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Journal of Ultrasound Jun 2024Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of...
AIM
Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of abdominal surgery or liver transplantation. We report a case of GG of the liver occurred after percutaneous microwave (MW) ablation of an hepatocellular carcinoma (HCC) successfully treated with percutaneous Radiofrequency ablation (RFA).
CASE PRESENTATION
A 76-year-old female patient was treated with MW ablation for a large HCC in the VIII segment; 2 days later she developed fever, weakness, abdominal swelling and was hospitalized with diagnosis of anaerobic liver abscess. Despite antibiotic therapy, the patient conditions worsened, and she was moved to the intensive care unit (ICU). Percutaneous drainage was attempted, but was unsuccessful. The surgeon and the anesthesiologist excluded any indication of surgical resection. We performed RFA of the GG by 3 cool-tip needles into the infected area. The procedure was well tolerated by the patient, who left the hospital for follow-up.
CONCLUSION
Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients refractory to antibiotics and when surgery and OLT are not feasible. A fast and early indication is needed in case of rapid worsening of the patient's conditions.
PubMed: 38940887
DOI: 10.1007/s40477-024-00928-2 -
Annals of Intensive Care Jun 2024A notable increase in severe cases of COVID-19, with significant hospitalizations due to the emergence and spread of JN.1 was observed worldwide in late 2023 and early...
Clinical phenotypes and outcomes associated with SARS-CoV-2 Omicron sublineage JN.1 in critically ill COVID-19 patients: a prospective, multicenter cohort study in France, November 2022 to January 2024.
BACKGROUND
A notable increase in severe cases of COVID-19, with significant hospitalizations due to the emergence and spread of JN.1 was observed worldwide in late 2023 and early 2024. However, no clinical data are available regarding critically-ill JN.1 COVID-19 infected patients.
METHODS
The current study is a substudy of the SEVARVIR prospective multicenter observational cohort study. Patients admitted to any of the 40 participating ICUs between November 17, 2022, and January 22, 2024, were eligible for inclusion in the SEVARVIR cohort study (NCT05162508) if they met the following inclusion criteria: age ≥ 18 years, SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction (RT-PCR) in nasopharyngeal swab samples, ICU admission for acute respiratory failure. The primary clinical endpoint of the study was day-28 mortality. Evaluation of the association between day-28 mortality and sublineage group was conducted by performing an exploratory multivariable logistic regression model, after systematically adjusting for predefined prognostic factors previously shown to be important confounders (i.e. obesity, immunosuppression, age and SOFA score) computing odds ratios (OR) along with their corresponding 95% confidence intervals (95% CI).
RESULTS
During the study period (November 2022-January 2024) 56 JN.1- and 126 XBB-infected patients were prospectively enrolled in 40 French intensive care units. JN.1-infected patients were more likely to be obese (35.7% vs 20.8%; p = 0.033) and less frequently immunosuppressed than others (20.4% vs 41.4%; p = 0.010). JN.1-infected patients required invasive mechanical ventilation support in 29.1%, 87.5% of them received dexamethasone, 14.5% tocilizumab and none received monoclonal antibodies. Only one JN-1 infected patient (1.8%) required extracorporeal membrane oxygenation support during ICU stay (vs 0/126 in the XBB group; p = 0.30). Day-28 mortality of JN.1-infected patients was 14.6%, not significantly different from that of XBB-infected patients (22.0%; p = 0.28). In univariable logistic regression analysis and in multivariable analysis adjusting for confounders defined a priori, we found no statistically significant association between JN.1 infection and day-28 mortality (adjusted OR 1.06 95% CI (0.17;1.42); p = 0.19). There was no significant between group difference regarding duration of stay in the ICU (6.0 [3.5;11.0] vs 7.0 [4.0;14.0] days; p = 0.21).
CONCLUSIONS
Critically-ill patients with Omicron JN.1 infection showed a different clinical phenotype than patients infected with the earlier XBB sublineage, including more frequent obesity and less immunosuppression. Compared with XBB, JN.1 infection was not associated with higher day-28 mortality.
