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Endoscopic Ultrasound 2024Endobronchial ultrasound (EBUS) imaging is a valuable tool for predicting lymph node (LN) metastasis in lung cancer patients. This study aimed to develop a risk-scoring...
BACKGROUND AND OBJECTIVES
Endobronchial ultrasound (EBUS) imaging is a valuable tool for predicting lymph node (LN) metastasis in lung cancer patients. This study aimed to develop a risk-scoring model based on EBUS multimodal imaging (grayscale, Doppler mode, elastography) to predict LN metastasis in lung cancer patients.
PATIENTS AND METHODS
This retrospective study analyzed 350 metastatic LNs in 314 patients with lung cancer and 124 reactive LNs in 96 patients with nonspecific inflammation. The sonographic findings were compared with the final pathology results and clinical follow-up. Univariate and multivariate logistic regression analyses were performed to evaluate the independent risk factors of metastatic LNs. According to the coefficients of corresponding indicators in logistic regression analysis, a risk-scoring model was established. Receiver operating characteristic curve was applied to evaluate the predictive capability of model.
RESULTS
Multivariate analysis showed that short axis >10 mm, distinct margin, absence of central hilar structure, presence of necrosis, nonhilar vascularity, and elastography score 4 to 5 were independent predictors of metastatic LNs. Both short axis and margin were scored 1 point, and the rest of independent predictors were scored 2 points. The combination of 3 EBUS modes had the highest area under the receiver operating characteristic and accuracy of 0.884 (95% confidence interval, 0.846-0.922) and 87.55%, respectively. The risk stratification was as follows: 0 to 2 points, malignancy rate of 11.11%, low suspicion; 3 to 10 points, malignancy rate of 86.77%, high suspicion.
CONCLUSIONS
The risk-scoring model based on EBUS multimodal imaging can effectively evaluate metastatic LNs in lung cancer patients to support clinical decision making.
PubMed: 38947743
DOI: 10.1097/eus.0000000000000051 -
Cureus May 2024With COVID-19 becoming a common disease, primary care facilities such as clinics are required to efficiently triage patients at high risk of severe illness within the...
BACKGROUND
With COVID-19 becoming a common disease, primary care facilities such as clinics are required to efficiently triage patients at high risk of severe illness within the constraints of limited medical resources. However, existing COVID-19 severity risk scores require detailed medical history assessments, such as evaluating the severity of pneumonia via chest CT and accounting for past and comorbid conditions. Therefore, they may not be suitable for practical use in clinical settings with limited medical resources, including personnel and equipment.
PURPOSE
The goal is to identify key variables that predict the need for oxygen therapy in COVID-19 patients and develop a simplified clinical risk score based solely on vital signs to predict oxygen requirements.
PATIENTS AND METHODS
A retrospective observational study of 584 outpatients with COVID-19 confirmed by polymerase chain reaction test visited Sasebo Chuo Hospital between April 28, 2022, and August 18, 2022. Analyses were conducted after adjustment for background factors of age and sex with propensity score matching. We used the Fisher test for nominal variables and the Kruskal-Wallis test for continuous variables.
RESULTS
After adjusting for age and sex, several factors significantly correlated with the need for oxygen within seven days including body temperature (p < 0.001), respiratory rate (p = 0.007), SpO (p < 0.001), and the detection of pneumonia on CT scans (p = 0.032). The area under the receiver-operating characteristic curve for the risk score based on these vital signs and CT was 0.947 (95% confidence interval: 0.911-0.982). The risk score based solely on vital signs was 0.937 (0.900-0.974), demonstrating the ability to predict oxygen administration with no significant differences.
CONCLUSIONS
Body temperature, advanced age, increased respiratory rate, decreased SpO, and the presence of pneumonia on CT scans were significant predictors of oxygen need within seven days among the study participants. The risk score, based solely on vital signs, effectively and simply assesses the likelihood of requiring oxygen therapy within seven days with high accuracy. The risk score, which utilizes only age and vital signs and does not require a detailed patient history or CT scans, could streamline hospital referral processes for admissions.
PubMed: 38947613
DOI: 10.7759/cureus.61270 -
Heliyon Jun 2024This work aimed to investigate the adoption value of blood lactic acid (BLA) combined with the National Early Warning Score (NEWS) in the early screening of sepsis...
