Nomogram to Predict Intensive Care Following Gastrectomy for Gastric Cancer: A Useful Clinical Tool to Guide the Decision-Making of Intensive Care Unit Admission

BackgroundWe aimed to generate and validate a nomogram to predict patients most likely to require intensive care unit (ICU) admission following gastric cancer surgery to improve postoperative outcomes and optimize the allocation of medical resources.MethodsWe retrospectively analyzed 3,468 patients who underwent gastrectomy for gastric cancer from January 2009 to June 2018. Here, 70.0% of the patients were randomly assigned to the training cohort, and 30.0% were assigned to the validation cohort. Least absolute shrinkage and selection operator (LASSO) method was performed to screen out risk factors for ICU-specific care using the training cohort. Then, based on the results of LASSO regression analysis, multivariable logistic regression analysis was performed to establish the prediction nomogram. The calibration and discrimination of the nomogram were evaluated in the training cohort and validated in the validation cohort. Finally, the clinical usefulness was determined by decision curve analysis (DCA).ResultsAge, the American Society of Anesthesiologists (ASA) score, chronic pulmonary disease, heart disease, hypertension, combined organ resection, and preoperative and/or intraoperative blood transfusions were selected for the model. The concordance index (C-index) of the model was 0.843 in the training cohort and 0.831 in the validation cohort. The calibration curves of the ICU-specific care risk nomogram suggested great agreement in both training and validation cohorts. The DCA showed that the nomogram was clinically useful.ConclusionsAge, ASA score, chronic pulmonary disease, heart disease, hypertension, combined organ resection, and preoperative and/or intraoperative blood transfusions were identified as risk factors for ICU-specific care after gastric surgery. A clinically friendly model was generated to identify those most likely to require intensive care.

Is It Beneficial to Optimize Vital Signs Before Embolization for Pelvic Fractures? A Dilemma Between Resuscitation and Hemostasis

Purpose Adequate resuscitation and definitive hemostasis are both important in the management of hemorrhage related to pelvic fracture. The goal of this study was to analyze the relationship between the amount of blood transfused before transcatheter arterial embolization (TAE) and the clinical outcome later in the disease course. Methods Patients with pelvic fractures who underwent TAE for hemostasis from January 2018 to December 2019 were studied. The characteristics of patients who received blood transfusions of >2 U (1000 mL) and ≤2 U before TAE were compared. The mortality rate, blood transfusion-related complications, and length of stay were compared between these two groups. Results Among the 75 studied patients, 39 (52.0%) received blood transfusions of ≤2 U before TAE, and the other 36 (48.0%) patients received blood transfusions of >2 U before TAE. The incidence rates of systemic inflammatory response syndrome, sepsis, and coagulopathy were significantly higher in the >2 U group (97.2% vs 81.1%, P = .027; 50.0% vs 27.0%, P = .045; and 44.4% vs 5.4%, P < .01, respectively). After nonsurvivors were excluded, the >2 U group had a significantly higher proportion (43.8% vs 14.7%, P < .001) of prolonged intensive care unit (ICU) length of stay (7 days or more) and a longer hospital length of stay (33.8 ± 15.1 vs 21.9 ± 94.0, P < .01) than the ≤2 U group. Pre-TAE blood transfusion >2 U serves as an independent risk factor for prolonged ICU length of stay and increased hospital length of stay. Conclusion Early hemostasis for pelvic fracture-related hemorrhage is suggested to prevent pre-TAE blood transfusion-associated adverse effects of blood transfusion.

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

Perbedaan PERBEDAAN NILAI LEKOSIT ANTARA KOMPONEN DARAH PACKED RED CELLS (PRC) DAN PACKED RED CELLS LEUCODEPLETED (PRC-LD) DI UTD PMI KOTA SURABAYA TAHUN 2019

This leukodepleted PRC (PRC-LD) is considered capable of preventing reactions related to blood transfusions because it contains only a small number of leukocytes. The blood component of PRC-LD has also been shown to prevent or reduce transfusion reactions. Leukodepleted is a procedure to reduce the number of leukocytes in the blood or blood components to be transfused to a minimum of <1x106 leukocytes/unit (European standard) or reduce the number of leukocytes >99%. The purpose of this study was to see the difference in leukocyte values ​​in the PRC and PRC-LD components. The method used is analytic, namely research that aims to determine the relationship between variables within the scope of the laboratory. The method used is a comparative study. This study used 30 samples of PRC products and 30 samples of Leucodepleted PRC products at UTD PMI Surabaya City with 450 cc bags. The study was conducted in October - December 2019. The result was that the leukocyte value in the PRC blood component contained blood quality that did not meet the specifications as many as 30 bags (100%) had leukocyte levels >1x106 per bag. Meanwhile, the blood component of PRC-LD contains blood quality that meets the specifications as many as 30 bags (100%), having leukocyte levels <1x106 per bag. Conclusion The quality of PRC Leukodepleted blood component products, the quality of leukocyte levels that meet the specifications, there are 30 blood bags (100%). Keywords: Packed Red Cells Leukodepleted

