Assessment of sarcopenic obesity as a predictor of pneumonia in patients with stable schizophrenia-A prospective study.

OBJECTIVE: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently released the first international consensus on the diagnostic criteria for Sarcopenic obesity (SO). The present study aimed to explore the ability of SO to predict the risk of pneumonia in patients with stable schizophrenia. METHODS: This was a prospective study involving hospitalized patients with schizophrenia aged ≥50 years from two mental health centers in western China. Baseline patient data were collected from September 1 to September 30, 2020. Follow-up data on pneumonia were collected from October 2020 to October 2022. The diagnosis of SO was based on the ESPEN/EASO criteria. Patients were assessed for handgrip strength (HGS), skeletal muscle mass/weight (SMM/W), and fat mass percentage (FM%). Logistic regression analysis was used to explore the effect of SO on the risk of pneumonia in patients with stable schizophrenia. RESULTS: A total of 320 patients with stable schizophrenia were included. Of these, 74 (23.13%) were diagnosed with SO, while 117 (36.56%) developed pneumonia. Compared with patients in the non-low HGS, non-low HGS + non-low SMM/W (or non-low HGS + low SMM/W or low HGS + non-low SMM/W) and non-SO groups, the proportions of patients with pneumonia in the low HGS (42.3% vs. 25.9%, p = 0.004), low HGS + low SMM/W (45.3% vs. 33.3%, p = 0.048), and SO (47.3% vs. 33.3%, p = 0.029) groups, respectively, were higher. However, there was no difference in the proportion of patients with pneumonia in the low SMM/W group and the obese group compared with the non-low SMM/W and non-obese groups. Further logistic regression analysis after adjustment for potential influencing factors showed that compared with the non-low HGS group, patients in the low HGS group had a higher risk of pneumonia (OR = 1.892, 95%CI: 1.096-3.264). CONCLUSION: SO defined according to the ESPEN/EASO criteria was not found to be significantly associated with the development of pneumonia in patients with stable schizophrenia. Further verification of these results is needed with larger sample sizes and the establishment of a cutoff value for this population.

The effectiveness of the sarcopenia index in predicting septic shock and death in elderly patients with community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) causes high morbidity and mortality in all age groups worldwide. Lower muscle radiodensity was associated with worse clinical outcomes (including shock) and higher in-hospital mortality. Prompt detection of sarcopenia in older adults with CAP is important. The measurement of muscle mass often involves specialized and expensive techniques. A relatively simple and inexpensive method such as the sarcopenia index (SI) to measure muscle mass would be helpful. Therefore, we performed a retrospective cohort study to assess the association between SI and septic shock risk and mortality in older patients with CAP. STUDY DESIGN: In this retrospective cohort study, information on hospitalized CAP patients, including general information and septic shock, were obtained from the medical record database of the Southwest Medical University Zigong Affiliated Hospital, China. Data on patient survival and mortality (all-cause) were acquired from government authorities and telephonic follow-up. Serum creatinine (Cr) and cystatin-C (CysC) levels on admission were included in the database. The SI was determined as the serum Cr/CysC ratio × 100 and the participants were assigned to low and high SI groups. The association between SI and septic shock was evaluated by logistic regression, and that between SI and mortality by Cox regression analysis. RESULTS: In total, 769 older adults (≥ 60 years) with CAP were included, of which 480(62.4%) were male and 289(37.6%)were female. We found that the total prevalence of septic shock in older adults with CAP was 16.0%. In the female group, septic shock was more prevalent in the low SI group than in the high SI group (low SI vs. high SI, 22.22% vs. 11.52%, p = 0.024). Following adjustment for confounders, there was a significant association between high SI and a lower risk of septic shock in female patients (OR = 0.38, 95%CI: 0.16-0.94; p < 0.05). The total death toll of older adults with CAP was 332(43.2%). Irrespective of sex, there was a higher risk of mortality in the low SI group (total group: low SI vs. high SI, 63.02% vs. 36.57%, p < 0.001; male group: low SI vs. high SI, 63.03% vs. 39.34%, p < 0.001; female group: low SI vs. high SI, 73.61% vs. 28.57%, p < 0.001) and, after adjustment for confounding factors and irrespective of sex, high SI was a protective factor for mortality in older adults with CAP (total group: HR = 0.64, 95%CI: 0.48-0.84; p < 0.05; male: HR = 0.69, 95%CI: 0.49-0.97; p < 0.05; female: HR = 0.39, 95%CI: 0.24-0.62; p < 0.05). CONCLUSION: While the SI effectively predicts mortality in older adults with CAP, it was only found to be associated with septic shock in older females.

