Aggressive fluid management may be associated with disease progression in suspected sepsis patients admitted to the intensive care unit: a retrospective cohort study

Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.

A retrospective analysis of gender among patients admitted to a clinical decision unit at risk for acute coronary syndrome

INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.

Outcome predictors for severely brain-injured patients directly admitted or transferred from emergency departments to a trauma center

Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.

Anti-voltage-gated potassium channel complex antibody-mediated limbic encephalitis:a case report of a 53-yearold man admitted to intensive care psychiatric unit with psychotic mania

Limbic encephalitis represents a cluster of autoimmune disorders,with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety,affective symptoms,psychosis,short-term memory impairment as well as faciobrachial and grand mal seizures.We aim to present a case of a 53-year-old man with positive anti-voltage-gated potassium channel(VGKC)complex antibodies who initially presented with symptoms of psychotic mania.Six weeks post-psychiatric symptomatology,he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure.The patient had no previous psychiatric history and was initially treated with psychotropic medications.Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms.Furthermore,immunological and laboratory testing takes a rather long time to determine the diagnosis.What is more,few psychiatrists consider autoimmune nature of the neuropsychiatric presentation.Therefore,it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness.Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching,seizures,confusion and cognitive decline.

Panic disorder in COVID-19 patients admitted in a tertiary care hospital in South India

COVID-19 has led to an increase in psychiatric disorders,stress,trauma and suicidal behaviour.Study published in the Lancet in 2021 have identified anxiety disorder as the most frequently diagnosed psychiatric disorder in COVID-19 survivors[1].Fear conditioning and hyper-vigilance towards abnormal breathing patterns attributable to COVID-19 or not,can act as etiological and maintenance factors of panic,and hence we should expect an onset or aggravation of panic disorder in COVID-19[2].

Determinants of mortality among seniors acutely readmitted for heart failure: racial disparities and clinical correlations

Heart failure(HF)is a devastating condi-tion characterized by a high rate of mor-tality.[1]About 6.2 million individuals are grappling with the burden of HF in the United States(U.S).[2]Of this over 6 million individuals af-fected with HF,a higher proportion is made up of people older than 65 years.[3,4]More than 50%of pa-tients hospitalized due HF are older than 75 years.[5]Seniors do not just account for the greater propor-tion of individuals affected by HF but also have a worse outcome compared to younger individuals with HF.[6−14]In the light of the above,we aim to address racial disparities as they affect seniors with HF in terms of mortality in addition to other potential prognostic indices.

Delirium Severity and Correlates among Medical Inpatients Admitted through Accident and Emergency Unit of Jos University Teaching Hospital

Background: Delirium is one of the most common medical emergencies and is associated with poor outcomes including: mortality, prolonged length of stay and poor functional outcome. The more severe delirium is the worst the clinical outcomes of medical illness. Despite the obvious, not much has been documented on delirium severity and its associated factors among medical inpatients in low income countries including Nigeria. Objectives: This study was conducted to examine the severity of delirium among medical inpatients admitted through the Accident and Emergency unit of Jos University Teaching Hospital as well as to assess its associated Sociodemographic and Clinical characteristics. Method: This was a cross-sectional study that employed a consecutive sampling technique to select 290 eligible subjects from medical inpatients that presented to Accident and Emergency unit of Jos University Teaching Hospital. On admission, patients were assessed for delirium using Confusion Assessment Method and severity of delirium was evaluated using Delirium Rating Scale-Revised-98. Results: Of the 105 delirious medical inpatients, 48 (45.7%) had severe delirium, 41 (39.1%) developed less severe delirium while 16 (15.2) presented with no severe delirium. Sociodemographic characteristics found to be significantly associated with less to more severe delirium include male gender (P = 0.001), nonprofessionals (P = 0.003), income range of N20,000 - N49,000 (P Conclusion: This study demonstrates that delirium is often associated with higher severity in Accident and Emergency unit admission and there are strongly associated clinical characteristics to watch out for in high risk medical inpatients.

