9 research outputs found
Bladder rupture following osteoporotic pubic ramus and sacral insufficiency fractures
No full textWe present a case report of an 86-year-old lady with pubic ramus and sacral insufficiency fractures who developed extra-vesical bladder rupture following displacement of the pubic ramus fracture, a very unusual complication
P91 High prevalence of vitamin d deficiency amongst patients with copd in the north east. highlighting a deficiency and need for improved assessment
No full textAdmission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence
No full textObjective: to study the implications of osteoporotic pelvic fractures in older patients in terms of mortality, length of hospital stay and independent living.Methods: the study included 110 consecutive patients, aged over 60 years, with osteoporotic pelvic fractures admitted to the Queen Elizabeth Hospital, Gateshead, between July 2009 and March 2011. Demographic and routine clinical data were collected prospectively until date of discharge, and vital status data were collected up to 3 months post-fracture. These data were analysed to assess associations with outcomes such as length of hospital stay, mortality and loss of independence (according to changes in residential housing status).Results: fourteen patients died either in hospital, or within 3 months of fracture. Length of hospital stay was associated with age (b = 0.77 days per year, 95% CI 0.001, 1.54, P = 0.05) and was significantly longer in those with acute medical problems on admission (b = 21.2 days, 95% CI 8.72, 33.73, P = 0.001). The odds of changing from independent to institutionalised accommodation were significantly associated with age (OR 1.08 per year, 95% CI 1.01, 1.04, P = 0.007) and length of hospital stay (OR 1.12 per day, 95% CI 1.01, 1.04, P = 0.007).Conclusion: in-hospital mortality rates in this patient group are similar to those seen for hip fractures, yet pelvic fractures in older people receive relatively little in the way of attention or funding. Guidelines to improve the management of such fractures in older people are important to improve care while in hospital, reduce time spent in hospital and reduce the impact on independent living
Intelligent Predictive Maintenance for Urban Energy and Transportation Systems: A Hybrid AI Approach
No full textToday's complex urban energy and transportation systems demand new maintenance solutions to keep them running properly. This study develops an AI-driven predictive maintenance solution for electrical substations and HEV batteries using data from the Internet of Things sensors. Our framework uses machine-learning methods such as Bi-LSTM, GRU, and GBT models to spot system weaknesses with higher accuracy. Based on test results Bi-LSTM proved better than other models by achieving a 91% F1 score alongside 4.3% Mean Absolute Error across predictions and anomaly detection. According to the results, the proposed framework lowered maintenance costs by half and proved better than traditional and recent methods. The proposed system combines insights from power substations and develops edge-cloud technologies to better use EV batteries. Real-world systems data validate those reductions in downtime happen together with better system reliability. This system now works in cities, tracks vehicle fleets, and supports smart city construction. The predictive system framework delivers exceptional energy and mobility management while remaining affordable and expandable for future urban infrastructure solutions
Combined pubic rami and sacral osteoporotic fractures: A prospective study of 67 patients
No full textIntroduction
Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality, in addition to prolonged rehabilitation and high costs. The most common sites of POFs include the pubic rami and the sacrum. Combined pubic rami and sacral osteoporotic fractures (SOFs) have been reported previously with varying comments on the mechanism of injury and incidence.
Purpose of the study
To evaluate the mobility, discharge destination, presence of back pain and length of stay of patients who sustained combined pubic rami and SOFs and to identify the significance of this association.
Methods
We prospectively studied 67 patients with low-impact pubic rami and/or SOFs over 12 months. The patients were over 60 years of age and were assessed by the fracture liaison service. MR imaging or bone scan were done when there was back pain or lumbo-sacral tenderness.
Results
There were 54 (80.4%) female and 13 (19.6%) male patients and the average age was 87.5 years (range 65–96). The mean length of stay was 45 (±35) days. Mortality rate was 10.4%. There was a significant relationship between low back pain and the presence of sacral fracture. Patients with combined pubic rami and SOFs showed significantly longer length of stay than those with isolated pubic rami fractures.