PubMed: 38940865
DOI: 10.1186/s13613-024-01319-w -
Naunyn-Schmiedeberg's Archives of... Jun 2024Sepsis is a life-threatening condition caused by the body's response to an infection. Dapsone is a sulfone with antibiotic properties, and experimental evidence suggests...
Sepsis is a life-threatening condition caused by the body's response to an infection. Dapsone is a sulfone with antibiotic properties, and experimental evidence suggests it has significant anti-inflammatory and anti-oxidative stress effects. The objective of this study was to investigate the efficacy of dapsone in mice after CLP (cecal ligation and puncture) surgery, which is a model for inducing sepsis. The study divided animals into five groups: CLP, sham, and three groups receiving different doses of dapsone (0.5, 1, 2 mg/kg). Sepsis was induced through CLP surgery, followed by dapsone administration. In each group, half of the mice were used to evaluate levels of various markers and pathological changes at 24 h post-CLP, while the other half was used to record the mortality rates within 96 h. The results showed that single-dose administration of dapsone at (0.5, 1, 2 mg/kg) after CLP surgery improved survival compared to the CLP group. Dapsone was also associated with a significant reduction in pro-inflammatory cytokines TNF-α, IL-1β, IL-6, NO, and MPO, as well as lactate and creatinine serum levels. However, dapsone did not have a significant effect on urea serum levels. In conclusion, the data suggest that dapsone treatment leads to increased survival in septic mice after CLP, and due to its ability to reduce TNF-α, IL-1β, IL-6, MPO, and lactate levels, it has anti-inflammatory effects in sepsis. The sepsis treatment with dapsone in mice protects against inflammation and oxidative stress.
PubMed: 38940849
DOI: 10.1007/s00210-024-03251-z -
The American Journal of Drug and... Jun 2024As resolution for opioid-related claims and litigation against pharmaceutical manufacturers and other stakeholders, state and local governments are newly eligible for...
As resolution for opioid-related claims and litigation against pharmaceutical manufacturers and other stakeholders, state and local governments are newly eligible for millions of dollars of settlement funding to address the overdose crisis in the United States. To inform effective use of opioid settlement funds, we propose a simple framework that highlights the principal determinants of overdose mortality: the number of people at risk of overdose each year, the average annual number of overdoses per person at risk, and the average probability of death per overdose event. We assert that the annual number of overdose deaths is a function of these three determinants, all of which can be modified through public health intervention. Our proposed heuristic depicts how each of these drivers of drug-related mortality - and the corresponding interventions designed to address each term - operate both in isolation and in conjunction. We intend for this framework to be used by policymakers as a tool for identifying and evaluating public health interventions and funding priorities that will most effectively address the structural forces shaping the overdose crisis and reduce overdose deaths.
PubMed: 38940829
DOI: 10.1080/00952990.2024.2364338 -
Pediatric Cardiology Jun 2024Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to...
Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to long-term outcomes are limited. The aim of this study was to evaluate the mid-term safety and efficacy of transcatheter CoA stenting based on centrally adjudicated outcomes. This retrospective cohort study included patients aged 15 years or younger undergoing de novo stenting for CoA or recoarctation (reCoA) between 2006 and 2017. Immediate and 5-year outcomes were assessed. Immediate outcomes (procedural and in-hospital) were retrieved from electronic records. Rates of 5-year reCoA, stent fractures, aneurysmal/pseudoaneurysmal formation, and all-cause mortality were mid-term outcomes. The study included 274 patients (64% male and 36% female) with a median (interquartile range) age of 9 (6-12) years. Procedural success was achieved in 251 patients (91.6%). Procedural complications occurred in 4 patients (1.4%), consisting of stent migration in 1 (0.3%) and small non-expanding non-flow-limiting aortic wall injuries in 3 (1.1%). Major vascular access complications were observed in 18 patients (6.6%), acute limb ischemia in 8 (2.9%). In-hospital mortality occurred in 4 patients (1.4%). Five-year cumulative incidence rates of stent fractures, reCoA, and aortic aneurysmal/pseudoaneurysmal formation were 17/100 (17%), 73/154 (48%), and 8/101 (7.92%), respectively. Of 73 reCoAs, 47 were treated with balloon angioplasty, and 15 underwent a second stent implantation. Five-year all-cause mortality occurred in 4/251 (1.6%) patients. Coarctoplasty with stents was safe and effective in our pediatric population during a 5-year follow-up despite a high rate of reCoA.