This work aimed to investigate the adoption value of blood lactic acid (BLA) combined with the National Early Warning Score (NEWS) in the early screening of sepsis patients and assessing their severity. The data and materials utilized in this work were obtained from the electronic medical record system of 537 anonymized sepsis patients who received emergency rescue in the emergency rescue area of Liuzhou People's Hospital, Guangxi, from July 1, 2020, to December 26, 2020. Based on the 28-day outcomes of sepsis patients, the medical records were rolled into Group S (407 survival cases) and Group D (130 dead cases). Basic information such as the mode of hospital admission, initial management, use of emergency ventilator within 24 h of admission, NEWS score, arterial oxygen pressure/alveolar oxygen pressure ratio (PaO/PAO), alveolar-arterial oxygen difference (A-aDO), serum creatinine (SCr), blood urea nitrogen (BUN), oxygenation index (OI), Glasgow Coma Scale (GCS), D-dimer, use of vasoactive drugs within 24 h of admission, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), N-terminal pro-B-type natriuretic peptide (NT-proBNP), quick Sequential Organ Failure Assessment (qSOFA) score, SOFA score, BLA level, NEWS with lactate (NEWS-L) score, SOFA score including lactate level (SOFA-L) score, Intensive Care Unit (ICU) length of stay, total hospital stay, ICU stay/total hospital stay, and septic shock condition were compared between groups. Logistic regression analysis was performed to assess the impact of various predictive factors on prognosis and to plot the receiver operating characteristic (ROC) curve. The results suggested marked differences between Group S and Group D in terms of mean age ( = -5.620; OR = -9.96, 95 % CI: -13.44∼-6.47; < 0.001). Group S showed drastic differences in terms of mode of hospital admission (χ = 9.618, < 0.01), method of initial management (χ = 51.766, < 0.001), use of emergency ventilator within 24 h of admission (χ = 98.564, < 0.001), incidence of septic shock (χ = 77.545, < 0.001), use of vasoactive drugs within 24 h of admission (χ = 102.453, < 0.001), heart rate ( = -4.063, < 0.001), respiratory rate ( = -4.758, < 0.001), oxygenation status (χ = 20.547, < 0.001), NEWS score ( = -6.120, < 0.001), PaO/PAO ratio ( = 2.625, < 0.01), A-aDO value ( = -3.581, < 0.001), OI value ( = -3.106, < 0.01), PLT value ( = -2.305, < 0.05), SCr value ( = -3.510, < 0.001), BUN value ( = -3.170, < 0.01), D-dimer ( = -4.621, < 0.001), CRP level ( = -4.057, < 0.001), PCT value ( = -2.783, < 0.01), IL-6 level ( = -2.904, < 0.001), length of hospital stay ( = -4.138, < 0.001), total hospital stay ( = -8.488, < 0.001), CCU/total hospital stay ( = -9.118, < 0.001), NEWS score ( = -6.120, < 0.001), SOFA score ( = -6.961, < 0.001), SOFA-L score ( = -4.609, < 0.001), NEWS-L score ( = -5.845, < 0.001), BLA level ( = -6.557, < 0.001), and GCS score ( = 6.909, < 0.001) when compared to Group D. The use of ventilators, septic shock, PCT, NEWS score, GCS score, SOFA score, SOFA-L score, NEWS-L score, and BLA level were identified as independent risk factors for predicting the prognosis of sepsis patients ( < 0.001). The areas under ROC curve (AUC) of blood lactic acid, PCT, NEWS, NEWS-L, GCS, SOFA, and SOFA-L were 0.695, 0.665, 0.692, 0.698, 0.477, 0.700, and 0.653, respectively. These findings indicate that the combination of BLA with NEWS (NEWS-L) score and SOFA score has certain advantages in assessing the prognosis of sepsis.
PubMed: 38947447
DOI: 10.1016/j.heliyon.2024.e31907 -
Health Care Science Jun 2024Silent hypoxemia is when patients do not experience breathing difficulty in the presence of alarmingly low O saturation. It could cause rapid deterioration and higher...
Evaluation of the predictors and frequency of silent hypoxemia in COVID-19 patients and the gap between pulse oximeter and arterial blood gas levels: A cross-sectional study.
BACKGROUND
Silent hypoxemia is when patients do not experience breathing difficulty in the presence of alarmingly low O saturation. It could cause rapid deterioration and higher mortality rates among patients, so prompt detection and identifying predictive factors could result in significantly better outcomes. This study aims to document the evidence of silent hypoxemia in patients with COVID-19 and its clinical features.
