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PloS One 2024Anemia is defined as a low hemoglobin (Hb) concentration and is highly prevalent worldwide. We report on the performance of a smartphone application (app) that records...
Anemia is defined as a low hemoglobin (Hb) concentration and is highly prevalent worldwide. We report on the performance of a smartphone application (app) that records images in RAW format of the palpebral conjunctivae and estimates Hb concentration by relying upon computation of the tissue surface high hue ratio. Images of bilateral conjunctivae were obtained prospectively from a convenience sample of 435 Emergency Department patients using a dedicated smartphone. A previous computer-based and validated derivation data set associating estimated conjunctival Hb (HBc) and the actual laboratory-determined Hb (HBl) was used in deriving Hb estimations using a self-contained mobile app. Accuracy of HBc was 75.4% (95% CI 71.3, 79.4%) for all categories of anemia, and Bland-Altman plot analysis showed a bias of 0.10 and limits of agreement (LOA) of (-4.73, 4.93 g/dL). Analysis of HBc estimation accuracy around different anemia thresholds showed that AUC was maximized at transfusion thresholds of 7 and 9 g/dL which showed AUC values of 0.92 and 0.90 respectively. We found that the app is sufficiently accurate for detecting severe anemia and shows promise as a population-sourced screening platform or as a non-invasive point-of-care anemia classifier.
Topics: Humans; Smartphone; Anemia; Conjunctiva; Female; Male; Hemoglobins; Middle Aged; Adult; Mobile Applications; Aged; Prospective Studies; Image Processing, Computer-Assisted; Aged, 80 and over
PubMed: 38739605
DOI: 10.1371/journal.pone.0302883 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2024This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery.
BACKGROUND
This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery.
METHODS
Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed.
RESULTS
Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05).
CONCLUSION
By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.
Topics: Humans; Aged; Male; Female; Intensive Care Units; Risk Factors; Aged, 80 and over; Postoperative Complications; Retrospective Studies; Length of Stay; Cardiovascular Surgical Procedures; Cardiac Surgical Procedures; Hospital Mortality
PubMed: 38738671
DOI: 10.14744/tjtes.2024.00569 -
Journal of Thoracic Disease Apr 2024Gastrointestinal bleeding (GIB) is a notable complication in patients diagnosed with aortic dissection (AD). We evaluated the outcomes and identified the risk factors...
BACKGROUND
Gastrointestinal bleeding (GIB) is a notable complication in patients diagnosed with aortic dissection (AD). We evaluated the outcomes and identified the risk factors associated with GIB in patients with AD.
METHODS
A retrospective case-control study was conducted on patients diagnosed with type A aortic dissection (TAAD) who underwent total aortic arch replacement (TAAR) at our institution from July 2021 to July 2023. Comprehensive clinical data, laboratory findings, and imaging results were meticulously gathered and analyzed to identify potential risk factors linked to GIB in this patient cohort.
RESULTS
Of the 198 AD patients who underwent TAAR, 38 (19.2%) developed postoperative GIB (GIB group), with a median interval of 7 days between surgery and bleeding onset. The GIB group exhibited significantly higher mortality (26.3% 3.1%, P<0.001), prolonged intensive care unit (ICU) stay {15 [interquartile range (IQR), 8-25] 7 (IQR, 5-12) days, P<0.001}, and extended duration of ventilation [168 (IQR, 120-372) 71 (IQR, 34-148) hours, P<0.001] compared to the control group (n=160, 80.8%). Logistic regression analysis identified age >54 years [odds ratio (OR): 3.529], intraoperative red blood cell (RBC) transfusion >600 mL (OR: 3.865), and concomitant celiac trunk and superior mesenteric artery (SMA) hypoperfusion (OR: 15.974) as independent risk factors for GIB in AD patients.
CONCLUSIONS
GIB subsequent to TAAR in AD patients is linked to adverse prognosis. Factors such as advanced age, extensive intraoperative transfusion, and gastrointestinal (GI) perfusion abnormalities may heighten the risk of GIB in this patient population.
PubMed: 38738230
DOI: 10.21037/jtd-23-1752 -
Trauma Surgery & Acute Care Open 2024Blood transfusions have become a vital intervention in trauma care. There are limited data on the safety and effectiveness of submassive transfusion (SMT), that is...
BACKGROUND
Blood transfusions have become a vital intervention in trauma care. There are limited data on the safety and effectiveness of submassive transfusion (SMT), that is defined as receiving less than 10 units packed red blood cells (PRBCs) in the first 24 hours. This study aimed to evaluate the efficacy and safety of fresh frozen plasma (FFP) and platelet transfusions in patients undergoing SMT.
METHODS
This is a retrospective cohort, reviewing the Trauma Quality Improvement Program database spanning 3 years (2016 to 2018). Adult patients aged 18 years and older who had received at least 1 unit of PRBC within 24 hours were included in the study. We used a multivariate regression model to analyze the cut-off units of combined resuscitation (CR) (which included PRBCs along with at least one unit of FFP and/or platelets) that leads to survival improvement. Patients were then stratified into two groups: those who received PRBC alone and those who received CR. Propensity score matching was performed in a 1:1 ratio.
RESULTS
The study included 85 234 patients. Based on the multivariate regression model, transfusion of more than 3 units of PRBC with at least 1 unit of FFP and/or platelets demonstrated improved mortality compared with PRBC alone. Among 66 319 patients requiring SMT and >3 units of PRBCs, 25 978 received PRBC alone, and 40 341 received CR. After propensity matching, 4215 patients were included in each group. Patients administered CR had a lower rate of complications (15% vs 26%), acute respiratory distress syndrome (3% vs 5%) and acute kidney injury (8% vs 11%). Rates of sepsis and venous thromboembolism were similar between the two groups. Multivariate regression analysis indicated that patients receiving 4 to 7 units of PRBC alone had significantly higher ORs for mortality than those receiving CR.
CONCLUSION
Trauma patients requiring more than 3 units of PRBCs who received CR with FFP and platelets experienced improved survival and reduced complications.
LEVEL OF EVIDENCE
Level III retrospective study.
PubMed: 38737815
DOI: 10.1136/tsaco-2023-001310 -
Trauma Surgery & Acute Care Open 2024
PubMed: 38737812
DOI: 10.1136/tsaco-2024-001482 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To determine the prevalence of dry eye (DE) and some related factors in patients with type 2 diabetic nephropathy (T2DN).
AIM
To determine the prevalence of dry eye (DE) and some related factors in patients with type 2 diabetic nephropathy (T2DN).
METHODS
We performed a cross-sectional study on 338 people, who were divided into 2 groups: 169 T2DN patients and 169 patients diagnosed with type 2 diabetic mellitus (T2DM) without renal complications as a control group. The Ocular Surface Disease Index (OSDI) and test fluorescein tear-film break-up time (TBUT) were done in all 338 subjects. Patients with OSDI scores < 13 and TBUT values equal to or under 10 seconds were diagnosed with dry eye.
RESULTS
The prevalence of DE in T2DN patients was significantly higher than T2DM group (55.6% versus 37.3%). The T2DN groups with dry eye had a median duration of DM, the proportion of hypertension, peripheral nerve complications, anemia, proportion of using insulin, and concentration of plasma glucose, HbA1C, urea, creatinine, CRP-hs significantly higher than those of T2DN without dry eye. Advanced age, high HbA1C level, and decreased eGFR were independent factors associated with dry eye in T2DN patients.
CONCLUSION
Dry eye was a common condition associated with advanced age, high HbA1C levels, and decreased GFR in T2DN patients.
PubMed: 38737597
DOI: 10.2147/OPTH.S458633 -
Regenerative Therapy Dec 2024In this multicenter clinical study, we aimed to investigate the efficacy and safety of the transhepatic arterial administration of granulocyte-colony stimulating factor...