PubMed: 38940826
DOI: 10.1007/s00246-024-03551-4 -
Alternative Therapies in Health and... Jun 2024Liver failure is a rare, life-threatening disease that has a high mortality rate and affects many organ systems. Bloodstream bacterial infection has played a key role in...
BACKGROUND
Liver failure is a rare, life-threatening disease that has a high mortality rate and affects many organ systems. Bloodstream bacterial infection has played a key role in liver failure patients with plasma exchange-centered artificial liver support systems, but the predicted risk factors of infection have not been fully understood.
OBJECTIVE
We aimed to predict bloodstream bacterial infection in high-risk groups of liver failure patients during a plasma exchange-centered artificial liver support system.
DESIGN
This was a prospective cohort study.
SETTING
This study was performed in Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School.
PARTICIPANTS
118 liver failure patients with plasma exchange-centered artificial liver support system therapy from Nanjing Drum Tower Hospital from November 2019 to November 2020 were selected.
INTERVENTIONS
We used a stepwise binary logistic regression model to select the optimal risk factors of infection with minimum Akaike information criterion, and the Nomogram prognostic model for bloodstream infection was constructed for visualization.
PRIMARY OUTCOME MEASURES
Risk factors of bloodstream infection (2) predictive accuracy of the constructed nomogram model.
RESULTS
Among the 118 liver failure patients, 22 (18.64%) were diagnosed with bloodstream bacterial infection. The univariable and multivariate logistic regression analyses suggested that culture level, glucocorticoids use, number of punctures, blood platelet counts, white blood cell counts, and indwelling catheter time were the sex predictors of bloodstream infection for liver failure patients during plasma exchange-centered artificial liver support system (P = .042, P = .013, P = .025, P = .003, P = .024 and P = .026). The nomogram predictive model was established with high prediction accuracy, of which the area under the curve was 0.935 (95% confidence interval: 0.884-0.986), the sensitivity was 0.955, and the specificity was 0.854.
CONCLUSION
The constructed nomogram prognostic model can recognize the risk factors and accurately predict bloodstream infection for liver failure patients during plasma exchange-centered artificial liver support system.
PubMed: 38940794
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Colorectal cancer is a malignant tumor with high mortality, but is hard to detect at its early stage. Recent studies highlighted the crucial roles of Ezrin protein and...
OBJECTIVE
Colorectal cancer is a malignant tumor with high mortality, but is hard to detect at its early stage. Recent studies highlighted the crucial roles of Ezrin protein and MMP-9 in the development and malignancy of colorectal cancer, but Ezrin protein and MMP-9 in early diagnosis of colorectal cancer require further investigation. Therefore, we aimed to investigate their roles in the occurrence and metastasis of colorectal cancer, and to analyze their clinical significance in diagnosing and treating colorectal cancer.
METHOD
The diagnosis of collected colorectal cancer tissue and adjacent tissue samples from colorectal cancer patients confirmed by clinical symptoms was performed using Hematoxylin Eosin staining. The expression levels of Ezrin and MMP-9 in 50 colorectal cancer tissue and 50 cases adjacent colorectal cancer tissue were detected by the immuno-histochemical MaxVision method. The relationship between the positive expression rate of Ezrin and MMP-9 in colorectal cancer tissue and clinical pathological factors was analyzed, and the correlation between Ezrin and MMP-9 was examined.
