BACKGROUND/OBJECTIVE

Although nutritional assessment tools have been available internationally, local data for their use in foreseeing adverse outcomes among admitted patients are currently unavailable. The primary objective of this study was to determine the association of nutritional status using Short Nutritional Assessment Questionnaire (SNAQ) and malnutrition risk using the MST (Malnutrition Screening Tool) with ICU admission and in-hospital mortality.

This was a prospective-cohort study which included 122 purposively-selected adult participants who were non-intubated, admitted for medical and surgical managements, stayed for at least 24 hours, had no COVID-19 infection, and were not admitted in any critical care unit. The SNAQ and MST questionnaires, which are validated tools and consists of  two to three easy-to-answer questions, were used among the participants and their scores were tallied in order to get their nutritional status and malnutrition risk. Primary endpoints measured were length of hospital stay, incidence of mortality, and ICU admission rate. Comorbidities were taken into account using the Charlson Comorbidity Index.

Categorizing the SNAQ scores showed 33.61% were severely malnourished which was similar when using the MST classification, wherein 34.43% were at risk of malnutrition. None of the participants were admitted to the intensive care unit (ICU). Malnutrition risk and nutritional status was not significantly associated with 30-day in-hospital mortality (p >0.05). On the other hand, results of the Cox proportional hazards showed that SNAQ and MST significantly predicted the hazard of 30-day in-hospital mortality, increasing the hazard of mortality by 2.58 times and 3.67 times, respectively, for every 1-unit increase in SNAQ and MST scores. Similarly, nutritional status using the SNAQ classification indicated the severely malnourished category significantly predicted the hazard of mortality, increasing it by 9.22 times for those who are severely malnourished. Also, malnutrition risk using the MST classification indicated that those who were at risk of malnutrition were 9.80 times at greater hazard of mortality than those who were not at risk of malnutrition.

The MST and SNAQ classification are screening tools for nutritional status (SNAQ) and malnutrition risk (MST) that can be administered at the onset of the patient’s hospital course and have been demonstrated in this study to predict 30-day in-hospital mortality. It is important to note that none of the patients included in this study required intensive care unit admission.

BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

Retrospective cohort study.

Pediatric patients aged 1 month to 18 years seen at the ED.

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

OBJECTIVES

To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality.

Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity.

In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity.

The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.

BACKGROUND AND OBJECTIVE

Patients with liver cirrhosis have an increased risk for poor postoperative outcomes after non-hepatic surgery, with liver dysfunction being the most important predictor of poor outcomes. This study aims to determine the association of the albumin-bilirubin (ALBI) grade, aspartate aminotransferase-platelet ratio index (APRI) score, and ALBI-APRI score with postoperative outcomes among cirrhotic patients who have undergone non-hepatic surgery.

This was a retrospective cohort study involving 34 patients. Age, ASA class, urgency of surgery, etiology of liver cirrhosis, preoperative Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, ALBI grade, APRI score, and ALBI-APRI score were documented. The outcomes analyzed were postoperative hepatic decompensation (POHD) and in-hospital mortality. Bivariate analysis using the Mann-Whitney U test and Fisher’s exact test was performed. Receiver operating characteristic (ROC) curve analysis was performed to compare the ability of the liver scoring systems to predict the occurrence of study outcomes. Binary logistic regression was performed to measure the odds ratio.

The ALBI grade and ALBI-APRI score were significantly associated with both POHD and in-hospital mortality. Both scores were non-inferior to the CTP and MELD scores in predicting study outcomes. Compared to CTP and MELD scores, the ALBI grade was more sensitive but less specific in predicting POHD and as sensitive but more specific in predicting in-hospital mortality. The ALBI-APRI score was less sensitive but more specific than the ALBI grade in predicting both POHD and in-hospital mortality.

The ALBI grade and ALBI-APRI score were both associated with postoperative hepatic decompensation and in-hospital mortality and were noninferior to the CTP score and MELD score in predicting short-term in-hospital outcomes among cirrhotic patients after non-hepatic surgery.

INTRODUCTION

The social determinants of health refer to an individual's social, political, and economic situation and environment, which can have an impact on their health. On the other hand, disability-adjusted life years (DALYs) reflect the mortalities and morbidities incurred due to disease and injury.

This study aims to analyze the social determinants of health indicators and their association with communicable, non-communicable, and injury-related DALYs and deaths.