Case Report: First Case of Cefotaxime-Sulbactam-Induced Acute Intravascular Hemolysis in a Newborn With ABO Blood Type Incompatibility by the Mechanism of Non-Immunologic Protein Adsorption.

Background: ABO blood type incompatibility hemolytic disease of newborn (ABO-HDN) and drug-induced immune hemolytic anemia (DIIHA) due to non-immunologic protein adsorption (NIPA) mainly cause extravascular hemolysis. All the reported severe DIIHA were caused by drug-induced antibodies, and rare report of acute intravascular hemolysis was caused by the NIPA mechanism or ABO-HDN. Case presentation: We report the first case of acute intravascular hemolysis induced by cefotaxime sodium - sulbactam sodium (CTX - SBT) in a case of ABO-HDN which resulted in death at 55 h after birth. The mother's blood type was O and RhD-positive, and the newborn's blood type was B and RhD-positive. No irregular red blood cell (RBC) antibodies or drug-dependent antibodies related to CTX or SBT was detected in the mother's plasma and the plasma or the RBC acid eluent of the newborn. Before the newborn received CTX - SBT treatment, the result of direct antiglobulin test (DAT) was negative while anti-B was positive (2 +) in both plasma and acid eluent. After the newborn received CTX - SBT treatment, the results of DAT for anti-IgG and anti-C3d were both positive, while anti-B was not detected in plasma, but stronger anti-B (3 +) was detected in acid eluent. In vitro experiments confirmed that NIPA of SBT promoted the specific binding of maternal-derived IgG anti-B to B antigen on RBCs of the newborn, thereby inducing acute intravascular hemolysis. Conclusion: The NIPA effect of SBT promoted the specific binding of mother-derived IgG anti-B in newborn's plasma to the newborn's RBC B antigens and formed an immune complex, and then activated complement, which led to acute intravascular hemolysis. Drugs such as SBT with NIPA effect should not be used for newborns with HDN.

Analysis of Risk Factors for Cognitive Dysfunction in Disabled Elderly Patients in Chengdu, China.

BACKGROUND With the aging population comes an increase in functional disability that leads to dependency and institutionalization, as well as social, medical, and economic challenges. This study aimed to classify and assess the factors affecting cognitive deficits in disabled elderly people. MATERIAL AND METHODS Disabled patients ≥60 years old were assessed by face-to-face cross-sectional surveys, which were conducted using advanced peer-to-peer software. The ability to perform daily life tasks was assessed using the Modified Barthel Index. Cognitive function was evaluated with the Mini-cognitive assessment instrument. Using these surveys, 9471 individuals were included in this study. The rank-sum test was used to investigate differences between groups. Disordered multi-class logistic regression was used to correct related confounding factors for multivariate analysis. RESULTS The ratios of normal cognitive function, cognitive impairment, and dementia were 3.71%, 38.59%, and 57.70%, respectively. The univariate analysis and multivariate analysis showed that older individuals (≥80 years), women, illiterate individuals, and lonely persons were more prone to dementia. Moreover, a history of hypertension, diabetes, osteoporosis, and fractures were significantly associated with dementia. CONCLUSIONS The proportion of dementia in the elderly disabled patients is very high (57.7%) in Chengdu City. Age (≥80 years), female sex, education level (illiterate individuals), living conditions, and chronic disease were closely correlated with cognitive functions.

[Genetic mutation screening of glucose-6-phosphate dehydrogenase deficiency in Dongguan district].

OBJECTIVE: To determine the incidence and genotypes of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Dongguan region of Guangdong Province and assess the efficacy and feasibility of flow-through hybridization. METHODS: Peripheral blood samples were randomly selected and detected by modified G6PD/6PGD ratio method. Flow-through hybridization was used to detect 14 G6PD mutations among all samples. RESULTS: In total 1005 samples were collected, the detection rate for modified G6PD/6PGD ratio method and flow-through hybridization were 2.79% and 20.90%, respectively. The consistency of the two methods was poor(Kappa=0.187). When c.1311C>T mutation is excluded, the consistency of the two methods was good for males (Kappa=0.952) but still poor for females (Kappa=0.194). The most common mutations were c.1376G>T, c.1388G>A and c.95A>G. No G6PD deficiency was found among those only carrying the c.1311C>T mutation. CONCLUSION: Flow-through hybridization can simultaneously detect 14 loci, covering over 90% of common mutations in Chinese population, and can be easily expanded. The routine method may miss many females carrying homozygous, compound heterozygous and heterozygous mutations, but the detection rate for male hemizygous mutation was much higher.

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia: A Large Sample Study in South China.

