAL ACNE

Comedonal acne is a common dermatological condition characterized by open and closed comedones. Treatment modalities, including chemical peels and topical retinoids, have managed comedonal acne. Aim and Objective: This study aimed to compare the efficacy of 35% trichloroacetic acid (TCA) peel with topical 0.1% adapalene gel in treating comedonal acne. Methodology: A randomized controlled trial (RCT) was conducted at the Sheikh Zayed Hospital, Rahim Yar Khan. A total of 80 patients with comedonal acne were recruited and randomly assigned to two treatment groups: Group A received 35% TCA peel, while Group B received topical 0.1% adapalene gel. The primary outcome measures included changes in comedonal lesion count and severity, assessed using standardized clinical photographs and dermatological examinations. Secondary outcomes comprised patient-reported improvement, adverse events, and treatment tolerability. Results: The mean age of participants was 25.4 ± 4.6 years, with a female predominance (65%). At baseline, both groups exhibited similar comedonal lesion counts and severity scores. Following treatment, a significant reduction in comedonal lesions was observed in both groups (p &lt; 0.001). However, the reduction in comedonal lesion count was more significant in the 35% TCA peel group than the adapalene gel group (mean decrease of 80% vs. 60%, respectively). Additionally, patients in the TCA peel group reported higher satisfaction rates and fewer adverse events than the adapalene gel group. Conclusion: Our study suggests that 35% TCA peel is more effective than topical 0.1% adapalene gel in reducing comedonal acne lesions and improving patient satisfaction. TCA peel may represent a promising treatment option for patients with comedonal acne, offering superior efficacy and tolerability compared to topical retinoids.

Comparison of Unilateral and Bilateral Transforaminal Epidural Steroid Injections in Unilateral Lumbar Disc Herniation: A Randomized Controlled Trial

Objective: To compare the efficiency of unilateral and bilateral transforaminal epidural steroid injections (TFESI) in patients with unilateral lumbar disc herniation (LDH). Methods: In this prospective randomized single-blinded study, patients with unilateral LDH were randomly divided into two groups: A unilateral TFESI group; and a bilateral TFESI group. The severity of pain and disability were assessed with the Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 1 week, 1 month, and 3 months after interventions. Treatment response was defined as ≥50% reduction in the NRS-11 at the 3-month follow-up. Changes in medication consumption at 3 months following the interventions were recorded. This study protocol is registered at ClinicalTrials.gov (NCT06240793). Results: A total of 104 patients were included in the study (n = 58 in the unilateral TFESI group and n = 46 in the bilateral TFESI group). The NRS-11, ODI scores and medical treatment consumption did not differ statistically between the groups at 3 months (p ˃ 0.05). At 3 months, the rates of patients with a &gt; 50% decrease in NRS-11 scores were 13.8% and 32.6% in the unilateral TFESI group and bilateral TFESI group, respectively. Conclusions: Unilateral and bilateral TFESI both decrease pain severity and disability scores to a similar degree, although bilateral TFESI was more effective in reducing pain severity by over 50% in patients with single-level unilateral LDH.

Respiratory Severity Score (RSS): A Predictive Tool for Successful Extubation in Preterm Neonates

Introduction: The coexistence of immature lungs, poor respiratory drive, overly compliant chest wall, and surfactant deficiency in preterm neonates, leads to dependency on mechanical ventilation during the first days of life. Respiratory Severity Score (RSS) is a readily available, simple and non-invasive extubation failure prediction tool. Objective This study aims to evaluate the utility of pre-extubation RSS as a tool for predicting successful extubation among preterms. Methods and Analysis: This was a retrospective study with a duration of two years started after obtaining clearance from the Institutional Ethics Committee. All preterm neonates ventilated in NICU were included in the study. The hospital unit number was noted and the respective patient records were procured from the hospital records department. Demographic data were recorded from the files. Pre-extubation RSS was calculated. Other findings related to clinical review such as duration of invasive and non-invasive ventilation, surfactant requirement, intraventricular hemorrhage (IVH), early and late-onset sepsis, length of hospital stay (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) mortality data etc. were also recorded. The age, time of extubation and weight of those babies who underwent planned extubation were also recorded. Results: The RSS and RSS/kg were significantly higher among the neonates who failed extubation ( P &lt; .001). The Area under curve (AUC) for RSS and RSS/kg was 0.921 and 0.85, respectively. There was a significantly higher proportion of morbidities such as late-onset sepsis ( P = .046), grade ≥3 IVH ( P = .004) and ROP ( P = .043) observed among the neonates with extubation failure. The prevalence of in-hospital mortality was observed only among neonates with extubation failure which was statistically significant ( P &lt; .001). Conclusion: This study shows that pre-extubation RSS is an excellent tool for predicting successful extubation and is more accurate than RSS/kg. RSS could be a useful tool for clinicians to assess readiness of extubation. However, more prospective, multicentric studies are necessary to validate the generalizability of RSS.