RESULTS
The positive expression rate of Ezrin in colorectal cancer tissue (78%) was significantly higher compared to adjacent non-cancerous tissues (6.0%) (P < .05). There was no significant correlation of gender/age and Ezrin/MMP-9 expressions (P > .05). The expression level of Ezrin exhibited statistically significant differences in the pathological factors including tumor diameter, depth of invasion, degree of differentiation, presence or absence of lymph node metastasis, and distant metastasis (P < .05). Additionally, the positive expression rate of MMP-9 in colorectal cancer tissue (76%) was markedly elevated compared to adjacent tissues (8.0%) (P < .05). The expression level of MMP-9 showed statistically significant differences in the pathological factors including tumor diameter, depth of invasion, degree of differentiation, presence or absence of lymph node metastasis, and distant metastasis (P < .05). In addition, the expression of Ezrin and MMP-9 in colorectal cancer tissue showed a significant positive correlation (r=0.637, P < .01).
CONCLUSION
Ezrin and MMP-9 may synergistically participate in the occurrence, invasion, and metastasis of colorectal cancer. The combined assessment of Ezrin and MMP-9 expression levels in colorectal cancer patients holds significant potential for clinical diagnosis and personalized therapeutic applications.
PubMed: 38940787
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024To analyze the effects of trimetazidine on ventricular remodeling and serum cystatin C (Cys C) and endothelin-1 (ET-1) levels in patients with chronic heart failure...
OBJECTIVE
To analyze the effects of trimetazidine on ventricular remodeling and serum cystatin C (Cys C) and endothelin-1 (ET-1) levels in patients with chronic heart failure (CHF).
METHODS
A total of 96 patients with CHF admitted to the fifth affiliated hospital of Xinjiang medical university. were enrolled as the research objects between June 2012 and June 2023. They were randomly divided into a control and observation groups, with 48 cases in each group. The control group was given routine treatment, while the observation group was additionally treated with trimetazidine hydrochloride tablets. All were continuously treated for 6 months. The clinical curative effect between the two groups was compared. The left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) were measured by cardiac echocardiography before and after treatment. 6MVT before and after treatment was recorded. A full-automatic biochemical analyzer detected the level of serum Cys C before and after treatment. The levels of serum ET-1, galectin-3 (Gal-3), brain natriuretic peptide (BNP), and atrial natriuretic peptide (ANP) were detected by enzyme-linked immunosorbent assay before and after treatment. The incidence of adverse events in the two groups of CHF patients was compared.
RESULTS
The total response rate of treatment in the observation group was significantly higher than that in the control group (91.67% vs 79.17%) (P = .037). After treatment, LVEDD and LVESD decreased, while LVEF and 6MVT increased in both groups. LVEDD and LVESD in the observation group were significantly lower than those in the control group, while LVEF and 6MVT were significantly higher than those in the control group (P < .05). After treatment, serum Cys C, ET-1, Gal-3, BNP, and ANP levels in both groups were significantly decreased, significantly lower in the observation group than in the control group (P < .05). The readmission rate of the observation group was lower than that of the control group (P = .045). There was no significant difference in mortality between the two groups (P = .315).
CONCLUSION
Trimetazidine is effective in treating patients with CHF. It can improve cardiac function and reduce the rate of re-hospitalization.
PubMed: 38940778
DOI: No ID Found -
JMIR Public Health and Surveillance May 2024Food-induced anaphylaxis (FIA) is a major public health problem resulting in serious clinical complications, emergency department visits, hospitalization, and death.
BACKGROUND
Food-induced anaphylaxis (FIA) is a major public health problem resulting in serious clinical complications, emergency department visits, hospitalization, and death.
OBJECTIVE
The objectives of this investigation were to assess the epidemiology and the trends in hospitalizations because of FIA in Spain between 2016 and 2021.
METHODS
An observational descriptive study was conducted using data from the Spanish National hospital discharge database. Information is coded based on the International Classification of Diseases, Tenth Revision. The study population was analyzed by sex and age group and according to food triggers, clinical characteristics, admission to the intensive care unit (ICU), severity, and in-hospital mortality (IHM). The annual incidence of hospitalizations because of FIA per 100,000 person-years was estimated and analyzed using Poisson regression models. Multivariable logistic regression models were constructed to identify which variables were associated with severe FIA.
