Significant Predictors Of Outcome Research Articles

Neuropsychological and psychiatric outcomes among community-dwelling young Chinese older adults affected by falls in the past year with and without vision impairment.

This study was to investigate the differences between young older adults with and without vision impairment on neuropsychological and psychiatric outcomes following falls during the past year and to identify predictors of cognitive decline or mental distress. A secondary analysis of 668 young older Chinese adults aged 65 ∼ 79 years old with a history of falls was conducted from the cross-sectional survey data in the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). Participants with vision impairment scored significantly higher on anxiety and depression and lower on cognitive function and SWB than those without vision impairment. And vision impairment was a significant predictor of adverse outcomes for all four neuropsychological and psychiatric measures. Neurocognitive deficits, psychological problems, and decreased self-sufficiency are quite common among community-dwelling older adults with visual impairment who have a history of falls within a year.

Pregnancy outcomes in correlation with placental histopathology in pregnancies complicated by fetal growth restriction with vs. without reduced fetal movements.

Fetal movements are crucial indicators of fetal well-being, with reduced fetal movements (RFM) suggesting potential fetal compromise. Fetal growth restriction (FGR), often linked to placental insufficiency, is a major cause of perinatal morbidity and mortality. This study aimed to investigate the neonatal, labor, and placental outcomes of FGR pregnancies with and without RFM at term. In this retrospective study, data from all term, singleton deliveries with FGR and concomitant RFM were obtained and compared to an equal control group of FGR without RFM. Maternal characteristics, pregnancy and neonatal outcomes, and placental histology were compared. The primary outcome was a composite of adverse neonatal outcomes. A multivariable regression analysis was performed to identify independent associations with adverse neonatal outcomes. During the study period, 250 FGR neonates with concomitant RFM and an equal control group were identified. The groups did not differ in maternal demographics aside from significantly higher rates of maternal smoking in the RFM group (p < 0.001). Polyhydramnios and oligohydramnios (p = 0.032 and p = 0.007, respectively) and meconium-stained amniotic fluid (p < 0.001) were more prevalent in the FGR+RFM group. Additionally, the RFM group showed higher rates of adverse neonatal outcomes despite having larger neonates (p = 0.047 and p < 0.001, respectively). No significant differences were observed in placental findings. Logistic regression identified RFM as an independent predictor of adverse neonatal outcomes (aOR 2.45, 95% CI 1.27-4.73, p = 0.008). Reduced fetal movements are significant and independent predictors of worse neonatal outcomes in FGR pregnancies, suggesting an additional acute insult on top of underlying placental insufficiency.

Severity and Clinical Outcomes of Pediatric Burns-A Comprehensive Analysis of Influencing Factors.

(1) Background: Burn injuries in children present a significant public health concern due to their potential for severe physical and psychological impact. (2) Methods: This study investigates the determinants of pediatric burn severity by analyzing the interplay of demographic and environmental factors. Through a retrospective analysis of pediatric burn cases over five years, encompassing patient demographics, burn causative agents, and clinical outcomes, this research aims to identify significant predictors of burn severity. (3) Results: This study presents a comprehensive analysis of pediatric burn injuries, focusing on the severity, clinical outcomes, and multifactorial aspects influencing recovery. We reviewed 1498 pediatric burn cases from January 2015 to December 2020. The mean age of patients was 5.8 years, with a slight male predominance (54%). Scalds (45%), flame burns (30%), and contact burns (15%) were the most common burn types. Our findings indicate significant differences in burn severity based on TBSA, with 32.5% of cases having TBSA greater than 20%. Multivariate logistic regression identified rural residence, male gender, flame burns, and lower socioeconomic status as significant predictors of severe burn outcomes. The overall mortality rate was 2.5%, with higher rates among patients with TBSA greater than 40%. These results highlight the need for targeted prevention strategies and improved access to specialized burn care. (4) Conclusions: Understanding these factors can inform targeted prevention strategies and improve treatment protocols.