Conclusion
We recommend considering the high association between SOFs and pubic rami fractures and the presence of back pain in planning the management of patients with POFs and their rehabilitation, which would potentially exhaust resources, due to their significantly increased length of stay and reduced mobility
Combined pubic rami and sacral osteoporotic fractures: a prospective study
No full textBackground - Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality mainly as a result of infections and cardiovascular events. Patients usually need prolonged institutionalization, rehabilitation, and follow-up, with a high rate of dependency and cost. The most common sites of POFs include the pubic rami, sacrum, ilium, and acetabulum. Combined pubic rami (PROFs) and sacral osteoporotic fractures (SOFs) have been reported, mostly in retrospective studies, describing the mechanism of injury and incidence. The aim of this study was to evaluate the association between PROFs and SOFs and to assess the effect of combined PROFs and SOFs on patients’ mobility, discharge destination, and length of stay.
Materials and methods - We prospectively studied 67 patients with low-impact PROFs and/or SOFs. There were 54 (80.4%) female and 13 (19.6%) male patients, and the average age was 87.5 (range 65–96) years. All patients were assessed by the fracture liaison service. Patients had magnetic resonance imaging or bone scan when there was history of low back pain following the injury or lumbosacral tenderness on clinical examination.
Results - The mean length of stay for all patients was 45 (±35) days. Mortality rate was 10.4%. A significant relationship was found between low back pain and a positive finding of sacral fracture. Patients with combined PROFs and SOFs showed significantly longer length of stay than those with isolated PROFs.
Conclusions - The presence of low back pain and tenderness in patients who had low-impact pelvic injuries was highly suggestive of the presence of an associated SOF. There was a high association between sacral and PROFs. The length of stay of patients with PROFs associated with sacral osteoporotic fractures was significantly longer than that of patients with PROFs only. Therefore, we recommend considering the high association between SOFs and PROFs in planning the management and rehabilitation of patients with POFs
Neutropenia in cancer patients, risk prediction models of neutropenia, and supportive measures
No full textEpidemiology studies the causes and distribution of population health and disease conditions in defined populations. It identifies risk factors for disease which may help to prevent disease and promote health.
Each year, the American Cancer Society describes the epidemiology of cancer in the USA. Breast cancer and CLL are the most common cancers in women and adults, respectively. European data for CLL are limited. For both cancers, chemotherapy is an important treatment option. But side effects such as neutropenia and infections remain the principal dose-limiting toxicities, which may affect the effectiveness of cancer chemotherapy. Several studies evaluated risk factors for chemotherapy-induced neutropenia (CIN; absolute neutrophil count [ANC] <1.5x10^9/L) and febrile neutropenia (FN; ANC <0.5x10^9/L and oral temperature =38° for more than 1 hour): e.g. older age, recent infection, prior chemotherapy, and planned relative dose intensity greater than 85% of standard chemotherapy dosing. The prophylactic use of granulocyte colony-stimulating factors (G-CSFs) has been shown to be protective.
Based on the above mentioned risk factors, a number of risk prediction models have been developed over the years. Very often, the risk prediction models considered patient-related, tumour-related, treatment-related, or genetic factors. The majority of these models are not validated using an independent dataset. Systematic reviews of G-CSFs to prevent neutropenia are available, but do not include new long-acting G-CSFs or observational study designs.
To address the epidemiology of CLL, the incidence and risk factors of CIN and FN, and to develop and externally validate a risk prediction model for the occurrence of FN including a broad range of risk factors, three quantitative studies were conducted and published. The fourth published study summarised the efficacy, effectiveness and safety of G-CSFs for the prevention of CIN and FN.
For the first study, the author conducted a cohort analysis of the UK Clinical Practice Research Datalink (CPRD) to identify the epidemiology of CLL, the incidence of neutropenia, and changes in medical resource utilisation of CLL patients. Due to limited data regarding the incidence of neutropenia, the study focused on the epidemiology of CLL and medical resource utilisation of CLL patients. The incidence of CLL was 6.2 per 100’000 person-years and remained stable between 2006 and 2011. Medical resource utilisation in CLL patients increased over the time period from 2000 to 2012. Primary care data from the UK CPRD seemed to be valid to determine the incidence of CLL. These data may not reflect the total of medical resource use in CLL patients as chemotherapy and treatment of related complications such as infections and neutropenia are mainly performed in secondary or tertiary care.
