Significant Risk Factor For Morbidity Research Articles

Evaluating Postoperative Prognosis: A Single Surgeon's Experience With Total Mesorectal Excision in Middle and Lower Rectal Cancer Cases in Iraq.

Surgical intervention for rectal cancer is widely recognized for its potential to significantly impact quality of life, chiefly due to the high probability of permanent colostomy and the associated postoperative complications. This study aimed to evaluate the short-term outcomes and morbidity associated with total mesorectal excision for middle and lower rectal cancer within an Iraqi cohort, in a prospective setting. This study prospectively collected and analyzed data from 89 patients who underwent a standardized radical rectal resection, with a follow-up period extending to one month post-surgery. The mean age of patients was 54.4 ± 12.9 years, with a gender distribution of 46 males and 43 females. A total of 33 patients presented with preoperative comorbidities, which heightened the risk of adverse short-term outcomes by a factor of 7.51. The most prevalent comorbidities were hypertension and diabetes mellitus, affecting 22 and 20 patients, respectively. Patients aged 60 years and above were at a 3.97 times greater risk of developing complications. The overall complication rate was 21.35%, with wound infections (9.0%) and cardiovascular events (3.4%) being the most common. Mortality during the follow-up was 1.1%. The findings indicate that increased age and the presence of comorbidities are significant risk factors for morbidity and mortality post-surgery. Neoadjuvant chemoradiotherapy or radiotherapy was shown to reduce morbidity and mortality rates while improving survival. The morbidity and mortality rates observed in this study concur with existing literature.

Comprehensive analysis of lactate-related gene profiles and immune characteristics in lupus nephritis.

The most frequent cause of kidney damage in systemic lupus erythematosus (SLE) is lupus nephritis (LN), which is also a significant risk factor for morbidity and mortality. Lactate metabolism and protein lactylation might be related to the development of LN. However, there is still a lack of relative research to prove the hypothesis. Hence, this study was conducted to screen the lactate-related biomarkers for LN and analyze the underlying mechanism. To identify differentially expressed genes (DEGs) in the training set (GSE32591, GSE127797), we conducted a differential expression analysis (LN samples versus normal samples). Then, module genes were mined using WGCNA concerning LN. The overlapping of DEGs, critical module genes, and lactate-related genes (LRGs) was used to create the lactate-related differentially expressed genes (LR-DEGs). By using a machine-learning algorithm, ROC, and expression levels, biomarkers were discovered. We also carried out an immune infiltration study based on biomarkers and GSEA. A sum of 1259 DEGs was obtained between LN and normal groups. Then, 3800 module genes in reference to LN were procured. 19 LR-DEGs were screened out by the intersection of DEGs, key module genes, and LRGs. Moreover, 8 pivotal genes were acquired via two machine-learning algorithms. Subsequently, 3 biomarkers related to lactate metabolism were obtained, including COQ2, COQ4, and NDUFV1. And these three biomarkers were enriched in pathways 'antigen processing and presentation' and 'NOD-like receptor signaling pathway'. We found that Macrophages M0 and T cells regulatory (Tregs) were associated with these three biomarkers as well. Overall, the results indicated that lactate-related biomarkers COQ2, COQ4, and NDUFV1 were associated with LN, which laid a theoretical foundation for the diagnosis and treatment of LN.

The Impact of Postoperative Pulmonary Complications on Perioperative Outcomes in Patients Undergoing Pneumonectomy: A Multicenter Retrospective Cohort Study of the German Thorax Registry.

Postoperative pulmonary complications have a deleterious impact in regards to thoracic surgery. Pneumonectomy is associated with the highest perioperative risk in elective thoracic surgery. The data from 152 patients undergoing pneumonectomy in this multicenter retrospective study were extracted from the German Thorax Registry database and presented after univariate and multivariate statistical processing. This retrospective study investigated the incidence of postoperative pulmonary complications (PPCs) and their impact on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs and in-hospital mortality were analyzed. A total of 32 (21%) patients exhibited one or more PPCs, and 11 (7%) died during the hospital stay. Multivariate stepwise logistic regression identified a preoperative FEV1 < 50% (OR 9.1, 95% CI 1.9-67), the presence of medical complications (OR 7.4, 95% CI 2.7-16.2), and an ICU stay of more than 2 days (OR 14, 95% CI 3.9-59) as independent factors associated with PPCs. PPCs (OR 13, 95% CI 3.2-52), a preoperative FEV1 < 60% in patients with previous pulmonary infection (OR 21, 95% CI 3.2-52), and continued postoperative mechanical ventilation (OR 8.4, 95% CI 2-34) were independent factors for in-hospital mortality. Our data emphasizes that PPCs are a significant risk factor for morbidity and mortality after pneumonectomy. Intensified perioperative care targeting the underlying risk factors and effects of PPCs, postoperative ventilation, and preoperative respiratory infections, especially in patients with reduced pulmonary reserve, could improve patient outcomes.