Data from World Health Organization, World Bank, and International Labor Organization were used and considered for the 17 Social Determinants of Health categories. Logistic regression was used to determine the relationship of social determinants of health indicators with communicable, non-communicable, and injury-related DALYs and deaths.

Results show that an increase in the population, monetary poverty, adult illiteracy, and fine particulate matter increase IPNN DALYs. This study also found correlations of socioeconomic factors to NCD deaths and DALYs attributable to the environment. NCD DALYs and deaths are found to increase with the number of poor living with 3.10 dollars a day, while median daily per capita income, and increase in persons above retiring age receiving pension decrease NCD DALYs attributable to the environment. Focusing on injury DALYs and deaths, an increase in the number of poor living at 3.10 dollars a day, non-agricultural informal employment, and total average concentration of f ine particulate matter increases injury DALYs while the latter is observed to decrease when there is an increase in the medial daily per capita income, agricultural employment outside the formal sector, and vulnerable persons covered by social assistance.

Socio-economic factors such as income, employment, education, and social welfare program affect morbidity, disability, and mortality.

BACKGROUND

Social determinants of health are wider set of forces and systems that greatly influence an individual’s health outcomes.

This study aims to determine the socio-economic indicators that influence certain health indicators focusing on maternal and children under-5 health.

Selected data from from the World Health Organization (WHO), World Bank, and International Labor Organization (ILO) were primarily used to model health outcomes such as mortality rates, disability-adjusted life years, and deaths and injuries due to occupational injuries. A total of 194 countries were considered as respondents in this study. Linear hierarchical multiple regression was used to determine the relationship of social determinants of health on life expectancy at birth, maternal mortality ratio (per 100,000 live births), under-5 years mortality ratio, prevalence of overweight in children under-5 years, and death rate (per 100,000 population).

Data from 194 countries shows that the global average life expectancy is 55.7 years. The global average maternal mortality ratio is 1119.509 per 100,000 live births, and maternal mortality is significantly increased by factors such as increase in total vulnerable employment, total unemployment, and CPIA gender equality rating. Focusing on children’s health outcomes, the global average under-5 mortality rate was 102.247 per 100,000 live births. Mortality rate for children under-5 increases with total vulnerable employment and total unemployment, while adult literacy rate, 1 medical doctor per 10,000 population, and food safety level decreases under-5 mortality rates. The global overweight prevalence in children under-5 is 10.389%. The increase in average monthly earnings of employees working in service and sales increases its prevalence. For death rate, the global average is 682.818 per 100,000 population. This is further positively affected by an increase in rural population and total unemployment. On the other hand, adult literacy rate decreases death rate.

Socio-economic factors such as income, education, employment, and government support influence maternal and children under-5 health indicators. Thus, programs, projects, and activities that aim to positively affect the health of the public should be holistic and should also focus on positively altering the health behavior of the public.

BACKGROUND

Laparoscopic surgery is a widely accepted treatment modality, but with few disadvantages.

To describe the demographic, clinical, tumor, and operative characteristics of patients with colorectal cancer who underwent laparoscopic surgery.

Descriptive study.

47 males and 40 females, aged 19 years and older with colorectal cancer who underwent laparoscopic colorectal surgery.

Surgery Department - Colorectal Surgery section, Southern Philippines Medical Center, Davao City, August 2014 to August 2018.

Demographic and clinical characteristics, tumor profile, and operative outcomes.

This study analyzed 87 patients with colorectal cancer who underwent laparoscopic colorectal surgery. The participants had a mean age of 56.55 ± 11.99 years, with a slight male predominance (54.02%). Most patients resided within Davao Province (72.41%) and commonly presented with comorbidities, particularly hypertension (22.99%). Tumors were mostly located in the rectum (62.07%), and the majority of patients had advanced disease, with 59.77% classified as stage IIIB. Advanced tumor invasion was common, with 60.92% of patients presenting with T3 and 32.18% with T4 disease, while lymph node involvement was observed in 75.86% of cases. Distant metastasis was present in 11.49% of patients, most frequently involving the liver. Low anterior resection was the most commonly performed procedure (39.08%). The mean operative time was 278.89 ± 72.76 minutes, with a mean blood loss of 476.73 ± 341.86 mL and a conversion-to-open rate of 23.26%. Postoperative outcomes showed a morbidity rate of 26.44% and a mortality rate of 3.45%, with patients resuming oral intake after a mean of 4.02 ± 2.17 days and a mean hospital stay of 8.35 ± 6.38 days.

