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Nivolumab-Induced Immune Mediated Colitis Localized to the Distal Colon: Seven Years Into Therapy
Get PDFNivolumab targets programmed cell death protein 1 (PD-1) and is used in cancer treatment by increasing the immune response. It has rarely been associated with immune-mediated colitis (IMC). We present a 66-year-old man with metastatic lung adenocarcinoma, treated with nivolumab for seven years, who developed tenesmus and mucoid bloody diarrhea. Colonoscopy revealed endoscopic and histopathological ulcerative colitis (UC)-like changes, limited to the distal 25cm of the colon. Although nivolumab-induced IMC resembling UC is a known adverse effect, there are very few reports of nivolumab-induced IMC localized to the distal colon and occurring seven years after treatment initiation
An Investigation of Mortality Associated With Comorbid Pneumonia and Thrombocytopenia in a Rural Southwest Missouri Hospital System
Get PDFBackground: Pneumonia places a significant burden on individuals and society, contributing to a substantial number of hospital admissions, emergency department visits, deaths, and healthcare costs each year. Comorbidities can greatly increase the risk of poor outcomes when associated with pneumonia. One comorbidity that has yet to be thoroughly researched is thrombocytopenia, which is known to play an important role in activating the immune response to infections. A decrease in platelet count may limit the immune response and consequently increase mortality in patients with pneumonia. The purpose of this study was to investigate whether comorbid thrombocytopenia and pneumonia are associated with poor outcomes.
Methods: This study was a retrospective cohort analysis comparing mortality rates among patients with comorbid thrombocytopenia and pneumonia, pneumonia without thrombocytopenia, and thrombocytopenia without pneumonia. Data were collected from Freeman Health System using International Classification of Diseases, Tenth Revision (ICD-10) codes from January 1, 2019, to December 31, 2021. ICD-10 codes for pneumonia and thrombocytopenia were extracted and stratified into three groups: those with both pneumonia and thrombocytopenia, those with pneumonia without thrombocytopenia, and those with thrombocytopenia without pneumonia. Mortality rates were then compared across the three groups.
Results: There were 4,414 patients admitted with pneumonia and 1,157 admissions for thrombocytopenia without pneumonia. Among the 4,414 patients admitted with pneumonia, 3,902 did not have thrombocytopenia, while 512 had thrombocytopenia. Of the patients without thrombocytopenia, 14% (3,902) expired. Among the 512 patients with thrombocytopenia, 43% expired. In the thrombocytopenia without pneumonia group, 11% (1,157) expired.
Conclusion: These results indicate a significant increase in mortality in patients with both pneumonia and thrombocytopenia compared to those with pneumonia without thrombocytopenia (an increase in mortality of 28.93% with a 95% CI: 24.50-33.36%, P \u3c 0.0001). While pneumonia itself increases mortality compared to the general population, patients with both pneumonia and thrombocytopenia exhibit even higher mortality rates
Enhanced Biomechanical Properties of the Pectineal Ligament Support Its Reliability for Apical Pelvic Organ Prolapse Repair
Get PDFPelvic organ prolapse impacts an increasing number of women in the United States. The standard approach to correcting apical pelvic organ prolapse uses the sacral anterior longitudinal ligament (SALL) to lift the vaginal apex; however, this approach may result in recurrent prolapse. A newer procedure utilizes the pectineal ligament (PL), which may be a more reliable anchor point. This study compares the biomechanical properties of these two ligaments to elucidate which can withstand more stress to provide long-term stability following prolapse. Seventeen formalin-embalmed donors were used (PL: 17 right, 16 left; SALL, 15). The PL was evaluated to better characterize the ligament’s properties within the pelvis using digital calipers and descriptive statistics. Mean values were statistically evaluated using an independent t test (p = 0.05) but no differences in laterality were appreciable. The PL and SALL samples were harvested and evaluated using a mechanical tester to determine their force at failure (N), toughness (Jm−2), and elastic modulus (MPa). The PL had increased values in the mean force at failure and toughness than the SALL when evaluated by each side as well as a combined mean value. These differences were statistically significant (p = 0.05) for toughness as evaluated using an independent t-test (right, p = 0.004; left, p = 0.005; combined, p = 0.002) and force at failure [right, p = 0.001 (independent t-test); left, p = 0.004 and combined, p = 0.005 (Mann–Whitney U test)], indicating that the PL may permit more deformation, but greater resistance to catastrophic failure as compared to the SALL. When evaluating any statistical differences in modulus, the individual and combined values were increased for the PL as compared to the SALL but were not significant (right, p = 0.290; left, p = 0.143; combined, p = 0.110) suggesting a stiffer material that may be more prone to catastrophic failure once a tear has begun. Collectively, these inherent biomechanical properties of the pectineal ligament indicate the ligament may be a more reliable anchor point for pelvic organ prolapse repair than the SALL
Characterization of the Posterior Femoral Cutaneous Nerve and Its Clinical Application for Autologous Breast Reconstruction