A Pharmacovigilance Study on Steroid Induced Osteoporosis

Background: In elderly people, osteoporosis and low bone density are significant risk factors for morbidity and death. Low bone strength distinguishes these illnesses, which are correlated to an increased risk of fractures from even minor traumas. Objectives: To study pharmacovigilance on steroid induced osteoporosis. Methods: A total of 950 individual who were diagnosed with osteoporosis. These individuals were deemed to be at a high risk of osteoporosis. Patients were given information regarding the risks of steroid-induced osteoporosis, as well as a handout. The patient's steroid duration and any medicines used to control the risks of steroid-induced osteoporosis were the focus of the initial evaluation. Following that, evaluations of the pharmacological therapy being examined. Any problems found were discussed with the patient and/or the prescribing practitioner. Data was gathered at the start of the study and again after 6 months of observation. Results: Glucocorticoids (prednisolone) was the main prescription drug of the entire study sample. Family history of Osteoporosis was reported in 20% of the cases. The history of fracture was reported in 30% of the cases. Low calcium diet was reported in 35% of the cases. Osteoporosis was diagnosed in 17% of the cases, Osteopenia in 22% of the cases. In 88% of the cases the drug prescribed was &gt;5mg daily. The duration of CS intake was high. This shows that the CS drug is being abused mostly in history of allergies and asthma as its easily available OTC leading to an increased risk of osteoporosis. Around 26% were prescribed antiosteoporosis treatment with Bisphosphonate. Estrogen therapy was prescribed in 16% of the cases. Calcium supplement consumption was increased by 17%. There was significant reduction in BMD, Glucocorticoid’s usage and daily dosage and result was statistically significant. Conclusion: Because all cells employ the same glucocorticoid receptor, corticosteroids' antiinflammatory effects cannot be distinguished from their metabolic effects; thus, precautions should be taken when corticosteroids are given. Clearly, the risk of serious adverse effects rises as the amount and duration of therapy increases, thus the smallest dose required to control the condition should be provided.

Patients with low ALT levels are at increased risk for severe COVID-19.

Frailty is a known risk factor for many diseases, including COVID-19. However, many frail patients are undiagnosed as the diagnosis can be cumbersome. Alanine transaminase (ALT) is found not only in the liver but also in the muscle tissue, and multiple studies show that frail sarcopenic patients have lower ALT. Frail patients are at increased risk for severe COVID-19. We evaluated the association between pre-infection low ALT and the risk for severe COVID-19. We collected data regarding all subjects tested for SARS-CoV-2 between 1 March 2020 and 31 December 2021 from a national state-mandatory HMO in Israel, serving more than 1.3 million patients. Clinical and laboratory data were collected, including ALT from the year prior to infection. Severe COVID-19 was defined either as death, ICU admission, or ≥10 hospitalization days. Patients with low ALT (ALT ≤ 10 IU/l) were compared with patients with normal ALT (11-40 IU/l). Patients younger than 18 years with a diagnosis of liver disease and with ALT > 40 IU/l were excluded. During the study period, 58,961 patients tested positive for SARS-CoV-2. The patients in the low ALT group were younger (40.53 vs. 42.73, p < 0.001), less likely to be males (12.3 vs. 38.7%, p < 0.001), and had lower BMI (25.97 vs. 27.15, p < 0.001). The patients in the low ALT group had higher mortality (2.36 vs. 0.57%, p < 0.001), more ICU hospitalizations (0.49 vs. 0.41%, p = 0.47), and more prolonged hospitalizations [2.63% (95% CI 2-3.2%) vs. 0.98% (95% CI 0.86-1.1%) p < 0.001]. In multivariate logistic regression analyses, low ALT was associated with an increased risk of severe COVID-19, with increased mortality (OR 1.88, 95% CI 1.37-2.56) and prolonged hospitalization (OR 1.78, 95% CI 1.33-2.35). Low ALT level prior to infection is a significant risk factor for morbidity and mortality from COVID-19 infection. Further studies are warranted to address treatment options for this population.