Laparoscopic colorectal surgery at our institution was performed among middle-aged patients, mostly males. Rectal cancer was the most common diagnosis, with most patients presenting with advanced stage IIIB disease, and low anterior resection was the most frequently performed procedure. The mean operative time was 279 minutes, with a conversion-to-open rate of nearly 25%. The mean intraoperative blood loss was 476 mL. Oral intake was resumed after a mean of 4 days. The mean hospital stay was 8 days, with low mortality despite a moderate morbidity rate.

OBJECTIVES: Hepatocellular carcinoma is one of the most common primary malignant tumors with the third highest mortality rate worldwide. This study aims to identify key genes associated with hepatocellular carcinoma prognosis using the Gene Expression Omnibus (GEO) database and provide a theoretical basis for discovering novel prognostic biomarkers for hepatocellular carcinoma. METHODS: Hepatocellular carcinoma-related datasets were retrieved from the GEO database. Differentially expressed genes (DEGs) were identified using the GEO2R tool. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID). A protein-protein interaction (PPI) network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), and key genes were identified using Cytoscape software. The University of Alabama at Birmingham Cancer Data Analysis Resource (UALCAN) was used to analyze the expression levels of key genes in normal and hepatocellular carcinoma tissues, as well as their associations with pathological grade, clinical stage, and patient survival. The Human Protein Atlas (THPA) was used to further validate the impact of key genes on overall survival. Expression levels of key genes in the blood of hepatocellular carcinoma patients were evaluated using the expression atlas of blood-based biomarkers in the early diagnosis of cancers (BBCancer). RESULTS: A total of 78 DEGs were identified from the GEO database. GO and KEGG analyses indicated that these genes may contribute to hepatocellular carcinoma progression by promoting cell division and regulating protein kinase activity. Sixteen key genes were screened via Cytoscape and validated using UALCAN and THPA. These genes were overexpressed in hepatocellular carcinoma tissues and were associated with disease progression and poor prognosis. Finally, BBCancer analysis showed that ASPM and NCAPG were also elevated in the blood of hepatocellular carcinoma patients. CONCLUSIONS This study identified 16 key genes as potential prognostic biomarkers for hepatocellular carcinoma, among which ASPM and NCAPG may serve as promising blood-based markers for hepatocellular carcinoma.
Humans ; Carcinoma, Hepatocellular/mortality* ; Liver Neoplasms/pathology* ; Prognosis ; Computational Biology/methods* ; Protein Interaction Maps/genetics* ; Biomarkers, Tumor/genetics* ; Gene Expression Regulation, Neoplastic ; Gene Expression Profiling ; Gene Ontology ; Databases, Genetic

OBJECTIVES: Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-related death worldwide, posing a serious threat to public health. Prognostication of overall survival (OS) in patients undergoing radical gastrectomy remains a clinical priority. Evidence suggests that preoperative nutritional and inflammatory status correlated with postoperative outcomes. This study aims to evaluate the prognostic value of the skeletal muscle index at the third lumbar vertebra (L3-SMI) as a trichotomous variable and to compare the performance of commonly used nutritional and inflammation-related indicators in predicting postoperative survival in GC patients. METHODS: This retrospective study analyzed clinical data of patients who underwent radical gastrectomy with neoadjuvant chemotherapy between 2011 and 2018 at the Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University. L3-SMI was measured by preoperative CT, and 8 preoperative nutritional/inflammatory indices were calculated from the latest laboratory tests before surgery: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), albumin-globulin ratio (AGR), and prognostic nutritional index (PNI). L3-SMI was categorized into 3 groups using X-tiler software. ROC curves were used to determine optimal cut-off values for the other eight indices. Kaplan-Meier curves and univariate/multivariate Cox proportional hazards models were used to analyze the association between variables and OS. Concordance index (C-index) and subgroup analysis assessed predictive performance and consistency across patient subgroups. RESULTS: A total of 546 patients were included, with a minimum follow-up time of 36 months. Kaplan-Meier and univariate analysis showed that L3-SMI and the 8 indicators were significantly associated with OS (all P<0.01). After adjusting for age, gender, tumor site, differentiation, pTNM stage, type of surgery, anemia, CEA, and AFP, multifactorial Cox analysis revealed that L3-SMI (HR=0.676, 95% CI 0.523 to 0.872), AGR (HR=0.611, 95% CI 0.452 to 0.827), and PNI (HR=0.590, 95% CI 0.418 to 0.833) were independent predictors of OS. The full model confirmed the independent prognostic roles of L3-SMI, AGR, and PNI. Among all indicators, PNI had the highest C-index for 1-year OS prediction (0.632, 95% CI 0.568 to 0.695), while AGR showed the best performance at 3 years (0.585, 95% CI 0.548 to 0.622) and 5 years (0.578, 95% CI 0.542 to 0.613). Subgroup analysis indicated that higher L3-SMI, AGR, and PNI were associated with lower mortality risk in patients aged<65 years, with lower gastric tumors, poor differentiation, stage III pTNM, or who underwent subtotal gastrectomy. CONCLUSIONS Compared with other indicators, preoperative nutritional markers such as L3-SMI, AGR, and PNI demonstrated superior prognostic value for OS in gastric cancer patients undergoing radical gastrectomy. Assessing these indices can help identify patients at high risk of poor prognosis, thereby guiding targeted nutritional interventions and potentially improving survival outcomes.
Humans ; Stomach Neoplasms/mortality* ; Gastrectomy/methods* ; Retrospective Studies ; Female ; Male ; Middle Aged ; Prognosis ; Aged ; Adult ; Nutritional Status ; Inflammation ; Predictive Value of Tests ; Preoperative Period ; Survival Rate