Long-term survival outcome of childhood acute myeloid leukemia: a 43-year experience in Thailand, a resource-limited country

Although there have been advances in treating pediatric patients with acute myeloid leukemia (AML) in developed countries, outcomes in low- to middle-income countries remain poor. The goal of this study was to investigate the outcomes in children with AML who were treated at a tertiary care center in Thailand. We divided the study into 4 research periods based on the chemotherapy protocols employed. The 5-year probabilities of event-free survival (pEFS) rates for periods 1–4 were 19.0%, 20.6%, 17.4%, and 37.3% (p value = 0.32), while the 5-year probabilities of overall survival (pOS) rates were 19.0%, 24.7%, 18.7%, and 42.5% (p value = 0.18), respectively. The multivariable model indicated an improvement in 5-year pOS between periods 1 and 4 (p value = 0.04). Age, white blood cell count, and study period were significant predictors of survival outcomes. The pOS of AML patients improved over time, increasing from 19.0% to 42.5%.

A longitudinal examination of appraisal, coping, stress, and mental health in students: A cross-lagged panel network analysis.

In their seminal Transactional Theory of Stress, Lazarus and Folkman described a complex adaptation mechanism that involves appraisal and coping processes that lead to the subjective experience of stress. In this study, we examined the temporal order of all components of this theory using a cross-lagged panel analysis. A sample of 354 students (62.10% female, mean age=20.63y.o.) participated in a 5-week study and completed weekly self-reported measures of prospective appraisal, coping, core burnout, and mental health (i.e. depression, anxiety, and stress). Using cross-lagged panel network analyses, we analyzed how each measured variable is predicted by all variables from the previous measurement moment. Convergent with the transactional stress theory, we found that threat appraisals and negative self-perception predicted future anxiety and depression. Contrary to expectations, core burnout and somatization emerged as significant predictors of poor mental health outcomes, suggesting a self-perpetuating spiral. Furthermore, our study highlighted the importance of recognizing the bidirectional connections between appraisals, coping strategies, and mental well-being.

The Impact of Pentraxin 3 Serum Levels and Angiotensin-Converting Enzyme Polymorphism on Pulmonary Infiltrates and Mortality in COVID-19 Patients.

The aim of this study was to examine the impact of the pentraxin 3 (PTX3) serum level and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism on the severity of radiographic pulmonary infiltrates and the clinical outcomes of COVID-19. The severity of COVID-19 pulmonary infiltrates was evaluated within a week of admission by analyzing chest X-rays (CXR) using the modified Brixia (MBrixa) scoring system. The insertion (I)/deletion (D) polymorphism of the ACE gene and the serum levels of PTX3 were determined for all patients included in the study. This study included 80 patients. Using a cut-off serum level of PTX3 ≥ 2.765 ng/mL, the ROC analysis (AUC 0.871, 95% CI 0.787-0.954, p < 0.001) showed a sensitivity of 85.7% and specificity of 78.8% in predicting severe MBrixa scores. Compared to ACE I/I polymorphism, D/D polymorphism significantly increased the risk of severe CXR infiltrates, OR 7.7 (95% CI: 1.9-30.1), and p = 0.002. Significant independent predictors of severe CXR infiltrates include hypertension (OR 7.71), PTX3 (OR 1.20), and ACE D/D polymorphism (OR 18.72). Hypertension (OR 6.91), PTX3 (OR 1.47), and ACE I/I polymorphism (OR 0.09) are significant predictors of poor outcomes. PTX3 and ACE D/D polymorphism are significant predictors of the severity of COVID-19 pneumonia. PTX3 is a significant predictor of death.

Impact of Robotic Assistance on Minimally Invasive Surgery for Type II Endometrial Cancer: A National Cancer Database Analysis.