The clinical characteristics and surgical outcomes in a large sample of patients with intermittent exotropia (IXT) as well as an analysis of risk factors associated with surgical failures are presented in this article. Data from IXT patients who received surgical management at the Eye Hospital, in the Zhongshan Ophthalmic Center, of Sun Yat-Sen University, China from January 2009 to December 2013 were reviewed retrospectively. Included within this analysis were data from pre- and postoperative ocular motility, primary alignment, and binocular vision.A total of 1228 patients with IXT were reviewed. Males (50.4%) and females (49.6%) were nearly equally represented in this sample. Thirty-two patients (2.6%) had a family history of strabismus. The mean age at onset was 6.77  ±â€Š 6.43 years (range 7 months -48.5 years), mean duration at presentation was 7.35  ±â€Š 6.68 years (range 6 months-47 years), and mean age at surgery was 13.7  ±  8.8 years (range 3-49 years). The mean refractive error was -0.84  ±â€Š 2.69 diopter in the right eye and -0.72  ±â€Š 2.58 diopter in the left eye. Amblyopia (4.2%), oblique muscle dysfunction (7.0%), and dissociated vertical deviation (4.7%) were also present in these patients. The most common subtype of IXT was the basic type (88.1%). Orthophoria was observed in 80.5% of patients and the ratios of surgical undercorrection and overcorrection were 14.7% and 4.8%, respectively, as determined with a mean follow-up time of 7.8  ±â€Š 3.7 months. When combining ocular alignment with binocular vision as the success criteria, the success rate decreased to 35.6%. Multivariate risk factor analysis showed that only the loss of stereoacuity (P = 0.002) was associated with a poor outcome. There were no differences in the long-term results between bilateral lateral rectus recession and unilateral lateral rectus recession with medial rectus resection.Most IXT patients displayed normal vision, with few having positive family histories, amblyopia, oblique muscle dysfunction, and dissociated vertical deviation. The most common subtype of IXT was the basic type. Long-term surgical results were less favorable when sensory status was included in the criteria for success. Patients with stereoacuity loss were at an increased risk for poor outcomes.

Single Stage Surgical Outcomes for Large Angle Intermittent Exotropia.

Although there were many prior studies about exotropia, few focused on large-angle intermittent exotropia. The goal of this study was to evaluate single-stage surgical outcomes for large-angle intermittent exotropia and analyze risk factors that may affect the success of surgery. Records from intermittent exotropia patients with exodeviations >60 prism diopters(PD) who were surgically treated at the Zhongshan Ophthalmic Center, of Sun Yat-Sen University were reviewed. Included within this review were data on, pre- and post-operative ocular motility, primary alignment, binocular vision and complications. Patients with exodeviations ≤70PD received two-muscle surgery, while those with exodeviations >70PD were subjected to a three-muscle procedure. A total of 40 records were reviewed. The mean exodeviation was 73±9PD at distance and 75±26PD at near. There were 25 patients received two-muscle surgery and 15 the three-muscle procedure. Orthophoria (deviation within 8PD) was obtained in 77.5% of these patients and the ratios of surgical under-correction and over-correction were 15% and 7.5% respectively. However, when combining ocular alignment with binocular vision as the success criteria, success rates decreased to 30%. No statistically significant differences in success rates were obtained between the two- and three-muscle surgery groups. Seven subjects experienced an abduction deficit during the initial postoperative stages, but eventually showed a full recovery. One patient required a second surgery for overcorrection. No statistically significant risk factors for poor outcome were revealed. Our data showed that single-stage two- and three-muscle surgeries for large-angle intermittent exotropia are effective in achieving a favorable outcome.

Severe microphthalmos with cyst and unusually huge dermolipoma.

PURPOSE: The purpose of this study was to report an unusual case of severe microphthalmos, together with an orbital cyst and huge ocular surface dermolipoma. METHODS: This is a clinical report relating clinical features as well as imaging and histopathologic findings, along with surgical management of the patient. RESULTS: A 5-month-old Chinese male infant was referred, with 2 large masses in the left eye that were present since birth. Ocular examination results revealed a complete absence of any eye structures in the left orbit. In its place were 2 large masses between the left upper and lower palpebral fissure. One was a 3 × 3 × 2.5-cm spherical red tumor with a smooth surface. The other was a large solid spherical tumor, 4 × 4 × 5 cm, covered with normal skin located in the temporal region and attached to the red mass by a pedicle. Orbital magnetic resonance imaging examination findings confirmed that no eye structures were present in the left orbit. However, a cystic lesion was found in the left orbit, with a low signal on T1-weighted imaging and high signal on T2-weighted imaging, and another huge spherical heterogeneous mass was located "outside" the left orbit. Anterior orbitotomy by conjunctival incision was performed under general anesthesia. A spherical cystic mass of 1.5 × 1.5 × 1.6 cm, a small eye of 0.7 × 0.7 × 0.6 cm, and a huge dermolipoma were removed completely. Pathologic examination results confirmed the diagnosis of severe microphthalmos, together with orbital dermoid cyst and dermolipoma. CONCLUSIONS: This rare case demonstrates that severe microphthalmos with a cyst may be completely covered by conjunctiva and associated with an unusually huge dermolipoma.