RESULTS
A total of 2161 hospital admissions for FIA in were recorded in Spain from 2016 to 2021. The overall incidence rate was 0.77 cases per 100,000 person-years. The highest incidence was found in the <15-year age group (3.68), with lower figures among those aged 15-59 years (0.25) and ≥60 years (0.29). Poisson regression showed a significant increase in incidence from 2016 to 2021 only among children (3.78 per 100,000 vs. 5.02 per 100,000 person-years; p=.047). The most frequent food triggers were ""Milk and dairy products" (419/2161, 19.4% of cases) and "Peanuts and tree nuts and seeds" (409/2161, 18.9%). Overall, 256 of 2161 (11.9%) patients hospitalized because of FIA required admission to the ICU, and 11 patients (0.5%) died in hospital. Among children, the most severe cases of FIA appeared in patients aged 0 to 4 years (40/99, 40.4%). Among adults, 69.4% (111/160) of cases occurred in those aged 15 to 59 years. Multivariable logistic regression showed the variables associated with severe FIA to be age 15-59 years (OR, 5.1; 95% CI, 3.11-8.36), age ≥60 years (OR, 3.87; 95% CI, 1.99-7.53), and asthma.
CONCLUSIONS
In Spain, the incidence of hospitalization because of FIA increased slightly, although the only significant increase was among children. Even if IHM remains low and stable, the proportion of severe cases is high and has not improved from 2016 to 2021, with older age and asthma being risk factors for severity. Surveillance must be improved, and preventive strategies implemented to reduce the burden of FIA.
PubMed: 38940759
DOI: 10.2196/57340 -
Sarcoidosis, Vasculitis, and Diffuse... Jun 2024Any test that provides sufficient prognostic information to guide treatment decisions in idiopathic pulmonary fibrosis (IPF) is not available. The aim of our study was...
BACKGROUND AND AIM
Any test that provides sufficient prognostic information to guide treatment decisions in idiopathic pulmonary fibrosis (IPF) is not available. The aim of our study was to determine the predictive factors of mortality in patients with IPF treated with antifibrotics.
METHODS
Patients with diagnosis of IPF who were treated with antifibrotics between 2016 - 2021 were included in the study. Demographic, clinical and laboratory characteristics of the patients was derived from hospital records retrospectively. Kaplan Meier and multivariate cox regression analysis were achieved for detection of mortality predictors.
RESULTS
Study population was composed of 119 IPF patients with a male predominance of 80.7% (n=96). Mean age of the patients was 67.9 ± 7.07 years. On univariate analysis, sex was not a significant predictor of mortality (HR 1.79; 95% CI: 0.87 - 3.69, p =0.11). BMI ≤ 26,6 m2/kg, DLCO ≤ 3.11 ml/mmHg/min, age over 62 years, 6DWT ≤ 382 meters, NLR ≤ 2.67 and PDW ≤ 16.7% were found to be significant for predicting mortality. On multivariate cox regression analysis four parameters remained significant for prediction of mortality: RDW > 14%, NLR ≤ 2.67, BMI ≤ 26,6 m2/kg and DLCO ≤ 3.11 ml/mmHg/min (respectively, HR: 2.0. 95% CI: 1.02 - 3.91, p=0.44; HR: 2.68. 95% CI: 1.48 - 4.85, p=0.001, HR: 2.07. 95% CI: 1.14 - 3.76, p=0.02, HR: 3.46. 95% CI: 1.85 - 6.47, p<0.001). A scoring system with these parameters discriminated patients with worse prognosis with a sensitivity of 89.1 % and a specificity of 65.8 % when total point was over 2 (AUC0.83, p<0.001). Conclusions In this study, DLCO, BMI, RDW and NLR levels significantly predicted mortality in IPF patients. Along with GAP index, scoring system with these simple parameters may give information about the prognosis of an IPF patient treated with antifibrotics.
PubMed: 38940720
DOI: 10.36141/svdld.v41i2.13779