Journal of investigative medicine : the official publication of the American Federation for Clinical Research
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Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by the formation of antigen-antibody complexes which trigger an immune response. We investigate certain autoantibodies including nucleosome, double-stranded DNA (dsDNA), Smith, ribonucleoprotein, and Sjögren's syndrome-related antigens, and examine their associations with disease activity, damage accrual, and SLE-related clinical and serological manifestations in patients with SLE. We conducted a cross-sectional study with a total 293 patients (90.4% female, mean age 46.87±12.94 years) and used the Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) to evaluate disease activity and disease-related damage, respectively. ⋯ Patients with antinucleosome or anti-dsDNA antibodies had a higher disease activity and were likely to have nephritis. Antinucleosome was also associated with more damage accrual. A greater understanding of these autoantibodies could lead to the development of new approaches to more accurate assessments of SLE.
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The role of thrombolysis in submassive pulmonary embolism (PE) is controversial due to the high risk of hemorrhage. This study aimed to evaluate the role of half-dose tissue-type plasminogen activator (rt-PA) in preventing death/hemodynamic decompensation in submassive (intermediate-risk) PE without increasing the risk of bleeding. In a prospective, non-randomized, open-label, single-center trial, we compared 50 mg rt-PA plus low molecular weight heparin (LMWH) with LMWH in submassive (intermediate-risk) PE. ⋯ There was no intracranial hemorrhage in any of the patients. There were no statistically significant differences between the two groups in terms of major or minor bleeding complications. This trial showed half-dose rt-PA treatment in submassive (intermediate-risk) PE prevented death/hemodynamic decompensation in the first 7-day and 30-day period compared with LMWH treatment without increasing the risk of bleeding.
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As of February 2, 2021, the USA has 26,431,799 reported COVID-19 cases with 446,744 deaths. A high mortality rate (15%-40%) was reported among hospitalized patients with COVID-19 during the first wave of the pandemic. However, data regarding variation in COVID-19-related mortality and severity of illness among hospitalized patients with COVID-19 are heterogeneous. ⋯ In-hospital mortality during the second wave was lower (5.9%) compared with the first wave (15.5%). At the last follow-up date, 86.1% were discharged alive from the hospital, 5.9% died and 7.9% were still in the hospital. Multivariate logistic regression showed higher odds of mortality were associated with higher age and elevated lactate dehydrogenase peak.
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Antibiotic treatment guidelines promote proper diagnosis and treatment and optimize antibiotic treatment, minimizing both antimicrobial resistance to antibiotics and financial expenditure. This study aimed to investigate whether community physicians and emergency department (ED) physicians diagnose and treat acute rhinosinusitis according to accepted guidelines. This was a retrospective study of medical records and referrer letters of patients admitted to the medical center between 2014 and 2015. ⋯ The duration of treatment prescribed by the ED physicians aligned with the guidelines in 37.7% of the cases. There was insufficient compliance with acute rhinosinusitis treatment guidelines among all treating physicians in this study, which was characterized by excessive antibiotic treatment. Therefore, ways to increase understanding and adherence to clinical guidelines, and to provide optimal settings in the clinics to carry out the guidelines should be investigated.
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Observational Study
Biomarker-based score for predicting in-hospital mortality of children admitted to the intensive care unit.
This study aims to establish a new scoring system based on biomarkers for predicting in-hospital mortality of children admitted to the pediatric intensive care unit (PICU). The biomarkers were chosen using the least absolute shrinkage and selection operator (LASSO)-logistic regression in this observational case-control study. The performance of the new predictive model was evaluated by the area under the receiver operating characteristic curve (AUC). ⋯ The calculated ORs showed a trend that higher scores indicated higher risk of death (p value for trend <0.001). In summary, this study develops and validates a totally biomarker-based new score to predict in-hospital mortality for pediatric patients admitted to PICU. More attention and more positive care and treatment should be given to children with a higher score.