Internal medicine
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Background Despite the controversy regarding its clinical utility, the PaO2/FIO2 ratio has been used to define the severity of acute respiratory distress syndrome (ARDS). This systematic review and meta-analysis (SRMA) details summary estimates of the predictive performance of PaO2/FIO2 ratio in predicting mortality in patients with ARDS. Methods To clarify the integrated diagnostic accuracy, we included studies in which the study population comprised patients with ARDS in any clinical setting, included adult patients (≥18 years old), and evaluated mortality. ⋯ Overall, the risk of bias is high. For PaO2/FIO2 of 100 and 200 the pooled sensitivity, specificity, and AUROC were 44.8% (95% CI, 38.1%-51.7%), 70.6% (95% CI, 65.9%-74.9%), 0.60 (0.58-0.64) and 83.9% (95% CI, 78.9%-87.8%), 26.1% (95% CI, 20.8%-32.1%), 0.64 (0.60-0.69), respectively. Conclusion The PaO2/FIO2 ratio alone did not have impressive prediction accuracy for mortality in patients with ARDS and might not be able to be used solely as a clinical prognostic tool.
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We herein report a 69-year-old man with acute kidney injury who required dialysis after receiving a combination of three drug-induced lymphocyte stimulation test-positive drugs. A kidney biopsy showed tubulointerstitial nephritis with severe eosinophilic infiltration and numerous granuloma formations. Acute eosinophilic granulomatous tubulointerstitial nephritis was diagnosed. ⋯ No clinical findings were suggestive of sarcoidosis. Based on the above findings, the disease was considered to be induced by these three drugs. The renal function was normalized with glucocorticoid treatment.
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We herein report a case of cutaneous squamous cell carcinoma (SCC) characterized by paraneoplastic hypercalcemia-leukocytosis syndrome. The patient presented with systemic symptoms, including anorexia, a fever, and a tumoral lesion on the upper arm. Laboratory test results revealed hypercalcemia and leukocytosis. ⋯ Immunostaining demonstrated G-CSF production by the tumor cells. Radiation therapy was administered, which improved leukocytosis and decreased G-CSF and PTHrP levels. Through a case report and literature review, we explored the clinical characteristics of tumors that produce G-CSF and PTHrP.
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Digital health, which encompasses digital medicine and therapy, integrates advanced technologies across healthcare. Central to this transformation is 'digitization,' which converts continuous analog data into a discrete digital form. However, this process is challenging. ⋯ Second, "digit bias," a cognitive distortion, emerges in the interpretation phase, where individuals' perceptions of and reactions to digital data are intrinsically skewed. There exist two major cognitive biases during digitization process: "digit preferences," where healthcare providers prioritize specific numbers, and "left digit bias" where continuous variables are disproportionately estimated by focusing on the leftmost digit. Although information loss and cognitive biases can cause significant distortions in healthcare, the effects of this "digitization" process have not been adequately quantified, and the accumulation of further evidence in this field is anticipated.
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Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. ⋯ Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.