5 research outputs found
Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy
No full textDiffuse alveolar hemorrhage (DAH) is a life-threatening clinical pathologic syndrome caused by a variety of diseases. We report a case of DAH related to therapy of warfarin use. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin
Bacteriological profile of diabetic foot ulcers and analysis of serum meteorin levels
No full textObjectiveWith the increase in the incidence of diabetes mellitus (DM) in recent years, diabetic foot ulcers (DFU), which are common and serious chronic complications of diabetes, have also become widespread. DFU is highly associated with a significant deterioration in quality of life as well as increased morbidity and mortality. Meteorin is a potent neurotrophic growth factor and shows antiangiogenic, antihyperalgesic, antinociceptive and neuroprotective effects. This study aimed to determine the possible relationship between meteorin, diabetes and diabetic foot ulcer by comparing the serum meteorin levels of healthy control group, DM patients and patients with diabetic foot ulcers.MethodsOur study included a total of 62 diabetic patients, 31 of whom had DFU, and 29 healthy individuals as a control group. Meteorin levels of the participants were measured using ELISA method in serum samples. Other laboratory and epidemiological data of the patients were obtained from the hospital database.ResultsIn the wound cultures taken from patients with DFU, the most commonly isolated bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Serum meteorin levels were found to be statistically significantly higher in diabetic patients as compared to the healthy control group, and among diabetic patients, those with DFU had significantly higher levels compared to those without DFU. A positive significant correlation was found between meteorin level and age, HbA1c, WBC, urea, sedimentation, CRP and ferritin.ConclusionThe results of our study, aimed at better understanding the biological functions and potential clinical applications of meteorin, suggest that meteorin could potentially be used as a biomarker for the development of DFU
CACER: Clinical Concept Annotations for Cancer Events and Relations
No full textClinical notes contain unstructured representations of patient histories, including the relationships between medical problems and prescription drugs. To investigate the relationship between cancer drugs and their associated symptom burden, we extract structured, semantic representations of medical problem and drug information from the clinical narratives of oncology notes. We present Clinical Concept Annotations for Cancer Events and Relations (CACER), a novel corpus with fine-grained annotations for over 48,000 medical problems and drug events and 10,000 drug-problem and problem-problem relations. Leveraging CACER, we develop and evaluate transformer-based information extraction (IE) models such as BERT, Flan-T5, Llama3, and GPT-4 using fine-tuning and in-context learning (ICL). In event extraction, the fine-tuned BERT and Llama3 models achieved the highest performance at 88.2-88.0 F1, which is comparable to the inter-annotator agreement (IAA) of 88.4 F1. In relation extraction, the fine-tuned BERT, Flan-T5, and Llama3 achieved the highest performance at 61.8-65.3 F1. GPT-4 with ICL achieved the worst performance across both tasks. The fine-tuned models significantly outperformed GPT-4 in ICL, highlighting the importance of annotated training data and model optimization. Furthermore, the BERT models performed similarly to Llama3. For our task, LLMs offer no performance advantage over the smaller BERT models. The results emphasize the need for annotated training data to optimize models. Multiple fine-tuned transformer models achieved performance comparable to IAA for several extraction tasks.This is a pre-copy-editing, author-produced PDF of an article accepted for publication in JAMIA following peer review. The definitive publisher-authenticated version is available online at https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocae231/774830
Clinical and inflammatory predictors of outpatient treatment failure in uncomplicated skin and soft tissue infections: a prospective multicenter study from Türkiye
No full textBackground Uncomplicated skin and soft tissue infections (uSSTIs) are highly prevalent; however, factors associated with outpatient treatment failure and subsequent hospitalization remain poorly defined in the existing literature. This prospective, multicenter observational study aimed to identify clinical and laboratory predictors of outpatient treatment failure in uSSTIs. Methods Adult patients diagnosed with uSSTIs were enrolled from 24 infectious diseases departments across T & uuml;rkiye between April 1st and September 30th, 2024, and their demographic, comorbidity, clinical, and laboratory data were systematically recorded. Hospitalization after initial outpatient therapy was considered a proxy for treatment failure, based on clinical judgment. Multivariable logistic regression was used to identify independent predictors of hospitalization following outpatient treatment failure, while receiver operating characteristic (ROC) analysis was performed to assess their discriminative performance. Results Of 599 patients, 263 completed outpatient therapy, 169 were hospitalized at presentation, and 167 required hospitalization after initial outpatient treatment. Univariate analysis identified higher body mass index (BMI, P = .015), chronic kidney disease (P = .044), immunodeficiency (P = .026), insect bite etiology (P = .047), and smoking (P = .019) as associated with hospitalization. Clinical predictors included lesion size > 10% body surface area (BSA, P 4.37, P 67.5 mg/L, P 10% BSA (OR 3.898, 95% CI 1.598-9.509), elevated CRP (OR 1.005, 95% CI 1.001-1.008), NLR (OR 1.073, 95% CI 1.012-1.138), and pulse rate (OR 1.027, 95% CI 1.004-1.051) as independent predictors. ROC analysis demonstrated moderate discriminative ability with AUC values for CRP, NLR, pulse rate of 0.695, 0.672 and 0.615, respectively. Conclusions Smoking, preseptal cellulitis, extensive lesions, and elevated NLR, CRP, and pulse rate may be associated with an increased likelihood of hospitalization in patients with uSSTIs. Early identification may guide initial management, favoring intravenous therapy in high-risk patients to reduce treatment failure