Hepatic arterial infusion of autologous CD34 cells for hepatitis C virus-related decompensated cirrhosis: A multicenter, open-label, exploratory randomized controlled trial.
INTRODUCTION
In this multicenter clinical study, we aimed to investigate the efficacy and safety of the transhepatic arterial administration of granulocyte-colony stimulating factor (G-CSF)-mobilized autologous peripheral blood (PB)-CD34 cells compared with standard therapy in patients with decompensated cirrhosis type C.
METHODS
Patients were randomly assigned (2:1) to the CD34 cell transplant (CD34 cell) or standard-of-care (SOC) group and followed up for 52 weeks. The primary endpoints were the non-progression rate of Child-Pugh (CP) scores at 24 weeks post-enrollment and the safety of the protocol treatment.
RESULTS
Fourteen patients (CD34 cell group: 10; SOC group: 4) were enrolled. CP scores at 24 weeks had a non-progression rate of 90% in the CD34 cell group and 100% in the SOC group, with no significant difference between groups. Importantly, 4 out of 10 patients in the CD34 cell group exhibited an improvement from decompensated to compensated cirrhosis, whereas all patients in the SOC group remained in decompensated cirrhosis. With regard to secondary endpoints, a trend toward increased serum albumin levels in the CD34 cell group was noted. Serious adverse events (SAEs) occurred in three patients in the CD34 cell group and in one patient in the SOC group. No causal relationship was observed between all SAEs and G-CSF, leukapheresis, or cell transplantation in the CD34 cell group. No patients died and no hepatocellular carcinoma occurred within the study period.
CONCLUSIONS
PB-CD34 cell infusion therapy may have the potential to circumvent the decompensated stage of cirrhosis, thus avoiding the need for liver transplantation.
PubMed: 38737403
DOI: 10.1016/j.reth.2024.04.018 -
The Pan African Medical Journal 2024Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis...
Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis and different treatment options for uterine rupture in healthy and scarred uteri. We conducted a retrospective monocentric descriptive and analytical study of 60 cases of uterine rupture collected in the Department of Gynaecology-Obstetrics of the Center of Maternity and Neonatology, Monastir, from 2017 to 2021. Patients were classified according to the presence or absence of a uterine scar. Sixty patients were enrolled in the study. The majority of cases of rupture occurred in patients with scarred uterus (n=55). The most common clinical sign was abnormal foetal heart rate. No maternal deaths were recorded and perinatal mortality rate was 11%. Mean BMI, fetal macrosomia rate and mean parity were significantly higher in the healthy uterus group than in the scarred uterus group (p=0.033, 0.018, and 0.013, respectively). The maternal complications studied (post-partum haemorrhage, hysterectomy, blood transfusion, prolonged hospitalisation) were significantly more frequent in patients with unscarred uterine rupture (p=0.039; p=0.032; p=0.009; p=0.025 respectively). Uterine rupture is a life-threatening obstetrical event for the foetus and the mother. Fetal heart rate abnormality is the most common sign associated with uterine rupture. Management is based on conservative treatment in most cases. Patients with scarred uterus have a better prognosis.
Topics: Humans; Female; Tunisia; Retrospective Studies; Uterine Rupture; Adult; Pregnancy; Postpartum Hemorrhage; Young Adult; Cicatrix; Prognosis; Hysterectomy; Perinatal Mortality; Fetal Macrosomia; Infant, Newborn; Heart Rate, Fetal; Blood Transfusion; Length of Stay
PubMed: 38737224
DOI: 10.11604/pamj.2024.47.83.42188 -
The Pan African Medical Journal 2024students worldwide receive little training on blood transfusion therapies during their time at medical schools and hospitals, then reformulation of academic programs is...