The objective of this study is to compare the overall survival (OS) and surgical outcomes between conventional laparoscopy and robot-assisted laparoscopy (RAL) in women with type II endometrial cancer. We identified a large cohort of women who underwent hysterectomy for type II endometrial cancer between January 2010 and December 2014 using the National Cancer Database (NCDB). The primary outcome was to compare the OS of conventional laparoscopy versus RAL. Secondary outcomes included the length of hospital stay, 30-day readmission rate, 90-day mortality, rates of lymph node retrieval, rates of node positivity, and rates of conversion to laparotomy. Cohorts were compared and multivariable logistic regression was used to determine characteristics with statistically significant predictors of outcome. We identified 7168 patients with stage I-III type II endometrial cancer who had minimally invasive surgery as primary treatment between 2010 and 2014. A total of 5074 patients underwent RAL. Women who underwent RAL were less likely to have stage III disease (26.4% vs. 29.9%, p = 0.008) and had smaller primary tumors (4.6 vs. 4.1 cm, p < 0.001). In a multivariable model, there was no difference in OS between conventional laparoscopy and RAL. With regard to postoperative outcomes, RAL was associated with a decreased risk for conversion to laparotomy (2.7% vs. 12%, p < 0.001), a shorter hospital stay (1 vs. 2 days, p < 0.001), a decreased 90-day mortality (1.3% vs. 2.2%, p = 0.004), and an increased number of lymph nodes sampled (14 vs. 12, p < 0.001). In multivariable analysis, the use of RAL was independently associated with a reduced rate of conversion to laparotomy. In conclusion, there was no difference in OS between conventional laparoscopy and RAL in type II endometrial cancer in a large retrospective cohort of patients from the NCDB. RAL was associated with a decreased risk of conversion to laparotomy.

Unilateral versus bilateral pedicle screw fixation with anterior lumbar interbody fusion: a comparison of postoperative outcomes.

To determine of the impact of ALIF with minimally invasive unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) on perioperative outcomes, radiographic outcomes, and the rates of fusion, subsidence, and adjacent segment stenosis. All adult patients who underwent one-level ALIF with UPSF or BPSF at an academic institution between 2015 and 2022 were retrospectively identified. Postoperative outcomes including length of hospital stay (LOS), wound complications, readmissions, and revisions were determined. The rates of fusion, screw loosening, adjacent segment stenosis, and subsidence were assessed on one-year postoperative CT. Lumbar alignment including lumbar lordosis, L4-S1 lordosis, regional lordosis, pelvic tilt, pelvic incidence, and sacral slope were assessed on standing x-rays at preoperative, immediate postoperative, and final postoperative follow-up. Univariate and multivariate analysis compared outcomes across posterior fixation groups. A total of 60 patients were included (27 UPSF, 33 BPSF). Patients with UPSF were significantly younger (p = 0.011). Operative time was significantly greater in the BPSF group in univariate (p < 0.001) and multivariate analysis (ß=104.1, p < 0.001). Intraoperative blood loss, LOS, lordosis, pelvic parameters, fusion rate, subsidence, screw loosening, adjacent segment stenosis, and revision rate did not differ significantly between fixation groups. Though sacral slope (p = 0.037) was significantly greater in the BPSF group, fixation type was not a significant predictor on regression. ALIF with UPSF relative to BPSF predicted decreased operative time but was not a significant predictor of postoperative outcomes. ALIF with UPSF can be considered to increase operative efficiency without compromising construct stability.

The Effect of Ecological Environment on Language-Minority Students’ Math and Reading Development: A Hierarchical Linear Analysis of a Longitudinal Study

ABSTRACT Research Findings: This study illustrated whether and how ecological environments are associated with language-minority students’ (N = 12,500) math and reading development from kindergarten to the eighth grade. Results identified the robust effects of preschool type, kindergarten length, classroom activities, parent-child reading, parent expectation, and teacher-child relationship on reading and math outcomes. In third and fifth grade, all significant predictors of reading outcome are at the family level: parent-child reading time and parent’s expectations. Additionally, parent-child reading time also significantly predicts LMSs’ reading in kindergarten. Meanwhile, predictors for math outcomes have a different pattern in the mid to late elementary periods. All predictors during this period are at the family level: parent-child reading time, parent showing love to children, and parent’s expectations. Lastly, the only significant predictor for eighth grade math is teacher-child closeness. Practice or Policy: The significant findings at different grade levels suggest a multifaceted approach to policy development, including (a) supporting parent engagement, (b) high-quality preschool, and (c) multicultural teacher education and professional development.