The impact of reoperative surgery on aortic root replacement in the United States

ObjectiveReoperative sternotomy is associated with poor outcomes after cardiac surgery. We aimed to investigate the impact of reoperative sternotomy on the outcomes after aortic root replacement. MethodsAll patients who underwent aortic root replacement from January 2011 to June 2020 were identified using the Society of Thoracic Surgeons Adult Cardiac Surgery Database. We compared outcomes between patients who underwent first-time aortic root replacement with those with a history of sternotomy undergoing reoperative sternotomy aortic root replacement using propensity score matching. Subgroup analysis was performed among the reoperative sternotomy aortic root replacement group. ResultsA total of 56,447 patients underwent aortic root replacement. Among them, 14,935 (26.5%) underwent reoperative sternotomy aortic root replacement. The annual incidence of reoperative sternotomy aortic root replacement increased from 542 in 2011 to 2300 in 2019. Aneurysm and dissection were more frequently observed in the first-time aortic root replacement group, whereas infective endocarditis was more common in the reoperative sternotomy aortic root replacement group. Propensity score matching yielded 9568 pairs in each group. Cardiopulmonary bypass time was longer in the reoperative sternotomy aortic root replacement group (215 vs 179 minutes, standardized mean difference = 0.43). Operative mortality was higher in the reoperative sternotomy aortic root replacement group (10.8% vs 6.2%, standardized mean difference = 0.17). In the subgroup analysis, logistic regression demonstrated that individual patient repetition of (second or more resternotomy) surgery and annual institutional volume of aortic root replacement were independently associated with operative mortality. ConclusionsThe incidence of reoperative sternotomy aortic root replacement might have increased over time. Reoperative sternotomy is a significant risk factor for morbidity and mortality in aortic root replacement. Referral to high-volume aortic centers should be considered in patients undergoing reoperative sternotomy aortic root replacement.

Reperfusion therapies in elderly and frail patients with pulmonary embolism: a nationwide inpatient sample analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Although mortality rates have decreased over the last two decades especially for older ages, among patients with PE, age is considered as a significant risk factor for morbidity and mortality. Purpose To assess the contemporary rates in the use of reperfusion therapies for the management of elderly and frail hospitalized patients with PE and specifically investigate their effect on safety outcomes. Methods The Nationwide Inpatients Sample (NIS) of years 2016-2018 was accessed to select all hospitalizations of elderly (≥65 years) patients with acute PE as a main discharge diagnosis code or PE as a second-listed diagnosis code following a main discharge diagnosis code for deep vein thrombosis or respiratory failure. We defined frail patients with the use of the Johns Hopkins Adjusted Clinical Groups frailty defining diagnoses indicator, which is an instrument based on ten clusters of frailty defining diagnoses (i.e., malnutrition, dementia, impaired vision, decubitus ulcer, urinary incontinence, weight loss, social support needs, difficulty in walking, and falls). Multivariate logistic regression was used to calculate odds ratios of in-hospital overall and major bleeding among patients who received at least one reperfusion therapy and make two comparisons: (i) systemic thrombolysis (ST) vs catheter-directed thrombolysis (CDT), and (ii) catheter-based thrombectomy (CBT) vs surgical embolectomy (SE). Results A total of 310,145 elderly hospitalizations with a primary PE diagnosis were estimated in 2016-2018, of which 66,745 (21.5%) were frail. Reperfusion therapies were used in 7.0% of all primary PE hospitalizations of elderly people without frailty (35.9% among high-risk patients), while in 4.4% with frailty (24.7% among high-risk patients) (Figure 1). In elderly, CDT was not associated with reduced overall in-hospital bleeding compared to ST (13.6% vs 17.9%, odds ratio [OR] 0.88, 95% confidence interval [CI] 0.73-1.05), but associated with reduced major bleeding (4.9% vs 8.9%, OR 0.68, 95%CI 0.51-0.90) (Figure 2A). Among frail patients, overall bleeding events were significantly fewer in the CDT group compared to ST (14.4% vs 27.6%, OR 0.49, 95%CI 0.31-0.78), although there was no difference in major bleeding (8.4% vs 11.2%, OR 0.85, 95%CI 0.46-1.59) (Figure 2A). Among all hospitalizations of elderly patients who received either CBT or SE, there was difference in overall bleeding events (20% vs 51.7%, OR 0.28, 95%CI 0.17-0.46), but not in major bleeding (8.2% vs 15.7%, OR 0.58, 95%CI 0.27-1.23) (Figure 2B). Among the subgroup of frail patients CBT tended to result in reduced overall bleeding (24.7% vs 45.5% for SE) and major bleeding rates (12.3% vs 27.3%), although without statistical significance (Figure 2B). Conclusion(s) Catheter-directed therapies appear to have a favorable safety profile over ST and SE and may offer an alternative for the high-risk PE management of elderly patients.