Surgical Management of Moderate to Severe Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Meta-Analysis

Background Epistaxis is one of the most common and debilitating symptoms of hereditary hemorrhagic telangiectasia (HHT), significantly impacting patients’ quality of life. While various medical and surgical interventions exist for managing epistaxis in patients with HHT, patients with moderate to severe epistaxis are high health-care utilizers who frequently need surgical treatment. Objective To compare the efficacy, complications, and patient-reported outcomes for common surgical interventions utilized in treating epistaxis in patients with HHT Methods Studies were identified in PubMed, Embase, Scopus, Redalyc, and LILACS databases and uploaded to Covidence. A systematic review following PRISMA guidelines was conducted on studies evaluating outcomes in adults with HHT with moderate to severe epistaxis who had undergone surgical interventions. We compared the respective outcomes for pre-operative and post-operative epistaxis severity/intensity, need for further interventions or transfusions, estimated blood loss, length of surgery, complications, and patient satisfaction. Results Twenty studies with a total of 546 patients were included. The most common surgeries studied were nasal closure and laser photocoagulation. Seven studies recorded the change in epistaxis severity score and observed a significant reduction postoperatively (3.91, [95% CI 2.73-5.09]). Eleven studies found a decrease in the number of transfusions and a rise in hemoglobin levels post-operatively. Common complications reported were partial dehiscence of a nasal closure, septal perforation, and continued bleeding requiring re-operation. Most patients report improved quality of life and satisfaction with surgical intervention. Conclusion Surgery can significantly reduce the severity of epistaxis in patients with HHT and improve quality of life. Further studies should focus on head-to-head comparisons of procedures and standardization of outcome measures.

Vancomycin administration and AUC/MIC in patients with acute kidney injury on hemodialysis (HD): randomized clinical trial

The pharmacokinetics and pharmacodynamics (PK/PD) of vancomycin change during HD, increasing the risk of subtherapeutic concentrations. The aim of this study was to evaluate during and after the conventional and prolonged hemodialysis sessions to identify the possible risk of the patient remaining without adequate antimicrobial coverage during therapy. Randomized, non-blind clinical trial, including critically ill adults with septic AKI on conventional (4 h) and prolonged HD (6 and 10 h) and using vancomycin for at least 72 h. Sessions were analyzed and randomized into three groups (G): control (C), dose of 15 mg/kg after session), intervention (I) 2 h (dose of 7.5 mg/kg in the second hour and 7.5 mg/kg after) and IG continuous infusion (dose of 30 mg/kg in 24 h). Of the 316 patients recruited, 87 were randomized, and 174 HD sessions were monitored. For the analysis, 28 sessions belonged to the CG, 47 to the 2-hour IG, and 31 to the continuous IG. The groups were similar in age, weight, severity scores, use of nephrotoxins, sérum albumin, Kt/V, HD modality, ultrafiltration, and intradialytic intercurrences. The intervention groups showed a higher therapeutic concentration frequency than the control group (p < 0.002). The initial concentration was identified as a risk factor (OR 1.16, p = 0.001) for a non-therapeutic vancomycin concentration in the logistic regression. In contrast, the 2-hour IG was identified as a protective factor (OR 0.24, p = 0.04). Administration of vancomycin during dialysis proved to be a protective factor against concentrations outside the therapeutic target. Further studies are needed to suggest more appropriate doses of vancomycin for patients with AKI on dialysis therapy and to assess the impact of these results on clinical outcomes.

Evaluation of Photoaging and Sun Protection Behavior in Children With Xeroderma Pigmentosum, Group C: A Prospective Analysis.

Thirteen children with xeroderma pigmentosum variant C were evaluated using the Dermoscopic Photoaging Assessment Scale (DPAS), the Glogau scale, and the Sun Protection Behavior Scale (SPBS). Most patients exhibited signs of epidermal photoaging, with pigmentary and vascular changes and poor sun protection behavior (mean SPBS score: 18.92 ± 5.69). The mean DPAS score of 13.15 correlated with the Glogau scale and ocular severity score. Sun protection behavior improved significantly at 6 months after repeated reinforcement of sun protection measures (35 ± 5.68).

