Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Sahara...Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.展开更多
Rationale:Paraquat,a highly toxic bipyridyl herbicide lacking a specific antidote,poses severe risks upon ingestion.However,the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms,partic...Rationale:Paraquat,a highly toxic bipyridyl herbicide lacking a specific antidote,poses severe risks upon ingestion.However,the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms,particularly when a detailed exposure history is not provided.Patient’s Concern:A 33-year-old man inadvertently ingested an unknown liquid and presented to medical services a day later with complaints of ongoing nausea,vomiting,and diarrhea.The assessment revealed elevated serum creatinine,signaling acute kidney injury,initially thought due to gastroenteritis and dehydration.Diagnosis:Acute renal insufficiency due to paraquat poisoning.Interventions:The treatment involved fluid resuscitation and antibiotics,but his decline led to intensive care unit transfer.Subsequent chest computed tomography scans indicated lung changes indicative of paraquat poisoning.A detailed history review and comprehensive blood and urine toxicology screens confirmed the diagnosis.Subsequently,aggressive interventions such as hemoperfusion and continuous renal replacement therapy were initiated,yet there was a further decline in respiratory function,necessitating mechanical ventilation.The prognosis was poor,and ultimately,the family chose to withdraw care.Outcomes:The patient succumbed to his illness.Lessons:This case underscores the importance of promptly and accurately diagnosing paraquat poisoning,as its vague early signs can lead to diagnostic delays,crucial due to the condition’s rapid progression.Alertness to paraquat poisoning is essential in patients with sudden gastrointestinal and renal symptoms post-exposure.Additionally,it underscores the necessity for public health measures to avert paraquat ingestion and advance therapeutic approaches.展开更多
Objectives:The objectives of this study are to investigate the effect of midwifery-led comprehensive care in improving perinatal outcomes among women with hypertensive disorders of pregnancy.Materials and Methods:A si...Objectives:The objectives of this study are to investigate the effect of midwifery-led comprehensive care in improving perinatal outcomes among women with hypertensive disorders of pregnancy.Materials and Methods:A single-blinded randomized controlled trial was conducted among 150 pregnant women diagnosed with gestational hypertension after 20 weeks of gestation.The study was conducted between February 14,2022,and March 15,2024.Participants were randomly assigned(75 intervention,75 control)through computer-generated block randomization.The intervention arm received the midwifery-led comprehensive care,while the control group received standard routine care.The intervention was provided in 5 contact points(at 20 weeks,28 weeks,32 weeks,36 weeks,and before delivery)at the antenatal outpatient department(OPD).The tools used were a structured demographic questionnaire,structured tool for maternal and fetal outcomes.Data were collected at 20 weeks,28 weeks,32 weeks,and 36 weeks.Results:Neonatal resuscitation rate was lower in the intervention group(6.7%)than in the control group(21.3%).IUGR incidence(5.3%vs.16%)and fetal mortality(5.3%vs.14.7%)were also reduced.The independent sample t-test and repeated measures analysis of variance revealed that intervention arm has significantly improved key maternal and fetal parameters in terms of higher APGAR scores,better fetal heart rate at 32 weeks,and significantly lower systolic and diastolic blood pressure,maternal weight,and proteinuria levels at various gestational weeks,indicating improved perinatal outcomes compared to the control group at P<0.05.Conclusion:Midwifery-led care positively influenced maternal health and fetal outcomes,reducing abnormal weight gain,stabilizing blood pressure,and reducing the adverse fetal outcome.As a feasible,scalable intervention,it can be generalized to diverse populations,emphasizing the need for broader implementation and further research.展开更多
BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are require...BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are required to be hospitalized in the intensive care unit(ICU).Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.AIM To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.METHODS The retrospective continuous cohort study included 51 patients(23 males,28 females)with immunoinflammatory diseases,including multisystem inflammatory syndrome associated with coronavirus disease 2019(n=18),systemic rheumatic diseases(n=24),and generalized infections(n=9).The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.RESULTS Thirteen patients(25.5%)died within 39(17;62)days after ICU admission.Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived(30 days vs 7 days,P=0.013)and had a longer stay in the ICU(30 days vs 6 days,P=0.003).The main predictors of the fatal outcome were age>162 months[odds ratio(OR)=10.7;95%confidence interval(CI):2.4-47.2,P=0.0006],time to ICU admission>26 days from the disease onset(OR=12.0;95%CI:2.6-55.3,P=0.008),preceding immune suppression treatment(OR=6.2;95%CI:1.6-24.0,P=0.013),invasive mycosis during the ICU stay(OR=18.8;95%CI:1.9-184.1,P=0.0005),systemic rheumatic diseases(OR=7.2;95%CI:1.7-31.1,P=0.004),and ICU stay over 15 days(OR=19.1;95%CI:4.0-91.8,P=0.00003).Multiple regression analysis(r^(2)=0.422,P<0.000002)identified two predictors of the fatal outcomes:Systemic rheumatic diseases(P=0.015)and ICU stay over 15 days(P=0.00002).CONCLUSION Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program.Avoiding ICU stays for patients with systemic rheumatic diseases,close monitoring,and preventing invasive mycosis might improve the outcome in children with systemic immunemediated diseases.展开更多
We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal a...We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.展开更多
Severe fever with thrombocytopenia syndrome(SFTS)is an emerging tick-borne disease with high mortality,and clinical practice lacks dynamic tools to assess its rapidly evolving course.This study aims to develop stage-s...Severe fever with thrombocytopenia syndrome(SFTS)is an emerging tick-borne disease with high mortality,and clinical practice lacks dynamic tools to assess its rapidly evolving course.This study aims to develop stage-specific machine learning models to predict mortality risk using longitudinal biomarker data.We conducted a retrospective analysis of 5359 laboratory-confirmed SFTS patients from two hospitals in the highly endemic region in China.Serial measurements of 46 clinical and laboratory variables were integrated into a three-stage prognostic model developed using extreme gradient boosting(XGBoost).Within each clinical stage,key predictors and their relative contribution(RC)of mortality risk were assessed.Model performance was assessed based on discrimination,calibration,and decision curve analysis(DCA)in internal and external test sets.XGBoost models were constructed across 10 temporal phases,later consolidated into three clinically distinct stages via hierarchical clustering:early(≤7 days),intermediate(days 8-9),and late(≥10 days).Key predictors included age(dominant in early phase;RC,18.44%),lactate dehydrogenase(LDH;RC peaking at 60.10% in late phase),and monocyte percentage(RC range from 5.25% to 16.04%).Pathophysio-logical shifts across clinical stages were revealed:early viral cytopathy(dominated by age and MONO%),intermediate immunopathology(marked by LDH surge),and late hepatic failure(dominated by LDH,AST,and TBA).The model showed strong discrimination(Area under the receiver operating characteristic curve,AUCs:0.84-0.98 internal;0.91-0.98 external),calibration(Brier scores:0.04-0.11),and clinical utility via DCA.This study introduces a dynamic staging system that lever-ages predictive models and real-time patient data to monitor mortality risk and personalize SFTS care,which enables timely interventions to reduce deaths.展开更多
We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause...We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.展开更多
Acute liver failure is a rare presentation of hematologic malignancy. Acute on chronic liver failure(ACLF) is a newly recognized clinical entity that describes acute hepatic decompensation in persons with preexisting ...Acute liver failure is a rare presentation of hematologic malignancy. Acute on chronic liver failure(ACLF) is a newly recognized clinical entity that describes acute hepatic decompensation in persons with preexisting liver disease. Diffuse large B-cell lymphoma(DLBCL) is an aggressive non-Hodgkin's lymphoma(NHL) with increasing incidence in older males, females and blacks. However, it has not yet been reported, to present with acute liver failure in patients with preexisting chronic liver disease due to human immunodeficiency virus(HIV)/hepatitis C virus(HCV) co-infection. We describe a case of ACLF as the presenting manifestation of DLBCL in an elderly black man with HIV/HCV coinfection and prior Hodgkin's disease in remission for three years. The rapidly fatal outcome of this disease is highlighted as is the distinction of ACLF from decompensated cirrhosis. Due to the increased prevalence of HIV/HCV co-infection in the African American 1945 to 1965 birth cohort and the fact that both are risk factors for chronic liver disease and NHL we postulate that the incidence of NHL presenting as ACLF may increase.展开更多