The second study addressed the identification of risk factors and the development of a risk prediction model for FN in a hospital-based breast cancer cohort. Risk factors for FN were lower platelet count and haemoglobin, higher alanine aminotransferase (ALT), and specific allele variants of two single nucleotide polymorphisms (SNPs) in a gene involved in multidrug resistance. Genetic testing beforehand might be helpful to identify patients at a very high risk of FN. Predictive performance of the model was improved by adding genetic information but overall remained limited.
The third study used an available risk prediction model for FN in Non-Hodgkin lymphoma (NHL) patients and applied its prediction rules to an independent dataset of NHL patients. Age, weight, baseline white blood cell count, and planned chemotherapy dose were confirmed to predict the risk of FN. However, there was a decrease of the predictive performance in the independent validation dataset. This limits its use in clinical practice. But if successful risk prediction models are developed and externally validated, these may help to optimally target prophylaxis with G-CSFs to those patients at high risk of FN.
Finally, a systematic literature review was conducted to identify studies evaluating the efficacy, effectiveness and safety of G-CSFs in the prevention of CIN and FN. Most studies showed better efficacy and effectiveness for the long-acting pegfilgrastim than daily filgrastim. Efficacy and safety profiles of new long-acting G-CSFs such as lipegfilgrastim and balugrastim were comparable to pegfilgrastim. In times of increasing health care costs and scarce resources, the cost-efficient use of supportive measures is necessary.
The studies this work is based on showed that the availability of and access to appropriate data sources are necessary to develop and systematically validate risk prediction models. The findings contribute to the development of an evidence-based, efficient and cost-efficient approach to prevent neutropenia in cancer patients
A Rare Case Resulting from Fungal Intoxication: Acute Pancreatitis
No full textA Rare Case Resulting from Fungal Intoxication: AcutePancreatitisali halıcı1 , mehmed ulu11kutahya health scienceuniversityBackgroundand aim: Mushrooms have been consumed by humans since theearliest periods of history. Of the more than 10,000 mushroom species knowntoday, approximately 100 are thought to be poisonous(1). Mushroomscollected from nature and consumed by local people, especially in spring,sometimes cause intoxication. This situation is most often caused by accidentalconsumption of toxic mushrooms due to their similar color and shape (2).Although the patient's clinic varies depending on the mushroom eaten and thetoxin exposed, most cases are mild to moderate and death rarely occurs. Themost common conditions are gastroenteritis, hepatic involvement, renalinvolvement and central nervous system involvement (3). While symptomsoccurring within the first 6 hours after mushroom ingestion rarely indicateserious toxicity, symptoms occurring after 6 hours are much more likely to be associatedwith lethal toxicity (1). Mushroom intoxication can rarely cause pancreatitis.In this article, the patient who applied to the emergency department withcomplaints of nausea, vomiting and abdominal pain after eating mushrooms andwas diagnosed with pancreatitis will be discussed together with her/hisclinical, laboratory results and outcome.Case: A61-year-old female patient had no known history of disease and applied to theemergency department with complaints of nausea, vomiting, diarrhea and abdominalpain. The patient was admitted to the emergency room at 08:00, and in theanamnesis taken from the patient, it was learned that he ate 4-5 mushroomscalled "morel" at around 14:00 the previous day, and that hiscomplaints of nausea, vomiting, and abdominal