METHODS
A total of 78 hospitalized, nonintubated patients with confirmed COVID-19 infection were included in this study. Their O saturation was measured with a pulse oximeter (PO), and arterial blood gas (ABG) was taken. Demographic and clinical features were recorded. The Borg scale was used to evaluate dyspnea status, and patients with a score of less than two accompanied by O saturation of less than 94% were labeled as silent hypoxic. Univariate analysis was utilized to evaluate the correlation between variables and their odds ratio (OR) and 95% confidence interval (CI).
RESULTS
Silent hypoxemia was observed in 20 (25.6%) of the participants. The average difference between the PO and ABG methods was 4.36 ± 3.43. Based on regression analysis, dyspnea and respiratory rate demonstrated a statistically significant correlation with the O saturation difference between PO and ABG (OR: 2.05; = 0.026; 95% CI: 0.248-3.847 and OR: 0.144; = 0.048, 95% CI: 0.001-0.286). Furthermore, the Borg scale (OR: 0.29; = 0.009; 95% CI: 0.116-0.740) had a significant reverse correlation with silent hypoxia.
CONCLUSIONS
Silent hypoxemia can be a possible complication that affects some COVID-19 patients. Further care should be bestowed upon the younger population and those with underlying neurological or mental illnesses. Furthermore, the respiratory rate, pulse oximeter, and arterial blood gas O levels should be considered alongside each other.
PubMed: 38947362
DOI: 10.1002/hcs2.98 -
American Journal of Critical Care : An... Jul 2024Continuous electrocardiographic (ECG) monitoring was first introduced into hospitals in the 1960s, initially into critical care, as bedside monitors, and eventually into...
Continuous electrocardiographic (ECG) monitoring was first introduced into hospitals in the 1960s, initially into critical care, as bedside monitors, and eventually into step-down units with telemetry capabilities. Although the initial use was rather simplistic (ie, heart rate and rhythm assessment), the capabilities of these devices and associated physiologic (vital sign) monitors have expanded considerably. Current bedside monitors now include sophisticated ECG software designed to identify myocardial ischemia (ie, ST-segment monitoring), QT-interval prolongation, and a myriad of other cardiac arrhythmia types. Physiologic monitoring has had similar advances from noninvasive assessment of core vital signs (blood pressure, respiratory rate, oxygen saturation) to invasive monitoring including arterial blood pressure, temperature, central venous pressure, intracranial pressure, carbon dioxide, and many others. The benefit of these monitoring devices is that continuous and real-time information is displayed and can be configured to alarm to alert nurses to a change in a patient's condition. I think it is fair to say that critical and high-acuity care nurses see these devices as having a positive impact in patient care. However, this enthusiasm has been somewhat dampened in the past decade by research highlighting the shortcomings and unanticipated consequences of these devices, namely alarm and alert fatigue. In this article, which is associated with the American Association of Critical-Care Nurses' Distinguished Research Lecture, I describe my 36-year journey from a clinical nurse to nurse scientist and the trajectory of my program of research focused primarily on ECG and physiologic monitoring. Specifically, I discuss the good, the not so good, and the untapped potential of these monitoring systems in clinical care. I also describe my experiences with community-based research in patients with acute coronary syndrome and/or heart failure.
Topics: Humans; Electrocardiography; Monitoring, Physiologic
PubMed: 38945816
DOI: 10.4037/ajcc2024781 -
The Journal of Pediatrics Jun 2024To investigate the extent of extra-skeletal manifestations along with inpatient outcomes and complications associated with osteogenesis imperfecta (OI).
National Trends in Inpatient Hospital Outcomes of Children with Osteogenesis Imperfecta and the Importance of Extra-skeletal Manifestations: A Kids' Inpatient Database Study.
OBJECTIVE
To investigate the extent of extra-skeletal manifestations along with inpatient outcomes and complications associated with osteogenesis imperfecta (OI).
STUDY DESIGN
This cross-sectional study utilized the Kids' Inpatient Database (KID) as part of the Healthcare Cost and Utilization Project (HCUP) to investigate inpatient hospital outcomes and management in patients with OI from 1997 through 2016. Data regarding hospital characteristics, cost of treatment, inpatient outcomes, and procedures were collected and analyzed.