Mansonic schistosomiasis is the main cause of portal hypertension in Brazil. Hepatosplenic (HS) form is manifested by hepatomegaly mainly on the left hepatic lobe associated with large splenomegaly and bleeding due to...Mansonic schistosomiasis is the main cause of portal hypertension in Brazil. Hepatosplenic (HS) form is manifested by hepatomegaly mainly on the left hepatic lobe associated with large splenomegaly and bleeding due to esophageal varices with high mortality rates.展开更多
Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the...Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke. Methods From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke. Results There were 39741 patients screened, 14526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% （1826） had in-hospital medical complications. The most common complication was pneumonia （1373; 11.9% of patients）, followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period （adjusted OR=6.946; 95% CI 5.181 to 9.314）, at 3 months （adjusted OR=3.843; 95% C/3.221 to 4.584）, 6 months （adjusted OR=3.492; 95% CI 2.970 to 4.106）, and 12 months （adjusted OR= 3.511; 95% CI 3.021 to 4.080）. Having multiple complications strongly increased the death risk of patients. Conclusion Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.展开更多
Background Button battery(BB)exposures are common in children and can have devastating consequences.We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes u...Background Button battery(BB)exposures are common in children and can have devastating consequences.We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes using individual patient-level data.Data sources We carried out a systematic review and pooled analysis by searching MEDLINE,Embase,and Scopus up to May 19,2023.Included studies describe complications following BB exposures in children(aged<18 years).Odds ratios(ORs)were calculated using binary logistic regression to measure associations between predictive factors and different outcomes.Results Two-hundred seventeen studies(439 children)were included.The median age at presentation was 1.75[interquartile range(IQR)1.00–3.00]years and 399(90.9%)exposures were ingestions.Of the 380 cases reporting sex,162(42.6%)were female.Feeding(192,48.1%)and respiratory difficulties(138,34.6%)were common presenting features for ingestions,while symptomatology was site-specific for insertions.Common complications included oesophageal mucosal damage alone(105,26.3%)and tracheooesophageal fistula(93,23.3%)for ingestions,and nasal septal perforation(22,55.0%)and mucosal damage alone(13,32.5%)for insertions.Intestinal perforation occurred in 2.5%of ingestion cases,including perforation of Meckel's diverticulum,peritonitis,and jejunocolic fistula.Vascular complications were common among children who died.Age(≤2 years),battery exposure duration(>6 hours),and battery diameter(≥20 mm)were associated with common and severe complications of ingestions.Conclusion BB injuries are time-critical,with severe sequelae predominantly affecting young children.Diagnosis is challenging.Preventative work through regulation and safer battery design are required to eliminate this problem.展开更多
文摘Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.
文摘Rationale:Paraquat,a highly toxic bipyridyl herbicide lacking a specific antidote,poses severe risks upon ingestion.However,the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms,particularly when a detailed exposure history is not provided.Patient’s Concern:A 33-year-old man inadvertently ingested an unknown liquid and presented to medical services a day later with complaints of ongoing nausea,vomiting,and diarrhea.The assessment revealed elevated serum creatinine,signaling acute kidney injury,initially thought due to gastroenteritis and dehydration.Diagnosis:Acute renal insufficiency due to paraquat poisoning.Interventions:The treatment involved fluid resuscitation and antibiotics,but his decline led to intensive care unit transfer.Subsequent chest computed tomography scans indicated lung changes indicative of paraquat poisoning.A detailed history review and comprehensive blood and urine toxicology screens confirmed the diagnosis.Subsequently,aggressive interventions such as hemoperfusion and continuous renal replacement therapy were initiated,yet there was a further decline in respiratory function,necessitating mechanical ventilation.The prognosis was poor,and ultimately,the family chose to withdraw care.Outcomes:The patient succumbed to his illness.Lessons:This case underscores the importance of promptly and accurately diagnosing paraquat poisoning,as its vague early signs can lead to diagnostic delays,crucial due to the condition’s rapid progression.Alertness to paraquat poisoning is essential in patients with sudden gastrointestinal and renal symptoms post-exposure.Additionally,it underscores the necessity for public health measures to avert paraquat ingestion and advance therapeutic approaches.