Factors associated with in-hospital mortality in sepsis patients admitted to the emergency department:A retrospective study

Objective Most patients with sepsis were diagnosed in the emergency department when admitted to the hospital. This study aimed to explore independent factors for hospital mortality in sepsis patients in the emergency department.Methods It was a retrospective study. All patients with sepsis admitted to the emergency department of Changsha Central Hospital between 1 July 2020 and 1 July 2021 were included. Variables that showed significant differences between the survivor group and the non-survivor group were caculated in multivariate logistic regression analysis. Independent factors associated with in-hospital mortality in sepsis were identified.Results A total of 194 patients were included in this study. In-hospital mortality was 17.01%(n=33). Two independent risk factors including albumin(ALB) and urea nitrogen were identified by multivariate logistic regression analysis. The optimal cut-off values of ALB and urea nitrogen were 26.5g/L and 8.03mmol/L. While combined ALB and urea nitrogen, the area under the ROC curve(AUC) was 0.790, which was superior to the SOFA, qSOFA, and APACHEⅡscores.Conclusions Independent factors including ALB and urea nitrogen for in-hospital mortality in sepsis in the emergency department were identified. It could help physicians identify those patients with a higher risk of a poor prognosis early and easily, so intervention and management could be performed quickly.

Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.

Light People:Prof.Juejun Hu,exploring the light

Editorial Professor Juejun Hu was admitted by Tsinghua University as top scorer in the science college entrance examination of Fujian Province.After graduating,he went to MIT to pursue further studies,where he continued to excel and became a faculty member.Each step of his journey has been marked by extraordinary achievements,setting a standard that few can match.Today,Prof.Hu is recognized as a leading expert in integrated photonics and optical materials.His pioneering research has not only advanced the frontiers of academia but also made significant impacts on industrial applications.In this interview,we invite you to delve into Prof.Hu's research world,exploring his unique insights into technological innovation and how he uses the power of science to shape the future.

Subdiaphragmatic abscess caused by the recently identifi ed pathogen Cutibacterium modestum: a case report

Subdiaphragmatic abscess is uncommon in patients who undergo resection for hepatocellular carcinoma.The identifi cation of pathogens and appropriate treatment can be challenging.[1]Herein,we present a case of subdiaphragmatic abscess caused by Cutibacterium modestum.A 66-year-old man was admitted to our hospital with fever,cough,and persistent,dull pain in the right upper quadrant for two days.The patient’s medical history included liver cirrhosis,radical resection of hepatocellular carcinoma three months prior to admission,and type 2 diabetes mellitus.Physical examination revealed tachycardia with small moist rales in the right lower chest.Abdominal examination revealed an L-shaped,well-healed surgical incision in the right upper quadrant without intra-abdominal mass or tenderness.

Obituary:Prof.Yun Zhang(1963-2023)-A scientist focused on toxins and their underlying mechanisms to decipher human diseases

Prof.Yun Zhang was born on 9 July 1963 in Kunming,Yunnan,China,during a tumultuous period which he often referenced.Throughout his life,he harbored a steadfast belief in using knowledge to unravel the mysteries of human diseases.His educational journey was marked by frequent changes in schools due to his parents’occupational relocations.However,despite these challenges,he consistently displayed diligence and was admitted to the East China University of Science and Technology,Shanghai,after completing high school in 1980.He remained an active and loyal member of the School of Biotechnology at the university.

A contradictory phenomenon of thicken pericardium and cardiac compression without inferior vena cava dilation:sign of IVC escape

A 77-year-old female presented with shortness of breath and tightness of chest was admitted.Her past medical history included hypertension and she has been taking nifedipine regularly.Two years before,she was diagnosed with pericardial effusion(Figure 1)and had pericardiocentesis drainage.On physical examination,her blood pressure was 151/100 mm-Hg and her pulse rate was 91 beats/min.

Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI) are available.METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months(interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level(< 170 mg/L) and those with the high prealbumin level(≥ 170 mg/L).RESULTS A total of 114 patients(4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class Ⅲ(9.9%vs. 4.4%, P = 0.034), cardiovascular death(8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events(19.2%vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level(< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events(odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cutoff value of prealbumin level for predicting in-hospital death was 170 mg/L(area under the curve = 0.703, 95% CI: 0.651–0.754, P< 0.001;sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level(170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results.CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

Management of ruptured renal angiomyolipoma with bilateral staghorn calculi

Dear Editor,We present a case of ruptured renal angiomyolipoma(AML)and bilateral renal staghorn calculi.We discuss about the management of this patient by angioembolization,partial nephrectomy,and pyelolithotomy,followed by contralateral interval percutaneous nephrolithotomy(PCNL).Our case is a 40-year-old male who presented with history of dull aching and dragging sensation in bilateral flanks of 6-month duration.He was admitted and evaluated at other hospital for dizziness,sweating,and loss of consciousness.He was found to have bilateral staghorn calculi and left AML and was referred to our institute for further management after initial stabilization.The proper written and informed consent was taken from the patient for management as well as publication of the report and images,maintaining the patient’s anonymity.

Dacryocystitis and canaliculitis secondary to residual of epidural catheter remaining in lacrimal duct for 25 years:a case report and literature review

Dear Editor,We present a case of dacryocystitis and canaliculitis secondary to residual of epidural catheter remaining in lacrimal duct for 25y.A 56-year-old male patient was admitted to our medical center on February 16,2023.We obtained the written informed consent from the patient,and this case study was in accordance with the tenets of the Declaration of Helsinki.The main complaint was that the right eye had suffered from persistent tears for more than 25y and discharge for more than 1y.

Virtual reality-based cognitive-behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction:a randomised clinical trial

Background The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction(AMI),significantly disrupting their recovery.Providing timely and easily accessible psychological interventions using virtual reality-based cognitive-behavioural therapy(VR-CBT)could potentially improve both acute and long-term symptoms affecting their mental health.Aims We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit(ICU)during the acute stage of their illness.Methods In this single-blind randomised clinical trial,participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023.Patients who were Han Chinese aged 18-75 years were randomly assigned(1:1)via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support,or the control group to receive standard mental health support only.VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period.Assessments were done at baseline,immediately after treatment and at 3-month follow-up.The intention-to-treat analysis began in June 2023.The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale(HAM-A).Results Among 148 randomised participants,70 were assigned to the VR-CBT group and 78 to the control group.The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention(Cohen’s d=−1.27(95%confidence interval(CI):−1.64 to−0.90,p<0.001)and 3-month follow-up(Cohen’s d=−0.37(95%CI:−0.72 to−0.01,p=0.024).Of the 70 participants who received VR-CBT,62(88.6%)completed the entire intervention.Cybersickness was the main reported adverse event(n=5).Conclusions Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness;the improvement was maintained at the 3-month follow-up.Trial registration number The trial was registered at www.chictr.org.cn with the identifier:ChiCTR2200066435.

Hong-Yang Wang:devoted to discovery—a female scientist who is willing to lead

1.Introducing Professor Wang ProfessorHong-YangWangwas admitted to the MedicalDepartment,Second Military Medical University,in 1973.After graduation,she worked as a physician for the Department of Gastroenterology,Changzheng Hospital,Shanghai,while earning herMaster's inGastrointestinal Immunology(awarded in 1984).As a chief physician,ProfessorWang was encouraged by academician Mengchao Wu to pursue a Ph.D.in clinical biochemistry at theMedical School of theUniversity of Ulm,Germany,in 1989.

How Can Foreign Trade Be Stabilized?

At an economy-themed press conference held on the day of the Second Session of the 14th National People's Congress,Minister of Commerce Wang Wentao admitted that the situation of foreign trade situation is still"very severe"this year.When it comes to the future policies for stabilizing foreign trade,Wang Wentao said that the government will provide better financial services forforeign trade enterprises.

Instruments of Change

Lucy Wahome stumbles and struggles to maintain her balance and walk as a nurse rushes to lend her support,soon after she got admitted at the clinic.Wahome,30,initially sought medical treatment at her home clinic in Kiambu County,Kenya,which seemed well organised;but she later realised that constant power outages at the facility seriously compromised the quality of care at the clinic.