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2022 ◽  
Vol 13 (2) ◽  
pp. 1-27
Author(s):  
Jiaheng Xie ◽  
Bin Zhang ◽  
Jian Ma ◽  
Daniel Zeng ◽  
Jenny Lo-Ciganic

Hospital readmission refers to the situation where a patient is re-hospitalized with the same primary diagnosis within a specific time interval after discharge. Hospital readmission causes $26 billion preventable expenses to the U.S. health systems annually and often indicates suboptimal patient care. To alleviate those severe financial and health consequences, it is crucial to proactively predict patients’ readmission risk. Such prediction is challenging because the evolution of patients’ medical history is dynamic and complex. The state-of-the-art studies apply statistical models which use static predictors in a period, failing to consider patients’ heterogeneous medical history. Our approach – Trajectory-BAsed DEep Learning (TADEL) – is motivated to tackle the deficiencies of the existing approaches by capturing dynamic medical history. We evaluate TADEL on a five-year national Medicare claims dataset including 3.6 million patients per year over all hospitals in the United States, reaching an F1 score of 87.3% and an AUC of 88.4%. Our approach significantly outperforms all the state-of-the-art methods. Our findings suggest that health status factors and insurance coverage are important predictors for readmission. This study contributes to IS literature and analytical methodology by formulating the trajectory-based readmission prediction problem and developing a novel deep-learning-based readmission risk prediction framework. From a health IT perspective, this research delivers implementable methods to assess patients’ readmission risk and take early interventions to avoid potential negative consequences.


2022 ◽  
pp. 1-114
Author(s):  
Davide Ermacora

Reports of women giving birth to a baby together with an animal (toad, mouse, bird, etc.), are documented in Europe from the 1100s onwards: the most important traditions of which are the frater Salernitanorum and the sooterkin. Throughout the centuries, authors have typically attempted to explain monstrous animal siblings in the light of contemporary medical knowledge. The present paper compares the medieval frater Salernitanorum with the later sooterkin and investigates both in historico-folklore terms. It argues that it is important to understand monstrous birth traditions not only in the light of medical history, but as beliefs and narratives actively shared through acts of communication. In so doing, this article is informed by both the history of medicine and folklore studies.


2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Suhail Khokhar ◽  
Daniela Garcia ◽  
Rajesh Thirumaran

Abstract Background Renal infarctions as a result of recreational drug use are rare and are commonly associated with cocaine use. Although amphetamines have a similar mechanism of action as cocaine, there are few reports linking them to ischemic events, and only one to renal infarction. Similarly, few reports link heroin use with infarcts, but never in the kidney. Although uncommon, several mechanisms have been implicated in heroin and amphetamine-induced infarction, including vasculopathy, vasculitis and the activation of the coagulation cascade. Case Presentation 47-year-old female with a past medical history of non-intravenous heroin and amphetamine abuse, chronic obstructive pulmonary disease, hypertension, hyperlipidemia presented with right lower extremity swelling and rash, which was diagnosed as cellulitis and treated appropriately. Incidentally, the patient was found to have an acute kidney injury and further workup identified multiple renal infarcts in the right kidney. The patient had no past medical history of clotting disorders. Blood culture and urine cultures were sterile; autoimmune and hypercoagulable workup were negative. Urinalysis was unremarkable. Urine toxicology was only positive for opiates and amphetamines, which were thought to be the most likely cause of the renal infarct. Patient was lost to outpatient follow up due to noncompliance, but returned to the hospital for re-emergence of her cellulitis, during which no new infarcts were discovered, and the previous renal infarct had scarred over. Conclusion There are very few reports of heroin and amphetamine-induced infarctions. This case report describes a rare but important complication of heroin/amphetamine abuse that could be easily overlooked.


2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Seyed Ali Tabatabaei ◽  
Soran Aminzade ◽  
Aliasghar Ahmadraji ◽  
Mohammad Soleimani ◽  
Bahram Bohrani Sefidan ◽  
...  