Renal Pathology Images Segmentation Based on Improved Cuckoo Search with Diffusion Mechanism and Adaptive Beta-Hill Climbing.

Lupus Nephritis (LN) is a significant risk factor for morbidity and mortality in systemic lupus erythematosus, and nephropathology is still the gold standard for diagnosing LN. To assist pathologists in evaluating histopathological images of LN, a 2D Rényi entropy multi-threshold image segmentation method is proposed in this research to apply to LN images. This method is based on an improved Cuckoo Search (CS) algorithm that introduces a Diffusion Mechanism (DM) and an Adaptive β-Hill Climbing (AβHC) strategy called the DMCS algorithm. The DMCS algorithm is tested on 30 benchmark functions of the IEEE CEC2017 dataset. In addition, the DMCS-based multi-threshold image segmentation method is also used to segment renal pathological images. Experimental results show that adding these two strategies improves the DMCS algorithm's ability to find the optimal solution. According to the three image quality evaluation metrics: PSNR, FSIM, and SSIM, the proposed image segmentation method performs well in image segmentation experiments. Our research shows that the DMCS algorithm is a helpful image segmentation method for renal pathological images.

Risk of Diarrhea in Infants on Breastfeeding Exclusive and Non-Exclusive Breastfeeding

Diarrheal disease is a significant risk factor for morbidity and mortality worldwide in children under five years of age. The study aimed to analyze the risk factors for diarrhea in infants with and without exclusive breastfeeding. The research approach used a case-control analysis with observational analytic methods. The population was all mothers who gave birth to babies aged 6-12 months. By determining the sample using the Lemeshow formula, the example was 152 babies with details of 76 cases and 76 controls. The results of the chi-square test showed (p-value= 0,000), which means that there was an effect of exclusive breastfeeding and non-exclusive breastfeeding with the incidence of diarrhea in infants with a value of OR=12,065, which means that mothers who did not breastfeed their babies 12,065 times more at risk of suffering from diarrhea higher inversely compared to mothers who exclusively breastfeed their babies. In conclusion, infants who are not exclusively breastfed are at risk of suffering from diarrhea than infants who are exclusively breastfed.

Risk Factors for Postoperative Pulmonary Complications Leading to Increased Morbidity and Mortality in Patients Undergoing Thoracic Surgery for Pleural Empyema

Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postoperative pulmonary complications (PPCs) and their effects on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs were analyzed. Retrospective observational study. A single, large university hospital. A total of 250 adult patients were included who underwent thoracic surgery for pleural empyema between January 2017 and December 2021. None. A total of 250 patients with pleural empyema underwent thoracic surgery by video-assisted thoracoscopic surgery (49%; n = 122) or open thoracotomy (51%; n = 128). A proportion (42% [105]) of patients had ≥1 PPCs; 28% (n = 70) had to undergo resurgery; and 10% (n = 25) were re-admitted unexpectedly to the ICU. Preoperative respiratory failure (odds ratio [OR]: 5.8, 95% CI: 2.4-13.1), general anesthesia without regional analgesia techniques (OR: 2.9, 95% CI: 1.4-5.8), open thoracotomy and subsequent resurgery (OR: 3.9, 95% CI 1.5-9.9), surgery outside the regular working hours (OR: 3.1, 95% CI 1.2-8.2), and postoperative sepsis (OR: 2.6, 95% CI 1.1-6.8) were identified as independent risk factors for PPCs. Postoperative pulmonary complications were independent factors for unplanned intensive care unit admission (OR: 10.5, 95% CI 2.1-51 for >1 PPC), death within 360 days (OR: 4.5, 95% CI 2.2-12.3 for ≥2 PPCs), and death within 30 days for ≥1 PPCs (OR: 1.2, 95% CI 1.1-1.3). The incidence of PPCs is a significant risk factor for morbidity and mortality after surgery for pleural empyema. Targeting the risk factors identified in this study could improve patient outcomes.