RESULTS
There were 7,291 admissions that listed OI as a diagnosis in the KID database from 1997 through 2016. Unexpectedly, over one third of all admissions in these children with OI presented with an extra-skeletal manifestation. The rate of major complications was 3.85%. The rate of minor complications was 19.4%, most commonly respiratory problems. Mortality rate was 18.2 % in the neonatal period and 1.0% in all other admissions. Total charges of hospital stay increased over the years.
CONCLUSION
We identified a striking prevalence of extra-skeletal manifestations in OI along with inpatient outcomes and complications associated with OI, of which respiratory complications were predominant. We observed a significant financial burden for patients with OI and identified additional risks for financial crisis, in addition to disparities in care identified among socioeconomic groups. These data contribute to a more holistic understanding of OI from diagnosis to management.
PubMed: 38945443
DOI: 10.1016/j.jpeds.2024.114174 -
Contemporary Clinical Trials Jun 2024Awake prone positioning is studied extensively during Covid-19 pandemic, but there is very limited evidence on its utility in acute hypoxic respiratory failure caused by...
BACKGROUND
Awake prone positioning is studied extensively during Covid-19 pandemic, but there is very limited evidence on its utility in acute hypoxic respiratory failure caused by bacterial infections or other causes. The aim of our research is to evaluate the impact of awake prone positioning on outcomes in non-intubated adult patients with acute non-Covid19 hypoxemic respiratory failure.
METHODS
This is a multi-center randomized controlled trial (RCT) with a parallel-group design and a 1:1 allocation ratio. Adult patients, admitted to ICU and diagnosed with hypoxemic respiratory failure will be randomly allocated into intervention (awake prone position (APP)) or control group. Our hypothesis is that addition of awake prone positioning to standard oxygen, high flow oxygen therapy and non-invasive ventilation may reduce the need for mechanical ventilation in adult patients diagnosed with acute hypoxemic respiratory failure. Primary outcome is rate of endotracheal intubation; secondary outcomes include intensive care and hospital mortality, duration of mechanical ventilation, length of intensive care and hospital stay and health related quality of life post hospital discharge. Primary and secondary outcomes will be assessed at hospital discharge, 30, 90 days and 1 year following randomisation.
CONCLUSION
The Hyper-AP study will assess the superiority of awake prone positioning versus standard treatment in spontaneously breathing ICU patients diagnosed with hypoxaemic respiratory failure.
PubMed: 38945293
DOI: 10.1016/j.cct.2024.107614 -
Toxicon : Official Journal of the... Jun 2024Morocco is one of the main countries affected in North African with the scorpion envenomations. Faced with the threat, significant morbidity and a major risk of death...
Morocco is one of the main countries affected in North African with the scorpion envenomations. Faced with the threat, significant morbidity and a major risk of death especially in children, a detailed identification of scorpionic profile of stings remains important for health authorities at national or even regional level. The current study aims to establish the epidemiological, clinical, biological and evolutionary data of the scorpionism by analyzing 383 cases of scorpion stings in children from three age groups (< 1 year, 1-5 years and > 5 years), admitted at the Regional Hospital Hassan II-Agadir in the Souss Massa region during the period of 9 years and 10 months from January 2013 to October 2022. Our results showed that patients under 1 year of age presented the most severe cases and had the highest mortality rate. However, the clinical signs and symptoms observed illustrated severe damages to vital systems, particularly the cardiovascular, neurological and pulmonary systems, although the signs associated with the latter were present only in cases admitted in grades 2 and 3 for the three age categories studied. Fluctuations in vital constants (temperature and peripheral oxygen saturation, blood pressure, heart rate and respiratory rate), biochemical parameters (ASAT, ALAT, urea and blood creatine, as well as blood sugar) and CBC results revealed major functional disturbances in vital organs, especially in envenomated cases admitted in grade 3. A positive correlation was mentioned between the state of evolution and the various epidemiological parameters, digestive symptoms, as well as signs and symptoms linked to hemodynamic state, general and neurological state. The main interest is to illustrate the seriousness of scorpion envenomations, especially in the high-risk population, for whom an improved therapeutic approach in health centers will undoubtedly be reinforced, and the admission of immunotherapy, as a fundamental part of the treatment, remains important.