Abstract Background Based on endophthalmitis vitrectomy study, intravitreal injection of antibiotics is preferred for initial management of cases of acute post cataract surgery endophthalmitis (APCE) with presenting vision of hand motions (HM). This study aimed to compare outcomes of early and complete vitrectomy (VIT) and vitreous tap and antibiotic injection (T&I) in cases of APCE presented with vision of HM. Methods In this prospective study, cases of APCE with vision of HM between 2018 and 2020 were enrolled. According to the time of presentation, the patients were arranged into two groups (VIT vs. T&I). Demographic data, elapsed time to developing endophthalmitis, past medical history, microbiology results, complications, and final visual acuity were recorded and analyzed. Results Seventy-six eyes of 76 patients were enrolled. Fifty-three eyes underwent T&I and twenty-three were arranged into the VIT group. Past medical history of 34.2% of patients was significant for diabetes mellitus. There was a statistically significant lower logMAR in VIT group compared to T&I group (diff = 0.14, 95% CI: 0.04 to 0.24, P-value = 0.007). The comparison of the diabetic and non-diabetic patients in both groups showed that the visual outcome was better in non-diabetic cases compared to the diabetic subjects. There was no statistically significant difference between the diabetic and non-diabetic groups regarding the superiority of procedure. Conclusion Based on our results, we could recommend that it’s maybe better to do early and complete vitrectomy as the initial management of APCE with the vision of HM. Past medical history of diabetes mellitus is not a determining factor for choosing initial management between vitrectomy and antibiotic injection.


2022 ◽  
pp. 106002802110701
Author(s):  
Francisco Ibarra ◽  
Kaitlyn Loi ◽  
Ann W. Vu

Background The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports. Objective To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia. Methods This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received. Results In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023). Conclusion and Relevance Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.


2022 ◽  
Vol 5 (2) ◽  
pp. 01-05
Author(s):  
Amin Bojdy ◽  
Yeganeh Ahrari ◽  
Mona Najafi ◽  
Mahnaz Arian ◽  
Nasrin khosravi Zeenyani

Background and aim: candidemia is a state that usually happens in immunocompromised patients. Thus it is more prevalent in ICU patients. This status brings mortality and morbidity; however, the outcome is various in different ICU care settings. The aim of this study is to assess epidemiology of outcome of candidemia in ICU in Mashhad during a 6-year period. Method: in a cross-sectional study between 2012 and 2018 in different ICU centers affiliating with Mashhad University of Medical Sciences, data of candidemia patients were extracted from hospital information system. These data were demographic, past medical history, result of the culture, and antifungal treatment. Result: totally, 55 patients (22 men and 33 women) were included in the study. The mean age of the patients was 45.9±1.9 years. Furthermore, the mean duration of hospitalization and the mean duration of ICU care were 43 and 37 days, respectively. Five patients had a history of immunosuppressive treatment and four patients were prescribed antifungal treatment in their past medical history (all with fluconazole and none with Itraconazole). Eighteen patients received caspofungin, eleven Amphotericin B treatment, and two fluconazole with no significant difference in outcome of the patients regarding antifungal type. In case of coincident antibiotic treatment, Carbapenems were prescribed in 43 patients, Glycopeptides in 48 patients, 25 patients had Cephalosporin treatment, and 13 patients had Fluoroquinolone treatment with no significant difference regarding the antibiotic type. Conclusion: The mortality percent of candidemia in ICU was 69.1 within mean time of 37 days. Furthermore, there was no significant difference in outcome of the patients regarding using Caspofungin or Amphotericin. Timely initiation of antifungal regarding to the culture result may bring better outcomes.


2022 ◽  
Vol 50 ◽  
Author(s):  
Fernanda Conte ◽  
Adriane Strack ◽  
Amanda Leite Bastos-Pereira ◽  
Marcy Lancia Pereira