Prognostic value of coronary artery calcium scoring in patients with non-small cell lung cancer using initial staging computed tomography

BackgroundLung cancer is a leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) comprising 85% of cases. Due to the lack of early clinical signs, metastasis often occurs before diagnosis, impacting treatment and prognosis. Cardiovascular disease (CVD) is a common comorbidity in lung cancer patients, with shared risk factors exacerbating outcomes.MethodsThis study investigates the association between coronary artery calcium (CAC) scores, major adverse cardiovascular events (MACE), and survival outcomes in NSCLC patients, utilizing positron emission tomography-computed tomography (PET-CT) for CAC scoring. A retrospective cohort study of 154 NSCLC patients (mean age 66.3 years, 52% women) at the University of Utah (2005–2022) was conducted. Baseline PET-CT or CT imaging was used to quantify CAC scores, categorized into five risk levels. Cox proportional hazards and logistic regression analyses assessed the impact of CAC scores on survival and cardiovascular events, adjusting for confounders such as age, gender, and smoking status.ResultsHigher CAC scores were significantly associated with increased MACE, acute myocardial infarction (MI), and poorer overall survival. The severe risk CAC score group had significantly lower survival (p = 0.022). Logistic regression revealed a strong association between higher CAC scores and MI incidence (moderate: OR = 13.8, severe: OR = 21.2) and MACE (severe: OR = 10.2). Smoking history was a significant predictor of overall survival (p = 0.006).ConclusionCAC scoring via PET-CT provides valuable prognostic insights in NSCLC patients, highlighting the need for integrated cardiovascular risk management in this population. Further research and advanced technologies like machine learning could enhance CAC scoring application in clinical practice.Trial registrationRetrospectively registered.

Risk of venous thromboembolic complications in pregnant trauma patients: A matched cohort study.

Trauma and pregnancy are both risk factors for venous thromboembolism (VTE). We hypothesized that pregnant blunt trauma patients would have a higher incidence of VTE complications compared with matched nonpregnant females. We conducted a retrospective cohort study using National Trauma Data Bank data from 2017 to 2022. Female patients with blunt mechanism, age between 15 and 50years old, were eligible for inclusion. Patients who presented as transfers, hospitalized for less than 72h, discharged against medical advice, injury severity score <9, or abbreviated injury scale=6 of any region were excluded. Pregnant patients were matched 1:2 with nonpregnant female patients by age, injury characteristics, comorbidities, and type and timing of chemical VTE prophylaxis. The primary outcomes were the incidences of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE). Secondary outcomes included other complications and length of stay. We included 735 pregnant and 1470 matched nonpregnant controls. The median time to initiate chemical VTE prophylaxis was 33h in pregnant and 34h in nonpregnant patients (p=0.42). The incidence of VTE in pregnant blunt trauma patients was 27 (3.7%) versus 45 (3.1%) in matched controls (p=0.446). There were no significant differences in DVT, PE, or any other complication or mortality or in ICU or hospital length of stay. Unplanned admissions to the ICU were significantly more frequent in pregnant patients (3.8% vs. 2.2% and p=0.026). The incidence of VTE complications was similar in pregnant and matched nonpregnant female blunt trauma patients in this retrospective cohort study, supporting the safety of current VTE prophylaxis practices in pregnant patients.

Machine learning analysis of population-wide plasma proteins identifies hormonal biomarkers of Parkinson's Disease.

As the number of Parkinson's patients is expected to increase with the growth of the aging population there is a growing need to identify new diagnostic markers that can be used cheaply and routinely to monitor the population, stratify patients towards treatment paths and provide new therapeutic leads. Genetic predisposition and familial forms account for only around 10% of PD cases [1] leaving a large fraction of the population with minimal effective markers for identifying high risk individuals. The establishment of population-wide omics and longitudinal health monitoring studies provides an opportunity to apply machine learning approaches on these unbiased cohorts to identify novel PD markers. Here we present the application of three machine learning models to identify protein plasma biomarkers of PD using plasma proteomics measurements from 43,408 UK Biobank subjects as the training and test set and an additional 103 samples from Parkinson's Progression Markers Initiative (PPMI) as external validation. We identified a group of highly predictive plasma protein markers including known markers such as DDC and CALB2 as well as new markers involved in the JAK-STAT, PI3K-AKT pathways and hormonal signaling. We further demonstrate that these features are well correlated with UPDRS severity scores and stratify these to protective and adversarial features that potentially contribute to the pathogenesis of PD.