文摘Objectives:The objectives of this study are to investigate the effect of midwifery-led comprehensive care in improving perinatal outcomes among women with hypertensive disorders of pregnancy.Materials and Methods:A single-blinded randomized controlled trial was conducted among 150 pregnant women diagnosed with gestational hypertension after 20 weeks of gestation.The study was conducted between February 14,2022,and March 15,2024.Participants were randomly assigned(75 intervention,75 control)through computer-generated block randomization.The intervention arm received the midwifery-led comprehensive care,while the control group received standard routine care.The intervention was provided in 5 contact points(at 20 weeks,28 weeks,32 weeks,36 weeks,and before delivery)at the antenatal outpatient department(OPD).The tools used were a structured demographic questionnaire,structured tool for maternal and fetal outcomes.Data were collected at 20 weeks,28 weeks,32 weeks,and 36 weeks.Results:Neonatal resuscitation rate was lower in the intervention group(6.7%)than in the control group(21.3%).IUGR incidence(5.3%vs.16%)and fetal mortality(5.3%vs.14.7%)were also reduced.The independent sample t-test and repeated measures analysis of variance revealed that intervention arm has significantly improved key maternal and fetal parameters in terms of higher APGAR scores,better fetal heart rate at 32 weeks,and significantly lower systolic and diastolic blood pressure,maternal weight,and proteinuria levels at various gestational weeks,indicating improved perinatal outcomes compared to the control group at P<0.05.Conclusion:Midwifery-led care positively influenced maternal health and fetal outcomes,reducing abnormal weight gain,stabilizing blood pressure,and reducing the adverse fetal outcome.As a feasible,scalable intervention,it can be generalized to diverse populations,emphasizing the need for broader implementation and further research.
文摘BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are required to be hospitalized in the intensive care unit(ICU).Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.AIM To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.METHODS The retrospective continuous cohort study included 51 patients(23 males,28 females)with immunoinflammatory diseases,including multisystem inflammatory syndrome associated with coronavirus disease 2019(n=18),systemic rheumatic diseases(n=24),and generalized infections(n=9).The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.RESULTS Thirteen patients(25.5%)died within 39(17;62)days after ICU admission.Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived(30 days vs 7 days,P=0.013)and had a longer stay in the ICU(30 days vs 6 days,P=0.003).The main predictors of the fatal outcome were age>162 months[odds ratio(OR)=10.7;95%confidence interval(CI):2.4-47.2,P=0.0006],time to ICU admission>26 days from the disease onset(OR=12.0;95%CI:2.6-55.3,P=0.008),preceding immune suppression treatment(OR=6.2;95%CI:1.6-24.0,P=0.013),invasive mycosis during the ICU stay(OR=18.8;95%CI:1.9-184.1,P=0.0005),systemic rheumatic diseases(OR=7.2;95%CI:1.7-31.1,P=0.004),and ICU stay over 15 days(OR=19.1;95%CI:4.0-91.8,P=0.00003).Multiple regression analysis(r^(2)=0.422,P<0.000002)identified two predictors of the fatal outcomes:Systemic rheumatic diseases(P=0.015)and ICU stay over 15 days(P=0.00002).CONCLUSION Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program.Avoiding ICU stays for patients with systemic rheumatic diseases,close monitoring,and preventing invasive mycosis might improve the outcome in children with systemic immunemediated diseases.
文摘We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.
基金supported by the National Natural Science Foundation of China(82330103)the Yantai Science and Technology Innovation Development Plan(2021YT06000862).
文摘Severe fever with thrombocytopenia syndrome(SFTS)is an emerging tick-borne disease with high mortality,and clinical practice lacks dynamic tools to assess its rapidly evolving course.This study aims to develop stage-specific machine learning models to predict mortality risk using longitudinal biomarker data.We conducted a retrospective analysis of 5359 laboratory-confirmed SFTS patients from two hospitals in the highly endemic region in China.Serial measurements of 46 clinical and laboratory variables were integrated into a three-stage prognostic model developed using extreme gradient boosting(XGBoost).Within each clinical stage,key predictors and their relative contribution(RC)of mortality risk were assessed.Model performance was assessed based on discrimination,calibration,and decision curve analysis(DCA)in internal and external test sets.XGBoost models were constructed across 10 temporal phases,later consolidated into three clinically distinct stages via hierarchical clustering:early(≤7 days),intermediate(days 8-9),and late(≥10 days).Key predictors included age(dominant in early phase;RC,18.44%),lactate dehydrogenase(LDH;RC peaking at 60.10% in late phase),and monocyte percentage(RC range from 5.25% to 16.04%).Pathophysio-logical shifts across clinical stages were revealed:early viral cytopathy(dominated by age and MONO%),intermediate immunopathology(marked by LDH surge),and late hepatic failure(dominated by LDH,AST,and TBA).The model showed strong discrimination(Area under the receiver operating characteristic curve,AUCs:0.84-0.98 internal;0.91-0.98 external),calibration(Brier scores:0.04-0.11),and clinical utility via DCA.This study introduces a dynamic staging system that lever-ages predictive models and real-time patient data to monitor mortality risk and personalize SFTS care,which enables timely interventions to reduce deaths.