OBJECTIVES: Multiple myeloma (MM) is a highly heterogeneous hematologic malignancy, with disease progression driven by cytogenetic abnormalities and a complex bone marrow microenvironment. This study aims to construct a prognostic model for MM based on transcriptomic data and lipid metabolism related genes (LRGs), and to identify potential drug targets for high-risk patients to support clinical decision-making. METHODS: In this study, 2 transcriptomic datasets covering 985 newly diagnosed MM patients were retrieved from the Gene Expression Omnibus (GEO) database. Univariate Cox regression and 101 machine learning algorithms were used for gene selection. An LRG-based prognostic model was constructed using Stepwise Cox (both directions) and random survival forest (RSF) algorithms. The association between the prognostic score and clinical events was evaluated, and model performance was assessed using time-dependent receiver operating characteristic (ROC) curves and the C-index. The added predictive value of combining prognostic scores with clinical variables and staging systems was also analyzed. Differentially expressed genes between high- and low-risk groups were identified using limma and clusterProfiler and subjected to pathway enrichment analysis. Drug sensitivity analysis was conducted using the Genomics of Drug Sensitivity in Cancer (GDSC) database and oncoPredict to identify potential therapeutic targets for high-risk patients. The functional role of key LRGs in the model was validated via in vitro cell experiments. RESULTS: An LRG-based prognostic model (LRG17) was successfully developed using transcriptomic data and machine learning. The model demonstrated robust predictive performance, with area under the curve (AUC) values of 0.962, 0.912, and 0.842 for 3-, 5-, and 7-year survival, respectively. Patients were stratified into high- and low-risk groups, with high-risk patients showing significantly shorter overall survival (OS) and event-free survival (EFS) (both P<0.001) and worse clinical profiles (e.g., lower albumin, higher β2-microglobulin and lactate dehydrogenase levels). Enrichment analysis revealed that high-risk patients were significantly enriched for pathways related to chromosome segregation and mitosis, whereas low-risk patients were enriched for immune response and immune cell activation pathways. Drug screening suggested that AURKA inhibitor BMS-754807 and FGFR3 inhibitor I-BET-762 may be more effective in high-risk patients. Functional assays demonstrated that silencing of key LRG PLA2G4A significantly inhibited cell viability and induced apoptosis. CONCLUSIONS LRGs serve as promising biomarkers for prognosis prediction and risk stratification in MM. The overexpression of chromosomal instability-related and high-risk genetic event-associated genes in high-risk patients may explain their poorer outcomes. Given the observed resistance to bortezomib and lenalidomide in high-risk patients, combination therapies involving BMS-754807 or I-BET-762 may represent effective alternatives.
Humans ; Multiple Myeloma/mortality* ; Prognosis ; Lipid Metabolism/genetics* ; Transcriptome ; Machine Learning ; Male ; Female ; Gene Expression Profiling ; Algorithms