The effect of temporary CSF diversion modality on shunt-dependency following aneurysmal subarachnoid hemorrhage: A nationwide assessment.

Aneurysmal subarachnoid hemorrhage (aSAH) carries a high economic cost and clinical morbidity in the United States. Beyond prolonged admissions and poor post-injury functional status, there is an additional cost of chronic shunt-dependent hydrocephalus for many aSAH patients. Adjuvant lumbar drain (LD) placement has been hypothesized to promote clearance of subarachnoid blood from the cisternal space, with an ultimate effect of decreasing shunt placement rates. In this nationwide database study, we aim to evaluate outcomes associated with different forms of temporary bedside cerebrospinal fluid (CSF) diversion in the aSAH patient cohort. Inpatient admissions were queried from the National Inpatient Sample (NIS; 2016-2020). Inclusion criteria included adult patients presenting with non-traumatic SAH that underwent treatment with either non-elective clip ligation or coil embolization of their underlying aneurysms and received either an external ventricular drain (EVD), lumbar drain (LD), or both (EVD+LD) for temporary CSF diversion during that admission. Outcome variables evaluated included inpatient mortality, bacterial meningitis, length of stay, discharge disposition, and need for shunt placement. A total of 5505 admissions met inclusion criteria, of which 18.42% required permanent CSF diversion. The majority of patients received EVD alone (4842, 87.96%). The remaining patients were split between LD alone (366, 6.65%) or EVD+LD placement (297, 5.4%). Patients receiving LD alone tended to be healthier, with lower rates of extreme APR-DRG subclass, Elixhauser Comorbidity Index (ECI), and NIS SAH Severity Score (NIS-SSS). Patients in the EVD+LD cohort had higher rates of shunt placement (OR 1.624, p=0.0009) and higher rates of bacterial meningitis (OR 8.715, p<0.0001), even when controlling for APR-DRG illness severity and ECI. Our study found higher rates of permanent CSF diversion, longer lengths of stay, and higher rates of bacterial meningitis in patients receiving both EVD and LD placement. Due to limitations inherent to nationwide database studies, these results should be interpreted cautiously. Further studies are needed to clarify whether adjuvant temporary CSF diversion with LD placement in the aSAH cohort for intent of minimizing chronic shunt-dependence is efficacious.

Elevated cell-free hemoglobin: A novel early biomarker following traumatic injury.

Cell-free hemoglobin (CFH) and free heme are potent mediators of endotheliopathy and organ injury in sepsis, but their roles in other hemolytic pathologies are not well-defined. A prime example is trauma where early hemolysis may initiate damage and predict outcome. Here, we investigated the presence of plasma CFH, heme, and their major scavengers after traumatic injury. Adult patients who presented as highest-level activations were prospectively enrolled at a level 1 trauma center between 2021 and 2023. Venous blood was collected upon arrival (pretransfusion) and 6, 12, and 24 hours after admittance for quantification of CFH, haptoglobin, heme, and hemopexin. We studied 119 mostly male subjects (101:18) with a median age of 48 years (interquartile range [IQR], 31-64 years) and an Injury Severity Score of 22 (IQR, 11-29); the majority had suffered blunt force trauma. The 28-day mortality rate was 11%. Cell-free hemoglobin was high upon emergency department arrival (10.9 μM; IQR, 6.8-17.6) and then declined but remained elevated compared with normative levels during the monitoring period (>5 vs. ~0.2 μM). The initial drop in CFH was attributed to haptoglobin binding and clearance. Notably, there was a subgroup of patients with two- to threefold higher levels of CFH on emergency department arrival (median, 25 μM). Patients with these highest CFH levels had longer hospital stays and more frequent complications. Cell-free hemoglobin is elevated in trauma patients very early after injury and may impact outcome. While further work is needed, early correction of hemolysis could provide benefit. Prognostic Study; Level III.

Embolization of Rectal Arteries for Treating Hemorrhoidal Disease Using a Combination of Microspheres and Microcoils: A Pilot Study.