Prognostic role of late gadolinium-enhanced MRI in confirmed and suspected cardiac sarcoidosis: meta-analysis.

The prognostic implications of late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in the context of cardiac sarcoidosis (CS) have attracted considerable attention. Nevertheless, a subset of studies has undistinguished confirmed and suspected CS cases, thereby engendering interpretative ambiguities. In this meta-analysis, we evaluated the differences in cardiac MRI findings and their prognostic utility between confirmed and suspected CS. A literature search was conducted using PubMed, Web of Science, and Cochrane libraries to compare the findings of cardiac MRI and its prognostic value in CS and suspected CS. A meta-analysis was performed to compare the prevalence of LGE MRI, odds ratios, and hazard ratios for predicting cardiac events in both groups. A total of 21 studies encompassing 24 different populations were included in the meta-analysis (CS: 393 cases, suspected CS: 2151 cases). CS had a higher frequency of LGE of the left ventricle (87.2% vs. 36.4%, p < 0.0001) and right ventricle (62.1% vs. 23.8%, p = 0.04) than suspected CS. In patients with suspected CS, the presence of left ventricular LGE was associated with higher all-cause mortality [odds ratio: 5.70 (95%CI: 2.51-12.93), p < 0.0001, I2 = 8%, p for heterogeneity = 0.37] and ventricular arrhythmia [odds ratio: 15.51 (95%CI: 5.65-42.55), p < 0.0001, I2 = 0, p for heterogeneity = 0.94]. In contrast, in CS, not the presence but extent of left ventricular LGE was a significant predictor of outcome (hazard ratio = 1.83 per 10% increase of %LGE (95%CI: 1.43-2.34, p < 0.001, I2 = 15, p for heterogeneity = 0.31). The presence of left ventricular LGE was a strong prognostic factor in suspected sarcoidosis. However, the extremely high prevalence of left ventricular LGE in confirmed CS suggests that the quantitative assessment of LGE is useful for prognostic estimation.

Predictive Value and Diagnostic Potential of IL-10, IL-17A, IL1-β, IL-6, CXCL, and MCP for Severe COVID-19 and COVID-19 Mortality.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) necessitates advanced prognostic tools to anticipate disease progression and optimize patient outcomes. This study evaluates the predictive value and diagnostic potential of interleukins interleukin (IL) IL-10, IL-17A, IL1-β, IL-6, chemokine ligand (CXCL), and Monocyte Chemotactic Protein (MCP) for severe coronavirus disease 2019 (COVID-19) and COVID-19 mortality, aiming to correlate cytokine levels with disease severity. Conducted from January 2023 to January 2024, this prospective cohort study involved patients hospitalized with moderate and severe COVID-19 from Romania. This study analyzed statistically significant predictors of severe COVID-19 outcomes. IL-6 and MCP emerged as significant, with hazard ratios (HRs) of 2.35 (95% confidence interval (CI): 1.54-3.59, p = 0.014) and 2.05 (95% CI: 1.22-3.45, p = 0.007), respectively. Compound scores integrating multiple inflammatory markers also demonstrated predictive value; Compound Score 2 had an HR of 2.23 (95% CI: 1.35-3.68, p = 0.002), surpassing most single markers in association with severe disease. Notably, interleukins IL-10 and IL-1β did not show significant associations with disease severity. This study underscores the importance of IL-6 and MCP as robust predictors of severe COVID-19, substantiating their role in clinical assessments to foresee patient deterioration. The utility of compound scores in enhancing predictive accuracy suggests a composite approach may be more effective in clinical settings.