Cholesterol granuloma of the orbit.

PURPOSE: The aim of this study was to present image findings, clinical and histopathologic features, and surgical management of orbital cholesterol granuloma (CG), a rare orbital entity. METHODS: Findings from 2 patients with orbitofrontal CG are presented along with a review of the literature on CG of the orbit. RESULTS: Both patients were 40-year-old men. The common symptoms of this condition in the present cases were proptosis and inferomedial displacement of the globe. Computed tomography scan in patient 1 revealed the presence of a cystic lesion without bone erosion in the superolateral orbital roof. Magnetic resonance imaging in patient 2 revealed a non-contrast-enhancing lesion with moderate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. For both cases, anterior orbitotomy through subbrow incision by drainage and curettage resulted in a curative outcome. No lesion recurrence was observed by 5 years after surgery in 1 case and 3 years in the other. Histopathologic evaluation revealed numerous inflammatory cells, blood degradation products, and cholesterol clefts. The absence of epithelial elements led to the diagnosis of CG. CONCLUSIONS: Orbital CG is a rare expansive cystic condition and nearly always occurs in the lateral region of the superior orbital ridge within the frontal diploic space. This condition shows a marked preponderance in middle-aged males. The findings that computed tomography scan did not reveal bone erosion in patient 1, and magnetic resonance imaging examination showed moderate signal intensity, rather than high signal intensity, on T1-weighted images in patient 2 indicated that these represented unusual presentations. Surgical excision has a high success rate with a low incidence of recurrence.

Orbital schwannoma originating from the superior oblique muscle.

PURPOSE: Orbital schwannoma in extraocular muscles is quite rare. In this study, we describe what, to the best of our knowledge, represents the first report of a schwannoma in the superior oblique muscle. METHODS: A case report relating clinical features as well as radiologic, surgical, and histologic findings is presented. RESULTS: A 27-year-old man presented with a 2-year history of progressive swelling in the left upper eyelid. A smooth mass was palpable within the superior nasal orbit. The left eye was slightly displaced inferiorly, and upward gaze was mildly impaired. There was no strabismus in the primary position. Magnetic resonance imaging revealed a well-defined mass in the left superior orbit measuring 32 × 18 × 8 mm, with a high T2 signal and low-to-moderate signal on T1. A left anterior orbitotomy was performed, and the tumor was completely resected. The mass originated from the tendon of the superior oblique muscle, and histologic diagnosis confirmed a schwannoma of Antoni type A. After this procedure, all symptoms were relieved and left superior oblique function was normal. No recurrence was evident at 6 months after surgery. CONCLUSIONS: This rare case demonstrates that orbital schwannoma may occur in association with the superior oblique muscle. With careful surgical dissection, normal function of the involved muscle can be restored.

Rare orbital cystic lesions in children.

PURPOSE: To analyze the clinical features, imaging findings and surgical management of rare orbital cystic lesions in children. MATERIALS AND METHODS: Clinical records of 5 Chinese children with rare orbital cystic lesions including cystic teratoma, congenital cystic eye, optic nerve sheath cyst, parasitic cyst, and meningoencephalocele were reviewed. Their clinical history, symptoms and signs, ultrasonography or computed tomography/magnetic resonance imaging (CT/MRI), surgical management were presented in detail. RESULTS: Among the 5 patients, 2 were male and 3 female. The right orbit was involved in 2 patients and the left orbit in 3 patients. Ages ranged from 2 months to 11 years (mean, 4.2 years). Cystic teratoma showed a well-outlined cystic mass with a focal bone-like structure (or calcific densities) in their lumens as revealed with CT scan. Congenital cystic eye was a rare ocular malformation that existed at birth and showed a cystic lesion with no definite ocular structures in the orbit. With MRI examination, the optic nerve sheath cyst demonstrated a clear figure of the central optic nerve and the surrounding sheath cyst. Patients with parasitic cysts usually had frequent animal contact and high levels of blood eosinophils. Meningoencephalocele, the herniation into the orbit of brain tissue, had the typical CT/MRI features, with bone defect and soft tissue mass in the orbit and a homogenous appearance that was isodense with brain. CONCLUSIONS: Besides common dermoid/epidermoid cyst, rare orbital cystic lesions such as cystic teratoma, congenital cystic eye, optic nerve sheath cyst, parasitic cyst, and meningoencephalocele should be considered in children.