Associations between source-apportioned PM2.5 and 30-day readmissions in heart failure patients

BackgroundAir pollution exposure is a significant risk factor for morbidity and mortality, especially for those with pre-existing chronic disease. Previous studies highlighted the risks that long-term particulate matter exposure has for readmissions. However, few studies have evaluated source and component specific associations particularly among vulnerable patient populations. ObjectivesUse electronic health records from 5556 heart failure (HF) patients diagnosed between July 5, 2004 and December 31, 2010 that were part of the EPA CARES resource in conjunction with modeled source-specific fine particulate matter (PM2.5) to estimate the association between exposure to source and component apportioned PM2.5 at the time of HF diagnosis and 30-day readmissions. MethodsWe used zero-inflated mixed effects Poisson models with a random intercept for zip code to model associations while adjusting for age at diagnosis, year of diagnosis, race, sex, smoking status, and neighborhood socioeconomic status. We undertook several sensitivity analyses to explore the impact of geocoding precision and other factors on associations and expressed associations per interquartile range increase in exposures. ResultsWe observed associations between 30-day readmissions and an interquartile range increase in gasoline- (16.9% increase; 95% confidence interval = 4.8%, 30.4%) and diesel-derived PM2.5 (9.9% increase; 95% confidence interval = 1.7%, 18.7%), and the secondary organic carbon component of PM2.5 (SOC; 20.4% increase; 95% confidence interval = 8.3%, 33.9%). Associations were stable in sensitivity analyses, and most consistently observed among Black study participants, those in lower income areas, and those diagnosed with HF at an earlier age. Concentration-response curves indicated a linear association for diesel and SOC. While there was some non-linearity in the gasoline concentration-response curve, only the linear component was associated with 30-day readmissions. DiscussionThere appear to be source specific associations between PM2.5 and 30-day readmissions particularly for traffic-related sources, potentially indicating unique toxicity of some sources for readmission risks that should be further explored.

Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years.