Determinants of thinness among school adolescents in Legehida district, Amhara region, north east Ethiopia: an unmatched case-control study

BackgroundAdolescence is a critical stage of human growth and development, and adolescent nutritional status is a significant predictor of health outcomes. However, adolescents in developing countries, including Ethiopia, have received little attention from nutrition-related programs in recent decades. Consequently, malnutrition among adolescents is a widespread issue in these regions.ObjectiveThe study aimed to identify the determinants of thinness among school adolescents in the Legehida district of South Wollo Zone, Northeastern Ethiopia.MethodsA school-based, unmatched case-control study was conducted from January 20 to February 2, 2019. A total of 525 school-aged adolescents (175 cases and 350 controls) from the Legehida district were enrolled using a multistage sampling technique. Data were collected through interview-administered questionnaires and anthropometric measurements. EpiData version 3.1 was used for data entry, while Anthroplus software was employed for anthropometric measurement entry and analysis. The data were then exported to SPSS version 25 for further analysis. Bivariate and multivariable logistic regression analyses were performed to assess the determinants of adolescent thinness.ResultsIn this study, thinness among school adolescents was significantly associated with several factors: the absence of a latrine at home [AOR = 8.2, 95% CI (3.8, 8.17)], meal skipping per day [AOR = 3.1, 95% CI (1.2, 7.3)], inadequate consumption of fruits and vegetables [AOR = 7.5, 95% CI (3.9, 14.5)], having more than four household members [AOR = 13.6, 95% CI (7.1, 26)], and the consumption of unsafe water [AOR = 7.7, 95% CI (3.8, 15.6)].Conclusions and recommendationsThe absence of latrines and access to clean water, dietary factors, and family size emerged as significant contributors to adolescent thinness in this study. Addressing the nutritional challenges faced by adolescents will require collaborative efforts across sectors.

Association between ultra-processed food consumption, sociodemographic characteristics, malnutrition and obesity among urban school-aged children in Lilongwe, Malawi: a cross-sectional study

IntroductionThe escalating consumption of ultra-processed foods (UPFs) among school-aged children in developing countries poses a significant threat to public health, contributing to the dual burden of malnutrition. In Malawi, where...

External validation of clinical risk prediction score for elderly treated with endovascular thrombectomy.

The thrombectomy in the elderly prediction score (TERPS) for functional outcome after anterior circulation endovascular therapy (EVT) in patients ≥ 80years was recently developed. The aim of this study was to assess predictors of functional outcome in the elderly and validate the prediction model. Consecutive patients treated with EVT from the Oslo Acute Reperfusion Stroke Study were evaluated for inclusion. Clinical and radiological parameters were used to calculate the TERPS, and functional outcome were assessed at 3-month follow-up. Out of 1028 patients who underwent EVT for acute ischemic stroke from January 2017 to July 2022, 218 (21.2%) patients ≥ 80years with anterior ischemic stroke were included. Fair outcome, defined as modified Rankin scale ≤ 3 (mRS), was achieved in 117 (53.7%). In bivariate analyses, male sex (p 0.035), age (p 0.025), baseline National Institute of Health Stroke Scale (NIHSS, p < 0.001), pre-stroke mRS (p 0.002) and Alberta Stroke Program Early Computed Tomography score (ASPECTS, p 0.001) were associated with fair outcome. Significant predictors for fair outcome in regression analyses were lower pre-stroke mRS, adjusted odd ratio, (aOR) 0.67 (95% CI 0.50-0.91, p 0.01), NIHSS, aOR 0.92 (95% CI 0.87-0.97, p 0.002), and higher ASPECTS, aOR 1.22 (95% CI 1.03-1.44, p 0.023). The area under the curve (AUC) using TERPS was 0.74 (95% CI 0.67-0.80). The risk prediction score TERPS showed moderate performance in this external validation. Other variables may still be included to improve the model and validation using other cohorts is recommended. NCT06220981.