No full textAutologous breast reconstruction (ABR) uses a harvested tissue flap from the abdomen, posterior thigh, or buttocks to rebuild the breast postmastectomy. Identification of nerves for use in autologous sensate breast reconstruction flaps is an important surgical consideration as loss of breast sensation is a common risk of ABR. The posterior femoral cutaneous nerve (PFCN) and its branches supply sensory innervation to skin of the posterior thigh, leg, perineum, and buttocks, creating a feasible candidate for sensate profunda artery perforator (PAP) flaps for reestablishing breast sensation through ABR. This study characterized PFCN perforating branches located within the PAP flap region as compared to an anatomical landmark intersection (ALI). Twenty-three posterior thigh regions from 15 formalin-embalmed donors were dissected to the level of deep fascia to identify PFCN branches. PFCN branch diameter (mean, 1.34 ± 0.35 mm) and length (mean, 8.82 ± 5.78 mm) piercing the deep fascia were measured; branches were retro-dissected proximally to the PFCN trunk and the distance recorded (mean, 92.55 ± 38.00 mm). The distance to branch emergence from ALI (mean, 113.55 ± 19.80 mm) and from the midline of the posterior thigh (mean, 18.90 ± 11.17 mm) were calculated. Two-Tailed T-tests comparing the left and right limb of 7 donors determined bilateral, statistically significant difference between the length of branch emergence back to the main trunk of PFCN (P = .00). These findings illustrate the presence of adequate yet variable PFCN branches within the PAP flap region in regards to diameter, length, and location for use in sensate ABR
Artificial Intelligence-Based Models for Prediction of Mortality in ICU Patients: A Scoping Review
No full textBackground and objective: Healthcare professionals may be able to anticipate more accurately a patient\u27s timing of death and assess their possibility of recovery by implementing a real-time clinical decision support system. Using such a tool, the healthcare system can better understand a patient\u27s condition and make more informed judgements about distributing limited resources. This scoping review aimed to analyze various death prediction AI (Artificial Intelligence) algorithms that have been used in ICU (Intensive Care Unit) patient populations.
Methods: The search strategy of this study involved keyword combinations of outcome and patient setting such as mortality, survival, ICU, terminal care. These terms were used to perform database searches in MEDLINE, Embase, and PubMed up to July 2022. The variables, characteristics, and performance of the identified predictive models were summarized. The accuracy of the models was compared using their Area Under the Curve (AUC) values.
Results: Databases search yielded an initial pool of 8271 articles. A two-step screening process was then applied: first, titles and abstracts were reviewed for relevance, reducing the pool to 429 articles. Next, a full-text review was conducted, further narrowing down the selection to 400 key studies. Out of 400 studies on different tools or models for prediction of mortality in ICUs, 16 papers focused on AI-based models which were ultimately included in this study that have deployed different AI-based and machine learning models to make a prediction about negative patient outcome. The accuracy and performance of the different models varied depending on the patient populations and medical conditions. It was found that AI models compared with traditional tools like SAP3 or APACHE IV score were more accurate in death prediction, with some models achieving an AUC of up to 92.9%. The overall mortality rate ranged from 5% to more than 60% in different studies.
Conclusion: We found that AI-based models exhibit varying performance across different patient populations. To enhance the accuracy of mortality prediction, we recommend customizing models for specific patient groups and medical contexts. By doing so, healthcare professionals may more effectively assess mortality risk and tailor treatments accordingly. Additionally, incorporating additional variables-such as genetic information-into new models can further improve their accuracy
Osteopathic Manipulative Treatment for Pediatric Long-COVID Headache: A Case Report
No full textBackground
SARS-CoV-2 is a disease with global impact, and in the United States alone, approximately 20 % of children have had SARS-CoV-2. Long-COVID affects a significant number of children and adults with an incidence reported as high as 57 % for a SARS-CoV-2 sequelae. Currently, a gold standard treatment has not been identified for long-COVID. There have been pathologic mechanisms of action proposed for long-COVID, but this is complicated by the wide variety of symptom manifestations.
Objectives
The goal of this case report is to demonstrate and discuss the application of osteopathic manipulative treatment (OMT) and osteopathic principles and practices (OPP) in a patient with long-COVID headache.
Clinical features
In our case report we describe a child with long-COVID headache of 12-months duration with high somatic dysfunction burden found on cranial osteopathic structural examination.
Intervention and outcomes
OMT was utilized to treat a patient with long-COVID headache and may have resulted in its resolution.
Conclusions
This case suggests that OMT and OPP may play a role in the treatment of patients with long-COVID headache.
Implications for practice Our case report highlights OPP as a potential treatment option that may be complimentary to other treatments for pediatric patients experiencing long-COVID headache. Our case report emphasizes the significance of individualized treatment plans, as osteopaths provide in a tailored fashion to each patient based upon their unique history and physical exam findings. Our case report utilizing OMT promotes a non-pharmacological intervention and fosters opportunities for interprofessional collaboration. Our case report sparks interest in further research and clinical trials to investigate the efficacy of OMT in pediatric long-COVID cases and its potential application in a broader range of post-viral syndromes
