Early Prediction of In-Hospital Mortality in Patients with Acute Infections: Development of the Acute Severity Infection Score (ASIs)

Introduction: Early prognostic stratification in patients hospitalized for acute infections is a major clinical challenge. Existing tools, such as the Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI), were not specifically developed for this purpose. Objectives: We aimed to design a novel multidimensional prognostic score, the Acute Severity Infection score (ASIs), to predict in-hospital mortality using routinely available clinical data. Methods: This retrospective cohort study included 149 adults admitted with acute infections to an internal medicine unit between January 2023 and December 2024. In-hospital all-cause mortality was the primary outcome. Demographic, clinical and laboratory variables obtained within 12 h of admission were analyzed. Variables significantly associated with mortality in both univariate and multivariate regression were incorporated into the ASIs, which ranges from 0 to 7 points. Its performance was compared to SOFA and CCI using ROC curve and Cox regression models. Results: In-hospital mortality occurred in 25.5% of patients. Five variables were independently associated with mortality: lactate ≥ 2.2 mmol/l, frailty composite (confined to bed status, long-term oxygen therapy or advanced malignancy), hemodynamic instability or need for non-invasive ventilation, age ≥ 79.5 years and symptom onset ≥ 3.5 days before admission. ASIs showed the highest discriminative ability (AUC = 0.883) compared to SOFA (AUC = 0.612) and CCI (AUC = 0.742). In multivariate models including all three scores, only ASIs retained independent prognostic significance. Conclusions: The ASIs is a simple tool for early prognostic stratification of patients hospitalized with acute infections. It outperforms existing scores and may enhance clinical decision-making in real-world medical settings

Two dimensional switched beam antenna at 28 GHz for fifth generation wireless system

Fifth generation (5G) wireless system is expected to enable new device-to-device (D2D) and machine-to-machine (M2M) applications that will impact both consumers and industry. Moreover, for efficient M2M communication, both one dimensional (1-D) and two dimensional (2-D) beam switching is highly needed for high data-rate wireless radio links. A planar array with 2-D beam switching capabilities is highly desirable in 5G system. This thesis proposes a new technique of achieving simple and cost effective 2-D beam switching array antenna at 28 GHz for 5G wireless system. The technique involves lateral cascading of Butler matrix (BM) beamforming network (BFN). However, designing a planar BM at 28 GHz that will allow K-connector is not a trivial issue because the distances between the ports are X/4 electrical length apart. Nevertheless, two branch line coupler (BLC) with unequal ports separation at 28 GHz on a single substrate are designed and applied to design 1-D switched beam antennas based on BLC and 4 * 4 BM. Then two of these antennas are laterally cascaded to achieve 2-D beam switching antenna. This novel concept is the basis for choosing BM BFN in the design. The proposed 1-D array antennas on BLC and BM have wide measured impedance bandwidth of 18.9% (5.3 GHz) and 21.7% (6.1 GHz) and highest gain of 14.6 dBi and 15.9 dBi, respectively. The 2-D switched beam antenna on cascaded BLC has highest realized gain of 14.9 dB, radiation efficiency of 86%, 86.8%, 85.5%, and 83.4% at ports 1 to 4, respectively. The switching range of from -25o to +18° in the x-z plane and from -18o to 24o in the y-z plane, while the 2-D switched beam antenna based on cascaded 4 * 4 BM has switching range of -41o to 43o in the x-z plane and -43o to 42o in the y-z plane with highest realized gain of 14.4 dBi. The proposed antennas have great potentials for 5G wireless communication system applications

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

Study of immunological activity and hemostasiological features in rats with experimental antiphospholipid syndrome

Antiphospholipid syndrome (APS) is a systemic autoimmune disease, which is characterized by thrombotic or obstetric events characterized by the presence in the blood of patients of a high titer of antibodies to natively charged membrane phospholipids, as well as to glycoproteins associated with them. The role of etiological factors, triggering mechanisms, especially at the initial stages of APS formation, is not clearly defined that’s why the aim of our work was to study of immunological activity and hemostasiological features in rats with experimental antiphospholipid syndrome. In animals with simulated APS, a positive microprecipitation reaction with cardiolipin antigen was observed, which indicated the development of APS. The development of hypercoagulation due to both the vascular and platelet and coagulation links of the hemostasis system was also noted. Established changes in hemocoagulation indicators in APS occur due to the interaction of blood clotting factors with APA

Acquired hemophilia A secondary to SARS-CoV-2 pneumonia: a case report

The acquired hemophilia A (AHA) is a life-threatening condition. The incidence of AHA is extremely low, which requires a multidisciplinary approach to diagnosis and treatment. This is case report of 73-year-old man who presented with AHA secondary to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pneumonia. The patient had extensive skin bleeding and hematomas. In the coagulation screening tests activated partial thromboplastin time (APTT) was prolonged with normal prothrombin time (PT), which was indication for further investigation. The APTT in a mixing study with normal plasma did not correct so clotting factors inhibitors were suspected. With signs of bleeding, extremely low factor VIII (FVIII) activity (2%) and presence of FVIII inhibitors, AHA was diagnosed and treatment initiated. Patient was treated with factor eight inhibitor bypassing agent (FEIBA) for three days, followed by long-term corticosteroid and cyclophosphamide therapy. Malignant and autoimmune diseases as the most common causes of AHA were ruled out. The patient had a good response to therapy with gradual normalization of APTT and FVIII activity. To the best of our knowledge, the present case is the first reported case of de novo AHA after SARS-CoV-2 pneumonia. The diagnosis of AHA should be suspected in a patient with bleeding into the skin and mucous membranes without a previous personal and family history of bleeding, and with isolated prolonged APTT. It is important to investigate any isolated prolongation of APTT in cooperation with clinical laboratory experts

Patterns of infections in older patients acutely admitted to medical wards: data from the REPOSI register

11N/Apartially_openopenRossio, Raffaella; Ardoino, Ilaria; Franchi, Carlotta; Nobili, Alessandro; Mannuccio Mannucci, Pier; Peyvandi, Flora; Biolo, G.; Zanetti, M.; Guadagni, M; Zaccari, M.; Chiuch, M.Rossio, Raffaella; Ardoino, Ilaria; Franchi, Carlotta; Nobili, Alessandro; Mannuccio Mannucci, Pier; Peyvandi, Flora; Biolo, G.; Zanetti, M.; Guadagni, M; Zaccari, M.; Chiuch, M

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria