Diagnostic accuracy of adropin as a preliminary test to exclude acute pulmonary embolism: a prospective study

Background This study aims to investigate the diagnostic accuracy of adropin as a biomarker to exclude the diagnosis of acute pulmonary embolism (PE). Methods Patients admitted to the emergency department of a tertiary health centre between August 2019 and August 2020 and diagnosed with PE were included in this prospective cohort study. The amount of serum adropin was determined in patients with (PE) and compared with that of healthy volunteers. Receiver operating characteristic analysis was performed with the obtained data, and the area under the curve (AUC) with a 95% confidence interval was determined. The parameters of diagnostic accuracy for PE were determined. Results A total of 57 participants were included in the study (28 controls and 29 PE patients). The mean adropin level in the PE group was 187.33 +/- 62.40 pg/ml, which was significantly lower than that in the control group (524.06 +/- 421.68 pg/ml) (p < 0.001). When the optimal adropin cut-off value was 213.78 pg/ml, the likelihood ratio of the adropin test was 3.4, and the sensitivity of the adropin test at this value was 82% with specificity of 75% (95% CI; AUC: 0.821). Conclusion Our results suggest that adropin may be considered for further study as a candidate marker for the exclusion of the diagnosis of PE. However, more research is required to verify and support the generalizability of our study results

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Experimental Study on Km-Range Long-Distance Measurement Using Silicon Photomultiplier Sensor with Low Peak Power Laser Pulse

Silicon photomultipliers (SiPM) have drawn considerable attention due to their superior sensitivity with a multi-pixel matrix structure. SiPM can be the choice of a detector for time of flight measurement which is one of the most promising applications in the field of light detection and ranging (LiDAR). In this work, we take advantage of SiPM and attempt to measure longer distances with a low peak power semiconductor laser under outdoor sunny and windy conditions. We achieved a long detection range of a few kilometers by using SiPM and a laser with a pulse energy of 9 &micro;j at 0.905 &micro;m and 3 dB enhancement in signal to noise ratio (SNR) by the implemented signal extraction algorithm. From the simulation performed, the minimum SNR value and detection probability were also determined for the outdoor field tests

Varfarin Doz Aşımına Bağlı Kanamalarda Hızlı ve Etkin Bir Tedavi Yöntemi: Plazma Kompleks Konsantresi

Özet81 yaşında kadın hasta halsizlik, iştahsızlık, siyah renkte dışkılama şikâyeti ile acil servise başvurdu. Protez kalp kapağı nedeniylede 5 yıldır varfarin kullandığı öğrenildi. Hipotansif olan hastanın rektal tuşesinde melena vardı. Hastanın kan tetkiklerinde Hgb: 5.14g/dl, INR: 12.08 tespit edildi. Hastaya acil serviste te- davi olarak K vitamini, plazma kompleks konsantresi, ve proton pompa inhibitörü uygulandı. İleri tetkik ve tedavi amacıyla yoğun bakıma yatırılan hastanın ertesi günkü kan tetkiklerinde Hgb: 8.84g/dl, INR: 3,83 tespit edildi. Gastroskopisinde aktif kanama odağı tespit edilmeyen ve hemoglobin değerinde düşme olmayan hasta hastaneye yatışının 2. gününde düşük molekül ağırlıklı heparin tedavisine başlanarak taburcu edildi. Varfarin; atrial fibrilasyon, mekanik kalp kapağı kullanımı, protein C-S eksikliği ve antifosfolipid antibody hastalığı gibi durumlarda halen kullanımına ihtiyaç duyulan bir ilaçtır. Endike olduğu durumların ortak patolojisi trombüs oluşumuna ve embolilere aşırı yatkınlıktır.Acil servislerde varfarin doz aşımına bağlı kanaması olan hastalara müdahale ederken hastaya ve ihtiyaçlarına göre karar vermek gerekir. Bir taraftan hasta- nın hemodinamisini sağlamak için kanamayı durdurmak diğer taraftan da varfarin kullanımına neden olan altta yatan nedene bağlı tromboemboli riskini göz ardı etmemek gerekir. Bu nedenle mevcut INR seviyesini hedeflenen INR seviyesine mümkün olan en hızlı ve en güvenli şekilde indirmek gerekmektedir. Sonuç olarak travma ve ilaca bağlı koagülopatili hastalarda bu durumu düzeltmek için zamanında ve protokollü yaklaşımın hastaların prognozlarını iyileş- tirebileceğini düşünmekteyiz.Anahtar kelimeler:&nbsp;acil servis, akut kanama, varfarin dozaşımıA 81 years old female presented with weakness, anorexia and black colored defecating. She uses warfarin for 5 years because of prosthetic heart valve. On clinical examination she had hypotension and melena. Blood tests revealed Hemoglobin: 5,14 g/dl and INR:12,08. Vitamin K, Prothrombin complex con- centrate and Proton pomp inhibitor was given as treatment in emergency service. The patient hospitalised in intensive care unit for further examination and treatment. Next day blood tests revealed Hemoglobin: 8,84 g/dl and INR:3,83. The patient with no active bleeding focus on gastroscopy and with no decrease in hemoglobin tests discharged from hospital on 2nd day of hospitalization. Low-molecular-weight heparin treatment started.Warfarin is a drug that still needed for treatment of atrial fibrillation, mechanical heart valves, protein c-s deficiency and antiphospholipid antibody dis- ease. Common pathology of these diseases is predisposition to embolism and thrombus formation. In the emergency services, we need to make decisions according to the patient while treating patients who have warfarin overdose bleeding. On the one hand to stop the bleeding to ensure the patient's he- modynamics, on the other hand, the risk of thromboembolism caused by the use of warfarin should not be ignored. Therefore, it is necessary to reduce the current INR level to the targeted INR level as quickly and safely as possible. In conclusion, we suggest that a timely and protocol-based approach to treat coagulapathy in patients with trauma and drug-induced coagulapathy may improve patients’ prognosis.Key words:&nbsp;acute bleeding, emergency service, warfarin overdose</div

Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes.

Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Turkiye. Clinical and paraclinical features were compared between patients with dis-ease onset before 12 years (earlier onset) and >= 12 years (later onset) as well as between our current (2015-2021) and previous (< 2015) cohorts. Results: A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset < 12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. Conclusion: Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought