CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

Introduction: Liver transplantation (LT) is burdened by the risk of post-operative morbidity. Identifying patients at higher risk of developing complications can help allocate resources in the perioperative phase. Controlling Nutritional Status (CONUT) score, based on lymphocyte count, serum albumin, and cholesterol levels, has been applied to various surgical specialties, proving reliable in predicting complications and prognosis. Our study aims to investigate the role of the CONUT score in predicting the development of early complications (within 90 days) after LT.Methods: This is a retrospective analysis of 209 patients with a calculable CONUT score within 2 months before LT. The ability of the CONUT score to predict severe complications, defined as a Comprehensive Complication Index (CCI) ≥42.1, was examined. Inverse Probability Treatment Weighting was used to balance the study population against potential confounders.Results: Patients with a CCI ≥42.1 had higher CONUT score values (median: 7 vs. 5, P-value < 0.0001). The CONUT score showed a good diagnostic ability regarding post-LT morbidity, with an AUC = 0.72 (95.0%CI = 0.64–0.79; P-value < 0.0001). The CONUT score was the only independent risk factor identified for a complicated post-LT course, with an odds ratio = 1.39 (P-value < 0.0001). The 90-day survival rate was 98.8% and 87.5% for patients with a CONUT score <8 and ≥8, respectively.Conclusions: Pre-operative CONUT score is a helpful tool to identify patients at increased post-LT morbidity risk. Further refinements in the score composition, specific to the LT population, could be obtained with prospective studies.

Fracture of pubic rami during hip fracture fixation: a rare case of traction table–related injury

We present a case of an elderly and comorbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intraoperatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Closed-reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed-fixation should be accounted for when managing this complex and often frail group of patients.

NT-pro BNP in AECOPD-PH: old biomarker, new insights-based on a large retrospective case-controlled study

Background Pulmonary hypertension (PH) is one of the common complications in chronic obstructive pulmonary disease (COPD). The study aimed to evaluate the predicting ability of N-terminal pro brain natriuretic peptide (NT-pro BNP) in patients with AECOPD-PH and its relationship with the severity of PH. Methods A large retrospective case-controlled study (n = 1072) was performed in the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2020, and patients were divided into stable COPD (n = 178), AECOPD (n = 688) and AECOPD-PH group (n = 206). Different statistical models were used to screen for reliable and stable biomarkers. Results In unadjusted analysis and PSM (model 1, 2, 3), red cell distribution width (RDW), total bilirubin (TBIL), and NT-pro BNP were higher in patients with AECOPD-PH than those in AECOPD group. Logistic regression analysis showed, when the range of NT-proBNP was 271–1165 pg/mL (OR: 0.293; 95%CI: 0.184–0.467; P < 0.001) and NT-proBNP > 1165 pg/mL (OR: 0.559; 95%CI: 0.338–0.926; P = 0.024), the morbidity risk of PH in AECOPD patients was increased, so did TBIL. In receiver operating characteristic (ROC) curves, at the cut-off value of NT-proBNP was 175.14 pg/mL, AUC was 0.651 (P < 0.001), which was better than TBIL (AUC: 0.590, P < 0.001). As for the results of rank correlation analysis, NT-proBNP had a weak correlation with severity of PH with AECOPD (rs = 0.299, P = 0.001) and its relative relevance with other biomarkers (RDW was 0.359 and TBIL was 0.238, P < 0.001). Conclusions Our findings suggest that NT-proBNP has a diagnostic efficacy in AECOPD-PH and NT-proBNP has a weak correlation with severity of PH with AECOPD.

The Evaluation of Acute Pancreatitis into Acute Recurrent Pancreatitis in Children: The Impact of Etiological Factors

Background: The incidence of acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in pediatric population is rising and becomes common clinical problem in gastroenterology. The assessment of morbidity risk factors is necessary to improve the quality of diagnosis, to determine further treatment and to identify groups with poor prognosis of the evolution of AP into ARP and CP. Objectives: The assessment of etiological factors in acute and acute recurrent pancreatitis in children. Material and methods: From January 2015 to November 2017, data on etiological factors responsible for the onset of AP and ARP were collected in a group of pediatric patients hospitalized at the Department of Paediatrics, Gastroenterology and Nutrition, Medical University of Wroclaw, Poland. The study group consisted of 39 patients (27 patients with AP, 11 patients with ARP and 1 with CP). Results: The potential etiological factor was established in 85.2% of children with AP and in 100% of children with ARP. Mutations in the SPINK1 gene were found in 44.4% of children from the ARP group, no mutations in the PRSS1 gene were found in this group. In all patients with a genetic predisposition (SPINK1 mutation) during the first episode of the ARP, coexistence of an additional predisposing factor was found. Conclusions: Patients with ARP require diagnostics towards mutations predisposing to the transition of AP into a chronic disease. The interaction of additional triggers plays a role in the development of pancreatitic inflammatory disease in genetically predisposed individuals.

Assessment of morbidity and mortality by P-POSSUM scores in Emergency GI Surgeries

Background: Assessment of morbidity and mortality risk in emergency gastrointestinal surgeries is a fairly difficult challenge. To have a better scientific, reliable, and reproducible method of assessment POSSUM and its modified version PPOSSUM scores have been devised. In this study, we tried to evaluate the P-POSSUM Scores in patients undergoing emergency GI surgical procedures. Methods: This study was done in the Department of General Surgery, PIMS a tertiary care hospital. Consecutive emergency surgical procedures following inclusion and exclusion criteria were selected for the study. A total of n=50 cases were included in the study. P-POSSUM scores were derived for each of the cases and analysis of the predicted morbidity and mortality was compared. Results: The range of 9.9% risk was done to categorize into 10 different groups with increasing order of scores. The highest frequency was observed in 20.1 – 30.0% which was 22% lower frequency scores were observed in higher extremes. The morbidity risk scores show the highest frequency in 32% in the range of > 90.0 cases followed by 80.1 – 90.0 having cases of 28%. Conclusion: P-POSSUM is an accurate and reliable scoring method for assessing morbidity and mortality in emergency Gastrointestinal surgeries. However, it was found to overestimate mortality and morbidity in our patient population. P-POSSUM over-estimates risk for morbidity in lowrisk groups w

The Marsden Morbidity Index: The Derivation and Validation of a Simple Risk Index Scoring System Using Cardiopulmonary Exercise Testing Variables to Predict Morbidity in High Risk Patients Having Major Cancer Surgery.

BackgroundMorbidity and mortality risk prediction tools are increasingly being used as part of preoperative assessment of patients presenting for major abdominal surgery. Cardiopulmonary exercise testing (CPET) can predict which patients undergoing major abdominal surgery are at risk of complications. The primary aim of this study was to identify pre-operative variables including those derived from CPET, that were associated with inpatient morbidity in high risk patients following major abdominal cancer surgery. Secondary aims were to use these variables to derive and validate a morbidity risk prediction tool.MethodsWe conducted a retrospective cohort analysis of consecutive adult patients who had CPET as part of their pre-operative work-up for major abdominal cancer surgery. Morbidity was a composite outcome, defined by the Clavien-Dindo score and/or the Postoperative Morbidity Survey (POMS) score which was assessed on postoperative day 7. A risk prediction tool was devised using variables from the first analysis which was then applied prospectively to a matched cohort of patients.ResultsA total of 1398 patients were included in the first phase of the analysis between June 2010 and May 2017. Of these, 540 patients (38.6%) experienced postoperative morbidity. CPET variables deemed significant (p<0.01) were Anaerobic Threshold (AT), Maximal Oxygen Consumption at Maximal Exercise Capacity (VO2 Max) and Ventilatory Equivalent for Carbon Dioxide at Anaerobic Threshold (AT VE/VCO2). In addition to the CPET findings and the type of surgery the patient underwent, eight premorbid variables that were associated with post-operative morbidity were identified. These include age, WHO category, body mass index (BMI), prior transient ischaemic attack (TIA) or stroke, chronic renal impairment, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and cancer stage. Both sets of variables were then combined to produce a validated morbidity risk prediction scoring tool called the Marsden Morbidity Index. In the second phase of the analysis, this tool was applied prospectively to 424 patients between June 2017 and December 2018. With an area under the curve (AUC) of 0.79, this new model had a sensitivity of 74.2%, specificity of 78.1%, a positive predictive value (PPV) of 79.7% and a negative predictive value of (NPV) of 79%. ConclusionOur study showed that of the CPET variables, AT, VO2 Max and AT VE/VCO2 were shown to be associated with postoperative surgical morbidity following major abdominal oncological surgery. When combined with a number of preoperative co-morbidities commonly associated with increased risk of postoperative morbidity, we created a useful institutional scoring system for predicting which patients will experience adverse events. However, this system needs further validation in other centres performing oncological surgery.