Zinc deficiency is prevalent in low- and middle-income countries, and is considered a significant risk factor for morbidity, mortality, and linear growth failure. The effectiveness of preventive zinc supplementation in reducing prevalence of zinc deficiency needs to be assessed. To assess the effects of zinc supplementation for preventing mortality and morbidity, and for promoting growth, in children aged 6 months to 12 years. A previous version of this review was published in 2014. In this update, we searched CENTRAL, MEDLINE, Embase, five other databases, and one trials register up to February 2022, together with reference checking and contact with study authors to identify additional studies. Randomized controlled trials (RCTs) of preventive zinc supplementation in children aged 6 months to 12 years compared with no intervention, a placebo, or a waiting list control. We excluded hospitalized children and children with chronic diseases or conditions. We excluded food fortification or intake, sprinkles, and therapeutic interventions. Two review authors screened studies, extracted data, and assessed the risk of bias. We contacted study authors for missing information and used GRADE to assess the certainty of evidence. The primary outcomes of this review were all-cause mortality; and cause-specific mortality, due to all-cause diarrhea, lower respiratory tract infection (LRTI, including pneumonia), and malaria. We also collected information on a number of secondary outcomes, such as those related to diarrhea and LRTI morbidity, growth outcomes and serum levels of micronutrients, and adverse events. We included 16 new studies in this review, resulting in a total of 96 RCTs with 219,584 eligible participants. The included studies were conducted in 34 countries; 87 of them in low- or middle-income countries. Most of the children included in this review were under five years of age. The intervention was delivered most commonly in the form of syrup as zinc sulfate, and the most common dose was between 10 mg and 15 mg daily. The median duration of follow-up was 26 weeks. We did not consider that the evidence for the key analyses of morbidity and mortality outcomes was affected by risk of bias. High-certainty evidence showed little to no difference in all-cause mortality with preventive zinc supplementation compared to no zinc (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.84 to 1.03; 16 studies, 17 comparisons, 143,474 participants). Moderate-certainty evidence showed that preventive zinc supplementation compared to no zinc likely results in little to no difference in mortality due to all-cause diarrhea (RR 0.95, 95% CI 0.69 to 1.31; 4 studies, 132,321 participants); but probably reduces mortality due to LRTI (RR 0.86, 95% CI 0.64 to 1.15; 3 studies, 132,063 participants) and mortality due to malaria (RR 0.90, 95% CI 0.77 to 1.06; 2 studies, 42,818 participants); however, the confidence intervals around the summary estimates for these outcomes were wide, and we could not rule out a possibility of increased risk of mortality. Preventive zinc supplementation likely reduces the incidence of all-cause diarrhea (RR 0.91, 95% CI 0.90 to 0.93; 39 studies, 19,468 participants; moderate-certainty evidence) but results in little to no difference in morbidity due to LRTI (RR 1.01, 95% CI 0.95 to 1.08; 19 studies, 10,555 participants; high-certainty evidence) compared to no zinc. There was moderate-certainty evidence that preventive zinc supplementation likely leads to a slight increase in height (standardized mean difference (SMD) 0.12, 95% CI 0.09 to 0.14; 74 studies, 20,720 participants). Zinc supplementation was associated with an increase in the number of participants with at least one vomiting episode (RR 1.29, 95% CI 1.14 to 1.46; 5 studies, 35,192 participants; high-certainty evidence). We report a number of other outcomes, including the effect of zinc supplementation on weight and serum markers such as zinc, hemoglobin, iron, copper, etc. We also performed a number of subgroup analyses and there was a consistent finding for a number of outcomes that co-supplementation of zinc with iron decreased the beneficial effect of zinc. Even though we included 16 new studies in this update, the overall conclusions of the review remain unchanged. Zinc supplementation might help prevent episodes of diarrhea and improve growth slightly, particularly in children aged 6 months to 12 years of age. The benefits of preventive zinc supplementation may outweigh the harms in regions where the risk of zinc deficiency is relatively high.

The Combination of Red Yeast Rice Extract, Oatmeal and Olive Oil Reduces Serum Cholesterol

Elevated serum cholesterol is a significant risk factor for morbidity and mortality. The main approach to reduce cholesterol is the use of statin drugs. The current study tested the use of a novel food-based technique to reduce cholesterol - the combination of red yeast rice extract (RYRE), extra virgin olive oil (EVOO) and oatmeal. The study was a non-randomized prospective intervention that enrolled 86 patients with elevated total and low-density lipoprotein cholesterol (LDL-C).

Con: Routine Use of Fresh Frozen Plasma Should Not Be Used to Prime Cardiopulmonary Bypass Circuits During Cardiac Surgery

BLEEDING is a well-documented and frequently encountered complication after cardiac surgery, affecting roughly 2%-to-10% of all patients. 1 Petrou A Tzimas P Siminelakis S. Massive bleeding in cardiac surgery. Definitions, predictors, and challenges. Hippokratia. 2016; 20: 179-186 PubMed Google Scholar Major bleeding is a known risk factor for significant morbidity and mortality after complex cardiac surgery such as aortic surgery, left ventricular assist device implantation, redo sternotomy, and transplant. 2 Ranucci M Baryshnikova E Castelvecchio S et al. Major bleeding, transfusions, and anemia: The deadly triad of cardiac surgery. Ann Thorac Surg. 2013; 96: 478-485 Abstract Full Text Full Text PDF PubMed Scopus (178) Google Scholar The definition of major hemorrhage remains controversial; however, most agree that bleeding requiring reoperation, transfusion, or significant decreases in hemoglobin should qualify. Numerous prophylactic agents have been studied for the reduction of bleeding and/or the need for transfusion. In this review, the authors examine the use of fresh frozen plasma (FFP) for priming the cardiopulmonary bypass (CPB) circuit and discuss the lack of evidence supporting its routine use in this population.