INTRODUCTION
students worldwide receive little training on blood transfusion therapies during their time at medical schools and hospitals, then reformulation of academic programs is mandatory. Indications for blood transfusions are more frequent than recommended, which helps to increase the risks associated with this procedure. To overcome this, structured objective training on nursing care and procedures was organised with the topic of transfusion safety. The purpose of our study was to assess medical students´ appreciation of this training and the degree to which this population had mastered it.
METHODS
we conducted a cross-sectional, descriptive, single-centre study. We conducted a survey among the 3-year medical students. A self-administered assessment questionnaire, as well as an evaluation grid for acquired skills, filled in by the training doctors during the session, were used. Data analysis was based on descriptive statistics using Excel software.
RESULTS
three hundred and eighty-four (n=384) students were invited to attend this training course, 275 (71.6%) of whom were enrolled in the study. The overall satisfaction rate was 93.8%. The objectives and organisation were 95.6% successful. The quality of the training was 90.3% satisfactory. The choice of topic for the station was satisfactory for 80% of participants, the flow of the session for 86.3%, the quality of the organisation and debriefing for 89%, the interaction between trainers and learners for 90.2%, the motivation of trainers and the reflection stimulated in the learners for 92%. We noted that 93% of students had never participated in training in transfusion safety. Mastery of global skills was total for 67%, partial for 26% and absent for 7%. The students mastered the procedures for checking the identity and grouping of the product to be transfused at 97%, the principle of interpreting the ultimate pre-transfusion test (96%), the purpose of ultimate test at the patient´s bedside 93% with mastery of its technical implementation 83%.
CONCLUSION
training in transfusion safety was well received, with a satisfactory level of proficiency. This experience can easily be extended to other topics.
Topics: Humans; Morocco; Cross-Sectional Studies; Students, Medical; Blood Transfusion; Surveys and Questionnaires; Male; Female; Clinical Competence; Young Adult; Adult
PubMed: 38737220
DOI: 10.11604/pamj.2024.47.84.35703 -
BMC Surgery May 2024Delayed gastric emptying (DGE) commonly occurs after pancreaticoduodenectomy (PD). Risk factors for DGE have been reported in open PD but are rarely reported in...
BACKGROUND
Delayed gastric emptying (DGE) commonly occurs after pancreaticoduodenectomy (PD). Risk factors for DGE have been reported in open PD but are rarely reported in laparoscopic PD (LPD). This study was designed to evaluate the perioperative risk factors for DGE and secondary DGE after LPD in a single center.
METHODS
This retrospective cohort study included patients who underwent LPD between October 2014 and April 2023. Demographic data, preoperative, intraoperative, and postoperative data were collected. The risk factors for DGE and secondary DGE were analyzed.
RESULTS
A total of 827 consecutive patients underwent LPD. One hundred and forty-two patients (17.2%) developed DGE of any type. Sixty-five patients (7.9%) had type A, 62 (7.5%) had type B, and the remaining 15 (1.8%) had type C DGE. Preoperative biliary drainage (p = 0.032), blood loss (p = 0.014), and 90-day any major complication with Dindo-Clavien score ≥ III (p < 0.001) were independent significant risk factors for DGE. Seventy-six (53.5%) patients were diagnosed with primary DGE, whereas 66 (46.5%) patients had DGE secondary to concomitant complications. Higher body mass index, soft pancreatic texture, and perioperative transfusion were independent risk factors for secondary DGE. Hospital stay and drainage tube removal time were significantly longer in the DGE and secondary DGE groups.
CONCLUSION
Identifying patients at an increased risk of DGE and secondary DGE can be used to intervene earlier, avoid potential risk factors, and make more informed clinical decisions to shorten the duration of perioperative management.
Topics: Humans; Pancreaticoduodenectomy; Male; Female; Retrospective Studies; Laparoscopy; Middle Aged; Postoperative Complications; Aged; Risk Factors; Gastric Emptying; Gastroparesis; Adult
PubMed: 38734631
DOI: 10.1186/s12893-024-02447-7