Quality of death certification based on the documented underlying cause of death: A retrospective study.

BACKGROUND: The underlying cause of death (UCOD) documented in the death certificate is a cornerstone in the mortality data that has significant impact on national policies, health system, and socioeconomics. However, a wide range of inaccuracies have been reported worldwide and were linked to multiple factors, including sociodemographic development and lack of physician training. Hence, this study aimed to assess the quality of death certification by reviewing the reported UCOD in the death certificate and study the potential factors that might be associated with inaccuracies. METHODS: All in-patient deaths that occurred in the Sultan Qaboos University Hospital from January 2020 to 31 December 2020 were included in this retrospective study. The study investigators reviewed all death certifications that were recorded during the study period for the accuracy of the documented UCOD using a systemic framework recommended by the World Health Organization. RESULTS: The study included 384 mortality cases. The mean age at the time of death was 55.7 ± 27.1 years, and 209 (54.3%) cases were men. Approximately 80% (95% confidence interval: 84-76%) of the deceased patients had inaccurate data on the UCOD. Old age (58.1 ± 25.8 vs 46.5 ± 30.1, p < 0.001), death certification by doctor in training (70.8% vs 51.9%, p = 0.001), and admission under the Department of Medicine (68.5% vs 54.4%, p = 0.019) were more common in mortality cases with inaccurate data on the UCOD. Regression analysis confirmed that old age, male sex, and certification by doctor in training were independent predictors of inaccurate data on the UCOD. CONCLUSION: Inaccurate data on the UCOD is a prevalent issue in many healthcare settings, especially in the developing countries. Introduction of death certification training in the medical curriculum for medical doctors, implementation of periodic auditing, and provision of feedback are among the evidence-based approaches that are likely to improve the overall accuracy of mortality data.

Coexistence of sickle cell disease and systemic lupus erythematosus is associated with quantitative and qualitative impairments in circulating regulatory B cells.

The incidence of connective tissue diseases such as systemic lupus erythematous (SLE), in adult patients with sickle cell disease (SCD), appears to be increasing. The exact causes underlying this increased risk are still unknown, but a link with B regulatory (Breg) cells is possible as these cells suppress inflammatory responses, and maintain tolerance. Quantitative and qualitative analyses of circulating Breg cells were performed in a cohort of SCD patients with SLE, and their levels were correlated with key soluble mediators promoting autoreactive B cells. We demonstrated that levels of Breg cells were significantly decreased in SCD patients with SLE compared to patients with SCD only or healthy controls. Functional analysis of Breg cells from SCD patients with SLE revealed impairments in IL-10 production that correlated with lower levels of STAT3 phosphorylation, without abnormal expression of IL-10 receptor on Breg cells. On the other hand, BAFF levels were substantially elevated in SCD patients with SLE, but not significantly associated with Breg cell levels. Collectively, these results indicated numerical and functional deficits of Breg cells in SCD patients with SLE and their capacity to maintain tolerance and control inflammation is imbalanced, which leads to the development of autoimmune responses.

Magnesium: The recent research and developments.

Magnesium is the fourth most abundant mineral in the human body, which facilitates more than 300 enzymatic reactions. Magnesium is essential for nucleic material and protein synthesis, neuromuscular conduction, cardiac contractility, energy metabolism, and immune system function. Gastrointestinal system and kidneys closely regulate magnesium absorption and elimination to maintain adequate storage of magnesium. Magnesium deficiency has been linked to many diseases and poor health outcomes. Magnesium has also been proven to be an effective therapeutic agent in many diseases, such as bronchial asthma, cardiac arrhythmia, and pre-eclampsia.

Paraneoplastic acral vascular syndrome: case presentation and literature review.

A 65-year-old man, a smoker, presented to the emergency department with progressive digital ischaemia, fever and weight loss. The clinical examination revealed generalised lymphadenopathy and ischaemic changes of the right distal phalanges of the second, third and fourth fingers. He had an ultrasound-guided biopsy of the cervical lymph node, which showed histopathological findings of classic Hodgkin's lymphoma. Paraneoplastic acral vascular syndrome (PAVS) is a rare phenomenon and seen more in solid malignancies. There are very few reported cases of PAVS in haematological malignancies, including Hodgkin's lymphoma. This case highlights the idea that the presence of acral vascular syndrome-especially in older patients-should alert physicians to search for an underlying malignancy as part of the medical evaluation. Also, it shows that medical treatment may slow the progress of the digital ischaemia until the culprit tumour has been identified and treated.