Hearing Loss in Beta-Thalassemia: Systematic Review

In the last half century, the life expectancy of beta-thalassemia patients has strikingly increased mostly due to regular blood transfusions and chelation treatments. The improved survival, however, has allowed for the emergence of comorbidities, such as hearing loss, with a non-negligible impact on the patients’ quality of life. This thorough review analyzes the acquired knowledge regarding hearing impairment in this hereditary hemoglobinopathy, aiming at defining its prevalence, features, course, and possible disease- or treatment-related pathogenic factors. Following PRISMA criteria, we retrieved 60 studies published between 1979 and 2021. Diagnostic tools and criteria, forms of hearing impairment, correlations with beta-thalassemia phenotypes, age and sex, chelation treatment and laboratory findings including iron overload, were carefully searched, analyzed and summarized. In spite of the relatively high number of studies in the last 40 years, our knowledge is rather limited, and large prospective studies with homogeneous diagnostic tools and criteria are required to define all the aforementioned issues. According to the literature, the overall prevalence rate of hearing impairment is 32.3%; age, sex, and laboratory findings do not seem to correlate with hearing deficits, while the weak relationship with clinical phenotype and chelation treatment seems to highlight the presence of further yet to be identified pathogenic factors.

A rare cause of recurrent gastrointestinal bleed: Blue rubber bleb nevus syndrome

Congenital venous malformations (VMs) are rare cause of gastrointestinal (GI) bleed in children. Blue rubber bleb nevus syndrome characterized by VMs in GI tract and skin affect at early age in life. Diagnosis is based on typical skin lesion and history of recurrent GI bleed. In this article, we presented a similar case of young girl with typical skin lesion and recurrent GI bleed requiring multiple blood transfusions presenting our department. She was subjected to surgical treatment and endoscopy therapy due to failure of conservative therapy. This case report depicts importance of typical clinical features of rare diseases.

Sistem Prediksi Kondisi Kesehatan Pasien Penderita Talasemia dengan Menggunakan Logika Fuzzy Tsukamoto

Thalassemia is a hereditary disease that makes sufferers experience red blood cell abnormalities and must receive continuous blood transfusions throughout their lives. Gunung Jati Hospital, Cirebon City handles registration and scheduling of thalassemia patients with assistance from Perhimpunan Orang tua Penderita Talasemia Indonesia (POPTI). In handling patient data, it is necessary to have a system that facilitates all activities ranging from registration, scheduling, and make predictions about the patient's health condition along with recommendations for handling the patient's condition. The purpose of this study is to make a prediction system for health conditions related to thalassemia suffered by patients based on influencing variables using the Fuzzy Tsukamoto method. This system can also handle patient data, scheduling, and storing patient medical recap data. The final results of this system are patient data, patient care schedules, predictions of patient health conditions, and recommendations for patients. Keywords— Fuzzy; Prediction; thalassemia; Tsukamoto.

Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

Background Prehospital administration of tranexamic acid (TXA) to injured patients is increasing worldwide. However, optimal TXA dose and need of a second infusion on hospital arrival remain undetermined. We investigated the efficacy and safety of the second in-hospital dose of TXA in injured patients receiving 1 g of TXA in the prehospital setting. We hypothesized that a second in-hospital dose of TXA improves survival of trauma patients. Methods A prospective, double-blind, placebo-controlled randomized, clinical trial included adult trauma patients receiving 1 g of TXA in the prehospital settings. Patients were then blindly randomized to Group I (second 1-g TXA) and Group II (placebo) on hospital arrival. The primary outcome was 24-h (early) and 28-day (late) mortality. Secondary outcomes were thromboembolic events, blood transfusions, hospital length of stay (HLOS) and organs failure (MOF). Results A total of 220 patients were enrolled, 110 in each group. The TXA and placebo groups had a similar early [OR 1.000 (0.062–16.192); p = 0.47] and late mortality [OR 0.476 (95% CI 0.157–1.442), p = 0.18].The cause of death (n = 15) was traumatic brain injury (TBI) in 12 patients and MOF in 3 patients. The need for blood transfusions in the first 24 h, number of transfused blood units, HLOS, thromboembolic events and multiorgan failure were comparable in the TXA and placebo groups. In seriously injured patients (injury severity score > 24), the MTP activation was higher in the placebo group (31.3% vs 11.10%, p = 0.13), whereas pulmonary embolism (6.9% vs 2.9%, p = 0.44) and late mortality (27.6% vs 14.3%, p = 0.17) were higher in the TXA group but did not reach statistical significance. Conclusion The second TXA dose did not change the mortality rate, need for blood transfusion, thromboembolic complications, organ failure and HLOS compared to a single prehospital dose and thus its routine administration should be revisited in larger and multicenter studies. Trial registration ClinicalTrials.gov Identifier: NCT03846973.