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.

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.

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.

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.

Eosinophilia and clonorchiasis presenting as fever of unknown origin in adult patients

Fever of unknown origin (FUO) is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1] Acute liver fluke infection is characterized by fever, right upper quadrant pain, hepatomegaly, jaundice, and peripheral bloodeosinophilia.Bycontrast,chronicliverfluke infection is asymptomatic in its early stage, but can easily progress to cirrhosis, cancer, or bile duct cancer initslaterstages. Thediagnosisofclonorchiasisis particularly challenging in non-endemic areas. We herein report an unusual case of liver fl uke infection in a patient who presented with FUO and eosinophilia.A 38-year-old male was admitted to our hospital with a history of intermittent and recurrent fever for over 10 d and a history of sudden abdominal pain for1 h. He had no other medical history. More than 10d ago, he visited our emergency department because of FUO, with his body temperature reaching 39.7°C,and he had no other symptoms at that time. Laboratory and radiological examinations revealed:white blood cell(WBC) counts, 10.9×109/L;neutrophil percentage, 84.5%;eosinophil percentage, 3.1%;C-reactive protein (CRP),141 mg/L;liver and kidney function, normal;influenza virus, negative;urine and stool tests, normal;and chest computed tomography (CT) fi ndings, normal. The fever subsided after 1 week of anti-infective treatment with moxifloxacin. Subsequent tests revealed the following results:WBC, 15.0×109/L;neutrophil percentage, 70.0%;eosinophil percentage, 16.8%;and CRP, 122 mg/L. The antimicrobial treatment was then discontinued.

Pediatric bronchial rupture: outcomes in four cases

Bronchial rupture from penetrating, perforating,or compressive cervical or thoracic injuries can lead tocompletetracheal,mainstembronchial,orlobar bronchialdetachment. Althoughrareinchildren,bronchial rupture presents significant risks, including dyspnea, respiratory failure, and potentially fatal airway obstruction, and is often overlooked or diagnosed late in clinical settings. Prompt diagnosis and intervention are prognostically crucial.[1,2] Between January 2013 and December 2023, four children (two male and two female)with bronchial rupture were admitted to the Pediatric SurgicalIntensiveCareUnit(ICU)atChildren’s Hospital, Zhejiang University School of Medicine. Here,we share our experience of patient management.

Applications of mPCR testing reduced initial antibiotic use and duration of mechanical ventilation in virus-infected children with severe community-acquired pneumonia admitted to the PICU

Community-acquired pneumonia(CAP)remains the leading cause of morbidity and mortality among children worldwide.It is critical for these patients to select and timely initiate appropriate empirical antimicrobial therapy against the causative pathogens[1].However,conventional pathogen-detecting methods,such as culture and serology,have no prospect of altering empiric therapy owing to their time delay in obtaining results and to their lower detection rates[2].Recent advances in molecular diagnostic assays,such as multiplex polymerase chain reaction PCR(mPCR)methods,have been used to detect multiple pathogens in CAP simultaneously within two hours and have dramatically improved the ability to diagnose respiratory pathogens[3].However,whether this molecular diagnosis method can reduce the use of antibiotics and can improve prognosis in severe CAP children,especially those less than 5 years old,remains to be explored.

Machine learning for the prediction of acute kidney injury in patients with acute pancreatitis admitted to the intensive care unit

To the Editor:Acute kidney injury(AKI)is a well-known and critical complication of acute pancreatitis in intensive care units(ICUs).Patients with acute pancreatitis who developed AKI had a significantly higher mortality than those without AKI.[1]Currently,the diagnosis of AKI in acute pancreatitis patients includes a sudden decrease in glomerular filtration rate manifested by an increase in serum creatinine or oliguria within 48 h to 7 days.[2]However,kidney damage occurs unstoppably when creatinineincreases or urine output decreases.This study aimed to establish prediction models based on the machine learning algorithm and traditional logistic regression method only with commonly collected variables when admitted to the ICU,and we also compared their performance for predicting the occurrence of AKI in patients with acute pancreatitis.

Should Students Be Admitted to Universities On Special Ability Alone?

A high school graduate from Shaanxi Province, Sun Jiankun, found it hard tounderst and his college application experience. He only believed fate played a joke on him. Sun’s long-cherished wish to study history at Fudan

Active screening of intestinal carbapenemresistant Enterobacteriaceae in high-risk patients admitted to the hematology wards and its effect evaluation

Objective To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection.Methods Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1.

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.

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.

Preface to special issue:dedicated to Professor Wenqing Shen in honor of his 80th birthday

We are honored to dedicate this issue to Professor Wenqing Shen to celebrate his 80th birthday,along with his distinguished career,great achievements in nuclear science,and fruitful contributions to science and technology management.Professor Wenqing Shen was born in Shanghai on August 21,1945.After graduating from middle school with outstanding grades,he was admitted to the preparatory program of Fudan University;this marked the frst turning point in his life.

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.