Bushfire exposure is associated with darker color of beef loin at grading

The effect of bushfires (also known as wildfires) on the Australian livestock industry extends beyond the direct loss of animals and farming assets, with anecdotal reports of increased incidence of dark meat color defects in beef carcasses at grading (AUSMEAT color score >3) from bushfire affected cattle. To understand the association between bushfire exposure and meat color, an investigation using historical MSA (Meat Standards Australia) grading data, pasture data and bushfire data over two bushfire seasons (2018–2019, 2019–2020) was conducted. For bushfire affected beef cattle (n = 451 299), predictive models were developed to estimate the association between bushfire exposure and (1) loin color at grading, and (2) the incidence of ‘dark color’ defects. Both models incorporated bushfire exposure, production, and animal variables, with hierarchical random effects specified as plant/processing date/consignment. For the two predictive models, distance of the animal's originating property from closest bushfire (km), the days the animal was exposed to bushfire, feed type (grass, grain), the use of hormone growth promotants (HGPs; no, yes), the interaction of distance of property from closest bushfire and feed type, and days of bushfire and HGP treatment, were all significant predictors of loin color outcomes (P < 0.05 for all). Model 1 indicated that as distance from closest bushfire decreased, loin from grain-fed animals had darker color (P < 0.001), and that as days of bushfire exposure increased, HGP treatment exacerbated dark color outcomes for grain-fed animals but had little effect on the consistently high color scores of grass-fed HGP treated animals (P = 0.001). For model 2, the highest predicted proportion of dark color defects (11.8 %) was for grass-fed, HGP treated cattle, 10 km from the closest bushfire and exposed to 150 days of bushfire. The lowest predicted proportion of dark colour carcasses (1.3 %) was for grain fed, non-HGP treated cattle, 30 km from the closest bushfire, with no change associated with increasing days of bushfire. Cattle can be categorized in order of increasing susceptibility to dark color defects as a result of being exposed to bushfires; grain-fed cattle with no HGPs were the least susceptible to dark color defects, and grass-fed cattle with HGP treatment were the most susceptible. Remediation strategies are discussed in relation to cattle susceptibility to adverse loin meat color outcomes associated with bushfire exposure.

Survival Prognostication in Patients with Differentiated Thyroid Cancer and Distant Metastases: A SEER Population-Based Study.

Background: For patients with thyroid cancer, distant metastasis is a significant predictor of poor outcome. Since distant metastasis occurs in less than 10% of patients with differentiated thyroid cancer, correlates of survival in this vulnerable patient population remain understudied. This study aimed to identify prognostic groups among patients with differentiated thyroid cancer and distant metastases and to determine the role of, and interactions between, patient and tumor characteristics in determining survival. Methods: We identified adult patients diagnosed with differentiated thyroid cancer with distant metastases from the U.S. SEER-17 cancer registry (2010-2019). Analyses were performed using Cox proportional hazards regression, survival trees, and random survival forest. Relative importance of patient and tumor factors important for disease-specific and overall survival was assessed based on the random survival forest analyses. Results: Cohort consisted of 2411 patients with differentiated thyroid cancer with distant metastases followed for a median of 62 months. Most common histopathologic subtype (86.0%) was papillary thyroid cancer, and the most common sites of distant metastasis were the lungs (33.7%) and bone (18.9%). Cox proportional hazards model illustrated significant associations between survival and the following: patient age (p < 0.001), tumor size (p < 0.01), and site of distant metastasis (p < 0.05). Survival tree analyses identified three distinct prognostic groups based on disease-specific survival (DSS) (5-year survival of the prognostic groups was 92%, 64%, and 41%; p < 0.001) and four distinct prognostic groups based on overall survival (OS) (5-year survival of the prognostic groups was 96%, 84%, 57%, and 31%; p < 0.001). The first split in the survival trees for DSS and OS was by age at diagnosis (≤57 years vs. ≥58 years) with subsequent splits based on presence/absence of lung metastases, tumor size (≤4 cm vs. >4 cm), and patient age. A total of 558 patients (23.1%) died from thyroid cancer, and 757 patients (31.4%) died from all causes during the study period. Conclusions: This study identifies distinct prognostic groups for patients with differentiated thyroid cancer with distant metastases and highlights the importance of patient age, lung metastases, and tumor size for determining both disease-specific and overall survival. These findings inform risk stratification and treatment decision-making in this understudied patient population.