The Use of Liraglutide in Obese Patients With COVID-19: A Case Report

Introduction: In December 2019, a new type of coronavirus was discovered in Wuhan, China, characterized by a picture of atypical pneumonia composed of fever, dry cough and progressive dyspnea. Autopsy analyzes of patients with Covid-19 were performed, and hyperactivation of cytotoxic T cells was observed, suggesting an increase in humoral-type immunological signaling, where interleukin 6 (IL-6) is a mediator present that can fit as a potential critical agent for exacerbation of inflammatory conditions. In addition, not only interleukin-6, but also serum C-reactive protein (CRP) and ferritin have been recognized as strong predictors of COVID-19 severity. Recent studies have shown that the use of liraglutide has antioxidant and anti-inflammatory effects in vitro. Thus, the present case report discusses the possible anti-inflammatory properties of the antidiabetic drug liraglutide (Saxenda), in Covid-19. Clinical Case: JCMS, 45 years, male, married, obese grade 2 (BMI: 38.2), sought medical service on August 18, 2020, bringing a positive result of the RT-PCR test for Covid-19, performed in last day. The patient was in good general condition, reporting mild headache and adynamia. He was prescribed to start a treatment with Saxenda (6mg/ml - started 0.6mg/day at week 1, with a gradual increase up to 3mg/day at week 5); Jardiance (25mg / day); Fluimicil (600mg); Ivermectin (6mg) and Colchicine (0.5mg every 12 hours). In addition, collection of laboratory tests was requested. Examination results: IL6: <1.5 pg/mL; Ferritin: 819 ng/ml; C-reactive protein: 5.1mg/L. On August 24, the patient was tachycardic (HR 120–140 bpm) associated with headache and fever (38 °C). Azithromycin (500mg), dexamethasone (4mg) and dipyrone (1g) were prescribed. Collection of laboratory tests was requested. Examination results: IL6: 9.3 pg/mL; Ferritin: 1085 ng/ml; C-reactive protein:23.9mg/L. On September 3, the patient was in good general condition, eupneic, afebrile, with no complaints to declare. On September 6, the collection of laboratory tests was requested. Examination results: IL6: <1.5 pg/mL; Ferritin: 687 ng/ml; C-reactive protein: 1.7mg/L. Conclusion: Based on the described report, it is possible to observe a good clinical and laboratory evolution of the patient with Covid-19 who, among the drugs used, made use of liraglutida. Diabetes and obesity are considered significant risk factors for morbidity and mortality by COVID-19, since they are a condition of low-grade chronic inflammation and in these conditions, inflammatory markers such as CRP, IL-6 and ferritin have strong signs of alteration. Thus, the possible beneficial effect of the administration of liraglutide in obese patients is highlighted, as a potential anti-inflammatory effect, especially in the COVID-19 era.

Chromatin accessibility differences of human monocyte identify age associated inflammatory heterogeneity.

Abstract Human aging is associated with low grade chronic inflammation termed, inflammaging, which is a significant risk factor for morbidity and mortality in elderly. The innate immune system is master regulator of this process via regulating expression of cytokines and other key mediators. We assayed chromatin landscape of the human monocytes during healthy aging with an aim to predict the inflammation associated contemporary and imminent states of monocytes. Our deep sequencing ATAC-seq data from healthy donors of the GESTALT cohort identified, chromatin landscape signatures defining heterogeneity of monocytes. Differentially open chromatin (DOC) clustered old individual monocytes in two distinct groups, while young donors demonstrated ethnicity-based differences. DOC’s heterogeneity of old donors was characterized by presence of intergenic enhancer-like elements dominated by the DNA binding motif of the transcription factor NF-κB. We identified the relationships of age-associated DOC with DNA methylation, gene expression and proteome of monocytes and serum. Finally, the intracellular cytokine staining analysis using multi-parameter flow cytometry demonstrated the DOC’s influence on the monocyte’s response to LPS stimulation. Our data revels the age associated heterogenous functional states of monocytes which can help us understanding decision making mechanisms during an immune response.