pain began around 23:30 at night.When the patient was admitted to the emergency department, his generalcondition was good, he was conscious, his vitals were stable with TA: 110/50,pulse: 88/min, respiratory rate 19/min, SpO2: 97. During the patient'sexamination, tenderness was detected in the right upper quadrant, but noabnormalities were detected in other examinations. When the patient'slaboratory results were examined, creatinine: 1.33, direct bilirubin: 1.12,indirect bilirubin: 2, total bilirubin: 3.1, AST: 894, ALT: 400, GGT: 274,amylase: 3358, lipase: 6746, WBC: 17.49, Neu: It was determined as 15.84troponin: 12 CRP: 19.6 lactate: 3.2, INR: 1.02. No feature was detected in theabdominal USG. The patient was consulted by gastroenterology and internalmedicine and his clinical findings were evaluated as compatible with toxicpancreatitis. Intensive care follow-up was recommended because the patient, whoalso had elevated liver enzymes, was at risk of acute hepatic failure. TheNational Poison Advisory Line was called, and liver enzyme monitoring and urineoutput monitoring were recommended to be completed within 5 days. The patientwas interned in the intensive care unit and was followed up in the intensivecare unit for 5 days. After his general condition was good, his vitals werestable, and his laboratory disorders regressed, he was transferred to theinternal medicine service. The patient was followed up for 7 days in theinternal medicine service and was discharged with the recommendation of afollow-up examination, as his clinical condition remained stable. Gyromitra Esculenta a: false morel mushroom b:morel mushroomDecisions: In mushroom intoxications, the clinical picturevaries depending on the type of mushroom and the amount of toxin consumed bythe patient. (one). Benign gastroenteritis, where symptoms typically beginwithin the first 3 hours after ingestion, is one of the most common clinicalconditions. Various types of fungi can cause this condition, and patients maycomplain of nausea, vomiting, abdominal pain and diarrhea. It is usuallyself-limiting and may rarely lead to hypovolemic shock in the elderly andchildren with low tolerance to fluid loss (4,5). Although our patient hadgastroenteritis symptoms such as nausea, vomiting, diarrhea, and abdominalpain, which started approximately 10 hours after mushroom ingestion, this didnot cause a hemodynamic disorder. Species containing psilocybin and psilocin,known as magic mushrooms, have 5-Hydroxytryptamine (5-HT) receptor It can causehallucinations by acting on it. Hallucinations occur within 1-2 hours afteringestion and can continue for 4-12 hours depending on the amount of toxiningested (4). Tachycardia and dilated pupils may be detected in patients duringphysical examination (6,7). The reasons why patients who consume magicmushrooms apply to the emergency department may be anxiety, panic, and paranoia(8). Other fungal groups that affect the central nervous system are speciescontaining Gyromitrin and can trigger seizures due to GABA decrease in thecentral nervous system (4). No neurological symptoms or findings were observedin our patient. Species containing muscarine may cause cholinergic toxicity,and patients may experience abdominal pain, sweating, salivation, lacrimation,bronchospasm, bronchorea and bradycardia, which typically begins 30 minutesafter ingestion. This effect occurs as a result of muscorin's stimulation ofpostganglionic cholinergic neurons. Unlike other etiologies that causecholinergic toxicity, such as organophosphate poisoning, it has a benign courseand does not usually cause a lethal clinic (1,4). No symptoms or findingssuggestive of cholinergic toxicity were found in our patient's clinic.Amatoxin-containing species cause RNA polymerase 2 enzyme inhibition and affectprotein metabolism at the cellular level and are among the most toxic fungalspecies known (4,9). Amatoxins are heat resistant and their structure is notdamaged by cooking. The lethal dose is low and even a single mushroom ingestioncan be fatal (10). In the first phase, gastroenteritis occurs within 6-12 hoursafter ingestion. The second phase is observed 24-36 hours after ingestion and aregression in the patient's symptoms is detected. However, liver damage beginsat this stage and is reflected in laboratory results. The third phase occurs 48hours after ingestion and progressive liver failure occurs. Coagulopathy,acidosis, hepatic encephalopathy and hemorrhages are the pathologies expectedat this stage. These patients may need liver transplantation within 4-7 days,and if this treatment cannot be achieved, death may occur (1,9). In ourpatient, elevated liver enzymes were detected at the first admission, but thesevalues showed a continuous downward trend during follow-up and returned tonormal levels before discharge. Species containing orelenin can causenephrotoxicity, but this effect can be seen 1-2 weeks after ingestion. Overtneuroleucine seen in some amanita species can also create a clinical picturethat begins with gastroenteritis and progresses to renal damage within 12-24hours (1,4). Our patient has a moderate elevation of creatinine, which may bedue to fungal toxicity or may have occurred due to prerenal acute kidney injurydue to fluid loss. Rhabdomyolysis, disulfram-like reaction, erythromyalgia anddermatitis are among the clinical conditions reported due to mushroomintoxication (1,4, 11,12,13). No clinical or laboratory findings were found inour patient that would suggest these diagnoses. Acute pancreatitis is one ofthe rare clinical conditions reported very rarely as a result of mushroomintoxication (14). Our patient's clinic, physical examination and laboratoryresults are compatible with acute pancreatitis. Since no other etiologicalfactor was detected in the evaluations that would explain the patient's clinic,the cause of acute pancreatitis was thought to be due to mushroom intoxication.When looking at the literature, it was seen that the mushroom described by thepatient with the scientific name Morchella Esculenta, locally known as"morel", is a consumable, delicious and nutritious type of mushroom(15,16). It has been reported in the literature that the toxic mushroom withthe scientific name Gyromitra Esculenta, known locally as "falsemorel", is consumed by patients mistaking it for Morchella Esculenta(1,17,18). Although the two mushrooms are similar in shape, there is only adifference in color. Impairment of consciousness, central nervous systemstimulation, agitation and seizures due to ingestion of toxins containinggyromitrin. It is reported in the literature that it may cause clinicalconditions such as liver and kidney damage and methemoglobinemia (19,20). Ithas also been reported in the literature that acute pancreatitis may occur veryrarely (21). The patient's clinic is expected to be seen 6-12 hours after toxiningestion (17). The amount of mushroom consumed determines the patient'sclinic, and central nervous system effects occur at high doses (19).Considering all these data, it is thought that our patient's clinical picturemay be compatible with gyromitrin toxicity. ConclusionPatients with a historyof eating mushrooms periodically apply to emergency services with variouscomplaints. The onset of symptoms within 6 hours of mushroom ingestion mayindicate serious toxicity. Although the mushroom type popularly known as"morel" is a nutritious mushroom that can be consumed, "falsemorel", which is very similar to this mushroom in shape and color, cancause impaired consciousness, seizures, liver and kidney damage, depending onthe amount taken. It would be useful for clinicians to keep gyromitrin toxicityin mind in cases of idiopathic hepatitis and pancreatitis.Notlar (Opsiyonel): 1-Uptodate. ClinicalManifestations and Evaluation of Mushroom Poisoning. [Internet]Erişim:https://www.uptodate.com/contents/clinical-manifestations-and-evaluation-of-mushroom-poisoningErişim Tarihi : 03.09.20232-Brandenburg WE, Ward KJ. Mushroom poisoningepidemiology in the United States. Mycologia. 