The Relationship Between Acute Kidney Injury in Sepsis Patients and Coagulation Dysfunction and Prognosis.

The aim of this study was to investigate the relationship between ARF and coagulopathy in patients with sepsis and to explore the prognostic value of these conditions. The data of 271 patients with sepsis-associated coagulopathy admitted from June 2021 to June 2022 were reviewed. The patients were divided into a survival group and a nonsurviving group according to patient prognosis. Independent sample t tests were utilized to compare laboratory parameters within 24 hours of admission, as well as the APACHE II and SOFA scores, between the two patient groups. According to the sepsis-associated coagulation dysfunction (SAC) grading criteria for grading, Spearman correlation analysis was used to study the relationship between blood creatinine and SAC grading and assignment scores, and receiver operating characteristic (ROC) curves and Cox's proportional risk regression model were used to explore the factors affecting the prognosis of SAC patients. Spearman correlation analysis revealed strong associations between serum creatinine (Scr) concentration, SAC classification, and SAC score, with coefficients above 0.7. SAC classification outcomes varied significantly with severity: mild severity had a 77.6% survival rate versus 22.4% mortality; moderate severity had 21.5% survival versus 78.5% mortality; and severe cases had a 0.7% survival rate versus 99.3% mortality (P<0.01 for all). Multivariate analysis revealed significant predictors of outcome, including multiple organ dysfunction syndrome (MODS), with an OR of 2.070 (P=0.019); the SOFA score (OR=1.200, P<0.01); the international normalized ratio (INR) (OR=0.72, P=0.013); and the Scr level (OR=0.995, P<0.01). The areas under the ROC curves for the SOFA score, APACHE II score, and SAC classification were >0.8, all P < 0.05. In patients with sepsis, SAC grade 3 or a SAC score of 4 or higher is associated with poorer prognosis, and the interaction of acute kidney injury exacerbates the degree of SAC, consequently affecting prognosis.

Life-Saving Resin: Hemoperfusion's Role in Overcoming Acute Organophosphate and Carbamate Poisoning

Background: Acute poisoning from organophosphates and carbamates is a major public health concern. These poisons inhibit acetylcholinesterase, leading to severe clinical manifestations. Traditional treatments, such as atropine and oximes, often fall short in severe cases, necessitating alternative therapeutic approaches. Hemoperfusion, an extracorporeal blood purification technique, has shown promise in improving outcomes for poisoning cases. This study aimed to estimate the clinical outcomes of resin-based HOD in individuals with acute organophosphate and carbamate poisoning admitted to a South Asian tertiary care hospital. Methods: A prospective observational study was carried out involving 50 patients diagnosed with acute organophosphate (n=30) or carbamate (n=20) poisoning. Patients underwent standard treatment protocols, and eligible individuals received resin-based hemoperfusion. Data on demographic details, clinical outcomes, complications, and biochemical parameters were collected and analysed using SPSS version 25.0. Results: The study found an overall recovery rate of 84%, with 80% recovery in the organophosphate group and 90% in the carbamate group. The complication rate was 12%, and the mortality rate was 4%. Cholinesterase levels significantly increased post-hemoperfusion, with a mean rise of 600 U/L. Time to treatment was a significant predictor of positive outcomes (p=0.011). Conclusion: Resin-based hemoperfusion is effective in treating acute organophosphate and carbamate poisoning, significantly improving recovery rates and reducing mortality. Early intervention is crucial for optimal outcomes. This treatment modality should be considered a valuable component of poisoning management protocols, especially in resource-limited settings. Recommendations: Further research with larger sample sizes and randomized controlled trials is recommended to confirm these findings and explore additional factors influencing treatment outcomes. Implementation of resin-based hemoperfusion in standard treatment protocols for severe poisoning cases is advised to enhance patient care and survival rates. Keywords: Organophosphate poisoning, Carbamate poisoning, Hemoperfusion, Clinical outcomes

Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture.