文摘We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.
文摘Acute liver failure is a rare presentation of hematologic malignancy. Acute on chronic liver failure(ACLF) is a newly recognized clinical entity that describes acute hepatic decompensation in persons with preexisting liver disease. Diffuse large B-cell lymphoma(DLBCL) is an aggressive non-Hodgkin's lymphoma(NHL) with increasing incidence in older males, females and blacks. However, it has not yet been reported, to present with acute liver failure in patients with preexisting chronic liver disease due to human immunodeficiency virus(HIV)/hepatitis C virus(HCV) co-infection. We describe a case of ACLF as the presenting manifestation of DLBCL in an elderly black man with HIV/HCV coinfection and prior Hodgkin's disease in remission for three years. The rapidly fatal outcome of this disease is highlighted as is the distinction of ACLF from decompensated cirrhosis. Due to the increased prevalence of HIV/HCV co-infection in the African American 1945 to 1965 birth cohort and the fact that both are risk factors for chronic liver disease and NHL we postulate that the incidence of NHL presenting as ACLF may increase.
文摘Mansonic schistosomiasis is the main cause of portal hypertension in Brazil. Hepatosplenic (HS) form is manifested by hepatomegaly mainly on the left hepatic lobe associated with large splenomegaly and bleeding due to esophageal varices with high mortality rates.
文摘Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke. Methods From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke. Results There were 39741 patients screened, 14526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% （1826） had in-hospital medical complications. The most common complication was pneumonia （1373; 11.9% of patients）, followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period （adjusted OR=6.946; 95% CI 5.181 to 9.314）, at 3 months （adjusted OR=3.843; 95% C/3.221 to 4.584）, 6 months （adjusted OR=3.492; 95% CI 2.970 to 4.106）, and 12 months （adjusted OR= 3.511; 95% CI 3.021 to 4.080）. Having multiple complications strongly increased the death risk of patients. Conclusion Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.
基金funded by the Queensland Department of Health,Ref ID:PSQIS 8309 to conduct surveillance for battery exposures in children.No industry or pharmaceutical grants were received for this studyThe Australian Government Department of Health and Age Care also funds the APSU through the Surveillance Branch of Communicable Diseases(Health/21-22/D21-5425703)EE has been supported by a MRFF Next Generation Fellowship(#MRF1135959)and NHMRC investigator Grant 2026176.
文摘Background Button battery(BB)exposures are common in children and can have devastating consequences.We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes using individual patient-level data.Data sources We carried out a systematic review and pooled analysis by searching MEDLINE,Embase,and Scopus up to May 19,2023.Included studies describe complications following BB exposures in children(aged<18 years).Odds ratios(ORs)were calculated using binary logistic regression to measure associations between predictive factors and different outcomes.Results Two-hundred seventeen studies(439 children)were included.The median age at presentation was 1.75[interquartile range(IQR)1.00–3.00]years and 399(90.9%)exposures were ingestions.Of the 380 cases reporting sex,162(42.6%)were female.Feeding(192,48.1%)and respiratory difficulties(138,34.6%)were common presenting features for ingestions,while symptomatology was site-specific for insertions.Common complications included oesophageal mucosal damage alone(105,26.3%)and tracheooesophageal fistula(93,23.3%)for ingestions,and nasal septal perforation(22,55.0%)and mucosal damage alone(13,32.5%)for insertions.Intestinal perforation occurred in 2.5%of ingestion cases,including perforation of Meckel's diverticulum,peritonitis,and jejunocolic fistula.Vascular complications were common among children who died.Age(≤2 years),battery exposure duration(>6 hours),and battery diameter(≥20 mm)were associated with common and severe complications of ingestions.Conclusion BB injuries are time-critical,with severe sequelae predominantly affecting young children.Diagnosis is challenging.Preventative work through regulation and safer battery design are required to eliminate this problem.