Socio-biological factors of increased morbidity risk in participants of educational process in higher education institutions related to the global epidemiological situation in 2020-2021

One of the numerous negative consequences of the COVID-19 pandemic is the "second epidemic" of negative psychological effects. Population stress in modern conditions can serve as a catalyst for mental disorders of teachers and students. In the present situation, restrictive and special measures should be considered as additional harmful socio-biological factors for participants of the university educational process.

Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Ovarian cancer (OC) has a poor prognosis. Hypertension may be a prognostic factor for OC, but it is unclear whether antihypertensive (anti-HT) drug use of modifies OC prognosis. We performed a population-based analysis assessing the effect of anti-HT drug use on OC mortality. A cohort of 12,122 women identified from the Finnish Cancer Registry with OC in 1995–2013 was combined with information on their anti-HT drug use during the same time period. Use of each anti-HT drug was analysed as a time-dependent variable. Analyses were run for five, ten and full follow-up (19-year) mortality with cardiovascular morbidity risk evaluated in competing risk analysis. No anti-HT drug group was associated with OC survival within five years after OC diagnosis. At ten years, a dose-dependent association was observed between pre-diagnostic ACE-inhibitor use and improved OC survival. With full follow-up, post-diagnostic high-intensity use associated with reduced OC death risk for multiple anti-HT drug groups. In competing risk analysis, only the post-diagnostic use of ACE-inhibitors associated with increased OC survival. Anti-HT drugs were not associated with survival benefits within five years after OC diagnosis. ACE-inhibitors may confer survival benefits in women with OC, but further confirmatory studies are needed.

An Observational Cohort Study and Nested Randomized Controlled Trial on Nutrition and Growth Outcomes in Moderate and Late Preterm Infants (FLAMINGO)

Background: Over the past decades, the preterm birth rate has increased, mostly due to a rise in late and moderate preterm (LMPT, 32–36 weeks gestation) births. LMPT birth affects 6–7% of all births in the United Kingdom and is associated with increased morbidity risk after birth in infancy as well as in adulthood. Early life nutrition has a critical role in determining infant growth and development, but there are limited data specifically addressing LMPT infants, which was the rationale for the design of the current study.Objective: The Feeding Late and Moderate Infants and Growth Outcomes (FLAMINGO) study aims to improve understanding of the longitudinal growth, nutritional needs, and body composition of LMPT infants as well as their microbiome development and neurodevelopment. In addition, having a nested non-inferiority trial enables evaluation of the nutritional adequacy of a concept IMF with large milk phospholipid-coated lipid droplets comprising dairy and vegetable lipids. The primary outcome of this RCT is daily weight gain until 3 months corrected age.Methods: A total of 250 healthy LMPT infants (32+0–36+6 weeks gestational age) with birth weight 1.25–3.0 kg will be recruited to the cohort, of which 140 infants are anticipated to be enrolled in the RCT. During six visits over the first 2 years of life, anthropometry, body composition (using dual energy X-Ray absorptiometry), feeding behavior, and developmental outcomes will be measured. Saliva and stool samples will be collected for oral and gut microbiota assessment.Discussion: The FLAMINGO study will improve understanding of the longitudinal growth, body composition development, and feeding characteristics of LMPT infants and gain insights into their microbiome and neurodevelopment.Study Registration:www.isrctn.com; Identifier ISRCTN15469594.