Femoral fractures often lead to complications such as altered pulmonary hemodynamics. Right ventricular global longitudinal strain (RV GLS), which correlates with pulmonary hemodynamics, indicates the subclinical function of the right ventricle (RV). This study aimed to investigate the predictive value of RV GLS for the risk of adverse clinical composite outcomes in patients with femoral fractures. Data were obtained from a prospective single-center cohort of patients hospitalized for femoral fractures and followed up for at least 1 year between March 2021 and October 2022. The primary outcome was the development of an adverse composite clinical event, which included pneumonia, pulmonary oedema or effusion, pulmonary thromboembolism, and all-cause mortality within the 1-year period following surgery. Among the 163 patients, 36 (22.09%) experienced adverse composite clinical events during 1-year follow-up. The adverse outcome group demonstrated poorer RV GLS and RV free wall strain values than the non-adverse outcome group. The optimal cut-off value of RV GLS for predicting composite adverse clinical events was -12.55%. The cumulative composite event-free survival rate was significantly lower in the RV GLS ≥ -12.55% group (log-rank p-value = 0.003). After adjusting for confounding factors, multivariate Cox proportional hazards regression analyses showed that RV GLS ≥ -12.55% independently increased the risk of composite adverse clinical events by 2.65-fold. Poor RV GLS is a significant predictor of adverse clinical outcomes in patients with femoral fractures. Specifically, an RV GLS value of ≥ -12.55% indicated a substantially increased risk of adverse events.

Vocabulary and expressive morpho-syntax in individuals with Down syndrome: Links to narration

BackgroundNarrative ability is crucial for social participation in everyday and school life but involves different language abilities such as vocabulary and morpho-syntax. This is particularly difficult for individuals who display both language and cognitive impairments. Previous research has identified productive vocabulary as a possible key factor for narrative performance in individuals with Down syndrome. Considering a close connection between lexical and morpho-syntactic performance within language acquisition and the distinct impairments that individuals with Down syndrome display concerning their morpho-syntactic skills, the nature of a relation between vocabulary and narrative skills under the influence of grammatical deficits requires further investigation. MethodsNarrations were obtained from 28 children and adolescents with Down syndrome (aged 10;0–20;1) using a non-verbal picture book. Narrative abilities were rated using the Narrative Scoring Scheme across seven narrative aspects (including macro- and microstructure). Vocabulary analyses and morpho-lexical context analyses including verb and conjunction enumerations, evaluation of verb position and MLU were conducted. Findings from the transcript analysis have been supplemented with data from standardized language measures evaluating expressive lexical and morpho-syntactic development. A multiple regression analysis was conducted to identify significant predictors for narrative outcome in the participants with Down syndrome. ResultsLexical analyses revealed a high heterogeneity in production of subordinating conjunctions as a link between lexical and morpho-syntactic abilities. Comparisons of standardized and narrative data demonstrated differences in subordinate clause production depending on the elicitation setting. A multiple regression analysis identified the number of different verbs in the narrative task as the most significant predictor for narrative performance in individuals with Down syndrome. Discussion and implicationsThe findings of this study contribute to the knowledge regarding factors that influence narrative performance in individuals with language impairment. A differentiated verb lexicon can be identified as the key ability for reaching advanced narrative skills in participants with Down syndrome. These findings are of clinical relevance for therapeutic and educational support and contribute to an understanding of the relation between strengths in vocabulary and morpho-syntactic weaknesses in individuals with Down syndrome within communicative participation.