Exercise-Induced Rhabdomyolysis: A Case Report and Literature Review.

A 19-year-old man presented to the ED with bilateral leg pain and dark discoloration of the urine after he started an intense aerobic exercise. Blood workup showed significantly elevated creatine kinase (CK), acute kidney injury (AKI), and disseminated intravascular coagulation (DIC). The patient had a double-incision, bilateral fasciotomy with debridement to relieve the bilateral, lower-limb, compartment syndrome following admission. Also, his kidney function deteriorated, requiring several sessions of hemodialysis. His hospital stay was complicated by multidrug-resistant (MDR) Acinetobacter baumannii bacteremia. After three weeks of hospital admission, the patient was discharged home with a follow-up outpatient physiotherapy for bilateral foot drop, which showed a remarkable recovery eventually. This case highlights the potentially life-threatening risks associated with unaccustomed physical exercise and emphasizing the essential preventive measures to reduce the risk of developing exercise-induced rhabdomyolysis. We present the pathophysiology of exercise-induced rhabdomyolysis, clinical presentation, diagnosis, treatment, and prognosis.

Hemoglobin F as a predictor of health-related quality of life in children with sickle cell anemia.

PURPOSE: As treatment options for children with sickle cell anemia (SCA) continue to expand survival, evaluation of factors associated with health-related quality of life (HRQoL) is becoming an important aspect for further improving clinical management. Although the general features of SCA are similar, factors influencing HRQoL within a country may differ from those of other countries, therefore this study aimed to explore factors affecting HRQoL in children with SCA living in the Sultanate of Oman. METHODS: This was a cross-sectional study in which the PedsQL™ Sickle Cell Disease Module was used to evaluate the overall HRQoL in children with SCA. The socio-demographic data, clinical, and treatment outcomes were collected. Univariate and multivariate linear regression analyses were used to identify predictors of HRQoL. RESULTS: A total of 123 children with SCA, aged from 2 to 16 years were enrolled. The mean total HRQoL score was 52 ± 15% (9-94), where Worry II scale recorded the highest score. The multiple regression analysis revealed that the only predictors of total HRQoL score were hemoglobin F (B = 0.64, 95% confidence interval [CI] 0.149-1.118, P = 0.009) and to a lesser degree white blood cell count (B = - 0.99, 95% CI - 1.761 to - 0.198, P = 0.01), independently of other study parameters such as age, gender, spleen status, and hydroxyurea therapy. CONCLUSIONS: Collectively, these findings indicated that hemoglobin F out-weighted white blood cell count in predicting HRQoL in Omani children with SCA. Recognition of these factors could help health professionals to develop effective strategies to improve the overall HRQoL in these young patients.

Levels of regulatory T cells and invariant natural killer cells and their associations with regulatory B cells in patients with non-Hodgkin lymphoma.

Due to their immunoregulatory properties, several specialized cell subsets, including regulatory T (Treg), invariant natural killer T (iNKT) and regulatory B (Breg) cells, are involved in the pathogenesis of non-Hodgkin lymphoma (NHL). However, the interaction between various cells remains to be elucidated. The aim of the present study was to evaluate the levels of Treg, iNKT and Breg cell subsets and their interrelationships in the peripheral blood (PB) and bone marrow (BM) of patients with B-cell NHL who received rituximab-based regimens and achieved a complete remission. A total of 20 patients and 20 healthy age- and sex-matched controls were prospectively enrolled for investigation of Treg, iNKT and Breg cell subsets in PB and BM by flow cytometry and cell culture. Prior to administration of combination chemotherapy with rituximab, the patients had lower levels of Breg cells and, to a lesser degree, Treg cells, but not iNKT cells, in PB compared with controls. Compartmental differences in the levels of Treg and Breg cell subsets, but not iNKT cells, were observed between PB and BM, suggesting an increase in trafficking through the blood of these regulatory cell subsets to the marrow. Following complete remission, the levels of circulating Treg, iNKT and Breg cell subsets increased. The levels of Treg cells were not significantly associated with iNKT and Breg cell subsets, although negative correlations were observed. Taken together, these results may provide new insights into the potential role of regulatory cell subsets in patients with B-cell NHL. However, whether the observed differences between PB and BM may affect clinical outcomes requires further investigation.