PubMed: 38945218
DOI: 10.1016/j.toxicon.2024.107832 -
Transplant Immunology Jun 2024Kidney transplantation has emerged as the most effective treatment for patients with uremia. Advances in immunosuppressant medications have significantly reduced the...
BACKGROUND
Kidney transplantation has emerged as the most effective treatment for patients with uremia. Advances in immunosuppressant medications have significantly reduced the risk of rejection. However, a notable increase in opportunistic infections, such as Pneumocystis jirovecii pneumonia (PJP), demands special attention in clinical practice. Our study aims to evaluate risk factors and identify predictive markers associated with PJP in kidney transplantation recipients.
METHODS
We conducted a case-control study (1:2 ratio) involving kidney transplant recipients with and without PJP, matched based on the same surgical date. The study was carried out at Zhongnan Hospital of Wuhan University, China.
RESULTS
Ninety-three participants were enrolled at Zhongnan Hospital of Wuhan University, comprising 31 with PJP and 62 without PJP. All patients tested negative for HIV. Our findings indicate that PJP patients exhibited lower levels of serum albumin (P = 0.001), reduced counts of total and CD3 (P < 0.001), CD4 (P = 0.001), and CD8 T lymphocytes (P < 0.001), and a lower rate of prophylactic trimethoprim-sulfamethoxazole (TMP-SMZ) usage compared to non-PJP patients (P = 0.02). Conversely, urea levels in PJP patients were significantly higher than in non-PJP controls (P < 0.001). We developed a model combining CD8 T cell count (< 241.11/μL, P < 0.001) and ALB levels (< 35.2 g/L, P = 0.003), which demonstrated excellent discriminatory power in distinguishing PJP from non-PJP cases, with an area under the curve (AUC) of 0. 920 (95% CI, 0.856-0.989).
CONCLUSIONS
Our study suggests that a baseline CD8 T cell count (< 241.11/μL) and serum ALB levels (< 35.2 g/L) offer robust predictive value for the occurrence of PJP infections in kidney transplant recipients.
PubMed: 38945175
DOI: 10.1016/j.trim.2024.102074 -
Journal of Gastrointestinal and Liver... Jun 2024During the coronavirus disease 2019 (COVID-19) pandemic a significant proportion of patients with severe acute respiratory distress syndrome (ARDS) due to COVID-19...
BACKGROUND AND AIMS
During the coronavirus disease 2019 (COVID-19) pandemic a significant proportion of patients with severe acute respiratory distress syndrome (ARDS) due to COVID-19 infection developed secondary sclerosing cholangitis (SSC) as a hepatobiliary complication.
METHODS
17 patients were endoscopically diagnosed and treated with COVID-19 SSC from February 2020 until October 2022 at our center. We retrospectively reviewed and analyzed the data to define risk factors, establish endoscopic treatment options, and to estimate incidence and outcomes.
RESULTS
258 patients with COVID-19 infection were admitted to our tertiary center and mechanically ventilated. 10 patients developed COVID-19 SSC in-house, and 7 patients were transferred for further endoscopic treatment. All 17 patients were mechanically ventilated, received vasoactive substances and 12 of them were treated with extracorporeal membrane oxygenation therapy. Endoscopic retrograde cholangiography (ERC) was performed in all patients to establish the diagnosis of COVID-19 SSC and evaluate endoscopic treatment options. All ERCs revealed biliary casts. 9 patients had developed severe rarefication of the intrahepatic bile ducts and 4 showed biliary strictures. As endoscopic treatment approaches, casts were removed repeatedly, and strictures were dilated. During the study period, 14 patients died (82%). 3 patients are in follow-up to reassess the need for liver transplantation.
CONCLUSIONS
COVID-19 SSC was observed in 2.6 % of the patients with severe COVID-19 in our center. We show that endoscopic approaches offer the opportunity to extract casts and to treat biliary strictures. As the mortality rate of COVID-19 SSC is high, endoscopic treatment can be of great clinical relevance as a bridge to liver transplantation.
Topics: Humans; COVID-19; Male; Female; Cholangitis, Sclerosing; Middle Aged; Retrospective Studies; Cholangiopancreatography, Endoscopic Retrograde; Tertiary Care Centers; Aged; SARS-CoV-2; Adult; Treatment Outcome; Risk Factors; Liver Transplantation
PubMed: 38944874
DOI: 10.15403/jgld-5476