To investigate the feasibility and initial results of superior (SRA) and middle (MRA) rectal artery embolization for patients with symptomatic hemorrhoidal disease. Prospective, single-center cohort that included ten consecutive patients (Goligher classification was II in 70% and III in 30%.) who underwent SRA and MRA embolization using a combination of microspheres and metallic coils, who completed a follow-up period of 12months. Technical success was defined as embolization of SRA and MRA whenever MRA dominance was observed. Clinical success was defined as an improvement of the hemorrhoid severity score (HSS) and quality of life (QoL) scores without recurrence, with the need for additional treatment. Procedure-related adverse events (AEs) were recorded and defined according to CIRSE classification as minor or major complications. Technical success was achieved in all patients. SRA was embolized in 100% of patients and MRA in 80%. The improvement in HSS and QoL scores was 88% and 88% (p < 0.05), respectively, without clinical recurrence in the 12-month follow-up. One patient had a major complication (level D), a rectal ischemia and perforation of the rectosigmoid leading to perforative acute abdomen with sepsis that required surgical treatment (Hartmann's procedure). Embolization of both SRA-MRA using a combination of microspheres and metallic coils was feasible and significantly improved HSS and QoL scores. One major complication was observed and therefore it is essential to further investigate the safety boundaries of this technique.

Endovascular therapy versus anticoagulation alone for subacute iliofemoral deep vein thrombosis.

This study evaluated whether endovascular therapy (ET) improved early symptom relief and decreased the incidence of moderate-to-severe post-thrombotic syndrome (PTS) compared to anticoagulation alone in patients with subacute (15-28 days) iliofemoral deep vein thrombosis (DVT). Consecutive patients with subacute iliofemoral DVT from January 2020 to June 2022 were identified. A total of 86 patients were categorized to treatment with ET alongside anticoagulation (endovascular group, n = 49) or anticoagulation alone (anticoagulation group, n = 37). Effectiveness outcomes including thrombus clearance rate, symptoms relief in 3 days (pain and swelling score), moderate-to-severe PTS rate, Villalta score, and Venous Clinical Severity Score (VCSS) at 12 months, as well as safety outcomes including major bleeding, minor bleeding, and death within 12 months were compared between the two groups. The endovascular group demonstrated greater symptoms relief in 3 days (1.1±1.0 vs. 3.6±1.1, P<0.001). The mean follow-up duration was 15.9 months for the endovascular group and 14.7 months for the anticoagulation group. Seventy-nine patients (91.8%) completed the 12-month follow-up. Villalta score (3.9±2.6 vs. 5.7±4.3; P =0.027), moderate-to-severe PTS (6.5% vs. 27.3%; P =0.011), and VCSS score (2.3±1.6 vs. 3.6±2.6; P =0.004) at 12 months were significantly lower in the endovascular group. No significant differences were observed regarding minor bleeding events, recurrence of symptomatic DVT, and deaths between the two groups. In patients with subacute iliofemoral DVT, the addition of ET to anticoagulation provided greater early symptoms relief and reduced the occurrence of moderate-to-severe PTS, with similar safety outcomes.

Increased prehospital mortality in patients with combined burns and trauma in Canada: Analysis of a provincial trauma registry database.

The combination of burns and non-thermal trauma may have a synergistic effect on mortality. Our objective was to determine if burn patients with concomitant trauma are at increased risk of mortality in both the prehospital and in-hospital settings. Data were collected from a population-based provincial trauma registry (2001-2019). Characteristics and outcomes of patients with trauma/burns were compared to isolated burn patients using t-tests, chi-square analysis and Fisher's exact tests. Risk ratios (RRs) were calculated to evaluate the impact of concomitant trauma on mortality, stratified by % total body surface area (TBSA) and injury severity score (ISS). Firth's penalized maximum likelihood estimation (PMLE) approach was used to fit multivariable logistic regression models to the outcomes of prehospital mortality and in-hospital mortality. Of 436 burn patients, 29.8 % (130/436) had combined trauma/burns. Prehospital mortality in the trauma/burns group was 57.7 % (75/130) versus 43.1 % (132/306) in isolated burn patients. Prehospital mortality risk was highest in trauma/burn patients with % TBSA ≥ 70 (RR 3.87, 95 % CI 2.99-4.99) or ISS ≥ 25 (RR 2.49, 95 % CI 1.84-3.36). Concomitant trauma was associated with increased odds of prehospital mortality (OR 2.42, 95 % CI 1.27-4.69), but had no impact on in-hospital mortality. Prehospital mortality was increased in patients with combined burns and trauma.