Safety of Same-day Discharge in High-risk Patients Undergoing Ambulatory General Surgery

BackgroundSame-day surgery is an increasingly utilized and cost-effective strategy to manage common surgical conditions. However, many institutions limit ambulatory surgical services to only healthy individuals. There is also a paucity of data on the safety of same-day discharge among high-risk patients. This study aims to determine whether same-day discharge is associated with higher major morbidity and readmission rates compared with overnight stay in high-risk general surgery patients. MethodsThis is a retrospective cohort using the data from the National Surgical Quality Improvement Program from 2005 to 2017. Patients with an American Society of Anesthesiologists class ≥3 undergoing general surgical procedures amenable to same-day discharge were identified. Primary and secondary outcomes were major morbidity and readmission at 30 d. A multivariable logistic regression model using mixed effects was used to adjust for the effect of same-day discharge. ResultsOf 191,050 cases, 137,175 patients (72%) were discharged on the same day. At 30 d, major morbidity was 1.0%, readmission 2.2%, and mortality <0.1%. Adjusted odds ratio of same-day discharge was 0.59 (95% confidence interval 0.54-0.64; P < 0.001) for major morbidity and 0.75 (95% confidence interval 0.71-0.80; P < 0.001) for readmission. Significant risk factors for morbidity and readmission included nonindependent functional status, ascites, renal failure, and disseminated cancer. ConclusionsMajor morbidity and readmission rates are low among this large sample of high-risk general surgery patients undergoing common ambulatory procedures. Same-day discharge was not associated with increased adverse events and could be considered in most high-risk patients after uncomplicated surgery.

Application of Health Behavioral Models in Smoking Cessation - A Systematic Review.

Smoking is a significant risk factor for morbidity and mortality. Health education by health promotion is such a gauge to control tobacco epidemic at both national and multinational levels. The objectives of the study were to systematically review the literature to identify models for health behavior change and evaluate evidence for their effectiveness in smoking cessation. A systematic review of the literature identified four peer-reviewed studies describing two smoking cessation behavioral interventional models (transtheoretical model [TTM] and health belief model [HBM]) between 2008 and 2018. Electronic databases MEDLINE (PubMed) and Google Scholar and Trip database were carried out. There were two randomized controlled trials and two nonrandomized controlled interventional studies. There was a high degree of homogeneity of design, definition of smoking and smoking abstinence, and implementation, followed by comparison of studies. All included studies have evaluated outcome by stage of changes (component of TTM model) and therefore show the reduction of smoking rate. All studies did not have blinding of study participants, leading to a higher risk of bias in the outcome. There was a statistically significant difference between TTM-based interventional group and control group in smoking cessation rate. While comparing HBM- and TTM-based behavioral counseling, there was no statistically significant difference in smoking cessation rate. Both HBM- and TTM-based trainings were found to have positive effects on both smoking cessation and progression between the stages.

IFN-I Mediates Dysfunction of Endothelial Progenitor Cells in Atherosclerosis of Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease including the cardiovascular system. Atherosclerosis is the most common cardiovascular complication of SLE and a significant risk factor for morbidity and mortality. Vascular damage/protection mechanism in SLE patients is out of balance, caused by the cascade reaction among oxidative stress, proinflammatory cytokines, Neutrophil Extracellular Traps, activation of B cells and autoantibodies and abnormal T cells. As a precursor cell repairing vascular endothelium, endothelial progenitor cells (EPCs) belong to the protective mechanism and show the reduced number and impaired function in SLE. However, the pathological mechanism of EPCs dysfunction in SLE remains ill-defined. This paper reviews the latest SLE epidemiology and pathogenesis, discusses the changes in the number and function of EPCs in SLE, expounds the role of EPCs in SLE atherosclerosis, and provides new guidance and theoretical basis for exploring novel targets for SLE treatment.

Human monocyte chromatin accessibility variations identify inflammaging heterogeneity

Abstract Human aging is associated with low grade chronic inflammation termed, inflammaging, which is a significant risk factor for morbidity and mortality in elderly population. The innate immune system is implicated as master regulator of this process via expression of cytokines and other key mediators. We used ATAC-seq to identify chromatin signatures in monocytes obtained from healthy donors of the GESTALT cohort. State of differentially open chromatin (DOC) between young (&amp;lt;60y) and older (&amp;gt;60y) donors were identified. Older donors segregated in two clusters, young-like and distinct old-like cluster. Old-like DOC’s enriched for intergenic enhancer-like elements dominated by the DNA binding motif of the transcription factor NF-κB. The relationships of age-associated DOC to gene expression and DNA methylation reveled enrichment of cytokine mediated inflammatory pathways. Ongoing studies of cytokine expression using high-dimensional flowcytometry will be used to determine the functional consequences of chromatin structural changes associated with age.