2018 Jul-Aug;110(4):637-641. doi:10.1080/00275514.2018.1479561. Epub 2018 Jul 31. 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In:Goldfrank's Toxicologic Emergencies, 11th ed, Nelson LS, Howland M, Lewin NA,Smith SW, Goldfrank LR, Hoffman RS (Eds), McGraw-Hill Education, 2019.p.1582.8-Kopra EI, Ferris JA, Winstock AR, Young AH, Rucker JJ. Adverseexperiences resulting in emergency medical treatment seeking following the useof magic mushrooms. J Psychopharmacol. 2022 Aug;36(8):965-973. doi:10.1177/02698811221084063. Epub 2022 Apr 7. PMID: 35388724; PMCID:PMC9353971.9-Kieslichova E, Frankova S, Protus M, Merta D, Uchytilova E, FronekJ, Sperl J. Acute Liver Failure due to Amanita phalloides Poisoning:Therapeutic Approach and Outcome. Transplant Proc. 2018 Jan-Feb;50(1):192-197.doi: 10.1016/j.transproceed.2017.11.032. PMID: 29407307.10-Vo KT, MontgomeryME, Mitchell ST, Scheerlinck PH, Colby DK, Meier KH, Kim-Katz S, Anderson IB,Offerman SR, Olson KR, Smollin CG. Amanita phalloides Mushroom Poisonings -Northern California, December 2016. MMWR Morb Mortal Wkly Rep. 2017 Jun2;66(21):549-553. doi: 10.15585/mmwr.mm6621a1. PMID: 28570504; PMCID:PMC5657817.11-Gupta AK. Disulfiram and disulfiram-like reactions. In:Goldfrank's Toxicologic Emergencies, 11th, Nelson LS, Howland M, Lewin NA,Smith SW, Goldfrank LR, Hoffman RS (Eds), McGraw-Hill Education, 2019.p.1172.12-Nakajima N, Ueda M, Higashi N, Katayama Y. Erythromelalgia associatedwith Clitocybe acromelalga intoxication. Clin Toxicol (Phila). 2013Jun;51(5):451-4. doi: 10.3109/15563650.2013.792933. Epub 2013 May 3. PMID:23641936.13-Diaz JH. Syndromic diagnosis and management of confirmed mushroompoisonings. Crit Care Med. 2005 Feb;33(2):427-36. doi:10.1097/01.ccm.0000153531.69448.49. PMID: 15699849.14-Karahan S, Erden A,Cetinkaya A, Avci D, Ortakoyluoglu AI, Karagoz H, Bulut K, Basak M. AcutePancreatitis Caused By Mushroom Poisoning: A Report of Two Cases. J InvestigMed High Impact Case Rep. 2016 Jan 21;4(1):2324709615627474. doi:10.1177/2324709615627474. PMID: 26835473; PMCID: PMC4724762.15-Tietel Z,Masaphy S. True morels (Morchella)-nutritional and phytochemical composition,health benefits and flavor: A review. Crit Rev Food Sci Nutr. 2018 Jul24;58(11):1888-1901. doi: 10.1080/10408398.2017.1285269. Epub 2017 Jul 21.PMID: 28350213.16-Gursoy N, Sarikurkcu C, Cengiz M, Solak MH. Antioxidantactivities, metal contents, total phenolics and flavonoids of seven Morchellaspecies. Food Chem Toxicol. 2009 Sep;47(9):2381-8. doi:10.1016/j.fct.2009.06.032. Epub 2009 Jun 27. PMID: 19563856.17-Wennig R, EyerF, Schaper A, Zilker T, Andresen-Streichert H. Mushroom Poisoning. DtschArztebl Int. 2020 Oct 16;117(42):701-708. doi: 10.3238/arztebl.2020.0701. PMID:33559585; PMCID: PMC7868946.18-Horowitz KM, Kong EL, Horowitz BZ. GyromitraMushroom Toxicity. 2023 Mar 27. In: StatPearls [Internet]. Treasure Island(FL): StatPearls Publishing; 2023 Jan–. PMID: 29262102.19-Saviuc P, Harry P,Pulce C, Garnier R, Cochet A. Can morels (Morchella sp.) induce a toxicneurological syndrome? Clin Toxicol (Phila). 2010 May;48(4):365-72. doi:10.3109/15563651003698034. PMID: 20507248.20-Perisetti A, Raghavapuram S,Sheikh AB, Yendala R, Rahman R, Shanshal M, Thein KZ, Farooq A. MushroomPoisoning Mimicking Painless Progressive Jaundice: A Case Report with Review ofthe Literature. Cureus. 2018 Apr 5;10(4):e2436. doi: 10.7759/cureus.2436. PMID:29896444; PMCID: PMC5995584.21-Brayer A. (2020). Mushroom Poisoning. EditorJudith E. Tintinalli. Tintinalli’s Emergency Medicine. 9th Edition. McGraw-HillEducation. United States of America. Page 1404-1409.Keywords