Background: Transmissible venereal tumors (TVT) are naturally occurring neoplasms that can be transmitted through copulation or cell transplantation. It is a disease that affects canines, has no preference for sex or breed, and generally noticed in the external genital apparatus. Extragenital occurrence may eventually be seen; however, nasal involvement has been described in only a few reports of studies conducted in Brazil. Therefore, the objective of this study is to report 3 cases of nasal TVT in dogs who were treated in 2 municipalities in the mountainous region of Santa Catarina, Brazil.Cases: This case report includes 3 male mixed-breed canines of age 3-13. Only 1 of the animals was castrated. As per the medical history, some points, such as an enlarged nasal region, sneezing, nasal discharge, and hoarseness, reported by the dogs’ respective owners were similar among all the dogs. Likewise, nosebleed was observed on physical examination in all the cases. The result of cytological examination was inconclusive only in 1 case. Rhinoscopy, incisional biopsy, and histopathological examination were then performed for achieving a definitive diagnosis. In the 2 cases wherein cytology gave conclusive results, the cytological smears showed changes suggestive of TVT, such as cells with eccentric nuclei and little cytoplasm, which had vacuoles inside them. In 2 cases, radiographic examinations of the skull were also performed. The images showed changes in bone radiopacity, conformation of trabeculae with areas of bone lysis and cell proliferation, and irregularity in the contour of the nasal bone. After TVT diagnosis was confirmed, chemotherapy was initiated using vincristine at a dose of 0.75 mg/m2 for 2 cases and 0.025 mg/kg for the remaining case. The number of chemotherapy sessions and duration of treatment until the resolution of lesions and clinical signs varied as per the differences in the patients’ blood counts performed prior to each session.Discussion: TVT occurs between 1 and 7 years of life. It occurs more frequently in sexually active animals and has no preference for breed. Of the 3 cases reported herein, only one of the patients was elderly. All the patients were male mixed-breed dogs, and only 1 of them was castrated. The implantation of neoplastic cells through natural mounts, licks, scratches, or bites of affected areas are the most widely accepted reasons for the transmission of this neoplasm. With regard to the nasal presentation described in the present report, it is hypothesized that the smelling or licking of the neoplastic areas by the animal may favor cell implantation, leading to the subsequent development of a tumor. Nasal TVT should be considered as a differential diagnosis for dogs with chronic symptoms of the upper respiratory tract, such as increased local volume, nasal discharge, nosebleed, and sneezing. These signs are consistent with those described in this report. Radiographic evaluation was performed in 2 cases and both showed changes in bone radiopacity and trabeculae conformation, in addition to areas of bone lysis and cell proliferation, which are common in neoplastic processes. A presumptive diagnosis can be achieved from the medical history, clinical signs, and physical examination. Cytological and histopathological examination are the confirmatory methods; however, it is used less frequently and especially when cytological evaluation does not provide a definitive diagnosis. Antineoplastic chemotherapy with vincristine is the first-choice treatment protocol, which also proved to be effective for the patients in this report. Although TVT commonly affects the external genitalia of dogs, in the cases reported herein, it was located exclusively in the nasal region. Keywords: TVT, dog, nasal, vincristine.Título: Tumor venéreo transmissível (TVT) nasal em cãesDescritores: TVT, cão, nasal, vincristine.


2022 ◽  
Vol 14 (1) ◽  
pp. e2022011
Author(s):  
SIMONA BIANCHI ◽  
ALESSIA ANGI ◽  
MAURO PASSUCCI ◽  
GIOVANNA PALUMBO ◽  
ERMINIA BALDACCI ◽  
...  

Rare cases of immune thrombocytopenia (ITP) occurring after SARS-CoV-2 mRNA vaccines have recently reached public attention. It has been reported in patients with previous ITP or other autoimmune diseases and in individuals with an apparent negative past medical history.  The management and the outcome of these cases are still not well investigated and reported in the medical literature. A 23-year-old female with a past medical history of ITP, in stable complete remission for 3 years and on mycophenolate treatment received SARS-CoV-2 mRNA vaccine. She presented severe ITP recurrence with hemorrhagic symptoms after the second vaccine dose. A combined treatment with high-dose immunoglobulin and prednisone was successfully administered with a full recovery of platelet count. The patient remains in ITP remission and on mycophenolate therapy, five months later. At our Center, none of the other 76 adult “fragile patients” with ITP on immunosuppressive treatment who had received the SARS-CoV-2 mRNA vaccine, developed such a severe thrombocytopenic recurrence. Follow-up of large cohorts of patients receiving mRNA vaccine will answer the question as to whether it increases the risk of autoimmune conditions. So far, the benefits of the vaccination largely outweigh the risk of infection in these patients.


Author(s):  
Yevheniya Sharhorodska ◽  
◽  
Olena Shkolnyk ◽  
Olena Rachkevych ◽  
Halyna Makukch ◽  
...  

Introduction. Congenital abnormalities are the most common medical and social problems and the primary cause of fetal loss and children’s disability in the World, and particularly in Ukraine. In Ukraine, about 5 thousand children with congenital heart disease (CHD) are born every year. Up to date, information on the future of patients who received medical care for CHD was not systematized and often remains unavailable. The aim of the study: To perform a survey of women who gave birth to children with CHD and collect information about distant health outcomes. Methods. The medical history files of 170 children born with CHD in Lviv Regional Clinical Hospital, Lviv, Ukraine between 2011-2015 were selected. The criterion for inclusion in the group was a clinical diagnosis ''Congenital malformations of the circulatory system'' based on International Classification of Diseases-10 (Q20 - Q28). Results. According to the medical history files analysed in our study, among 170 children born with CHD, heart defects were detected at the prenatal stage in 67 patients (39.4%). Urgent surgical intervention was performed in 32 (18.6%) children.


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