Modeling for Prediction of Mortality Based on past Medical History in Hospitalized COVID-19 Patients: A Secondary Analysis.

Introduction: Although COVID-19 is not currently a public health emergency, it will affect susceptible individuals in the post-COVID-19 era. Hence, the present study aimed to develop a model for Iranian patients to identify at-risk groups based on past medical history (PMHx) and some other factors affecting the death of patients hospitalized with COVID-19. Methods: A secondary study was conducted with the existing data of hospitalized COVID-19 adult patients in the hospitals covered by Iran University of Medical Sciences. PMHx was extracted from the registered ICD-10 codes. Stepwise logistic regression was used to predict mortality by PMHx and background covariates such as intensive care unit (ICU) admission. Crude population attributable fraction (PAF) as well as crude and adjusted odds ratio (OR) with 95% confidence interval (CI) were reported. Results: A total of 8879 patients were selected with 19.68% mortality. Infectious and parasitic diseases' history showed the greatest association (OR = 5.72, 95% CI: 4.20, 7.82), while the greatest PAF was for cardiovascular system diseases (20.46%). According to logistic regression modeling, the largest effect, other than ICU admission and age, was for history of infectious and parasitic diseases (OR = 3.089, 95% CI: 2.13, 4.47). A good performance was achieved (area under curve = 0.875). Conclusion: Considering the prevalence of underlying diseases, many mortality cases of COVID-19 are attributable to the history of cardiovascular disease. Future studies are needed for policy making regarding reduction of COVID-19 mortality in susceptible groups in the post-COVID-19 era.

Laparoscopic small bowel length measurement: nonassociative nature of total small bowel length with anthropometric and clinical characteristics in patients undergoing bariatric surgery.

BACKGROUND: Small bowel length (SBL) may have an impact on the outcomes of bariatric surgeries, but it can be difficult to make a direct association between SBL and the safety and outcome of bariatric surgeries. OBJECTIVES: To address this issue, we set out to devise a predictive model for SBL determination based on clinical and anthropometric variables. SETTING: An academic tertiary medical center. METHODS: Anthropometric and clinical data, including age, sex, height, weight, and past medical history, were collected upon enrollment. SBL was measured twice during the surgery using a marked grasper. In all cases, measurements were carried out by a single surgeon. To create a predictive model, a 2-step approach was employed. In the first step, linear regression was used to determine influential variables. In the second step, all variables with a P value < .2 were entered into a multivariate regression model. RESULTS: Overall, 961 bariatric candidates were enrolled. The mean age of the participants was 40.08 years, and 77.5% (n = 745) were female. The mean SBL was 748.90 centimeters. There was a weak but statistically significant positive correlation between SBL with both weight and height. Our univariate linear model determined only anthropometric parameters as a predictor of SBL. The multivariate model also yielded that none of the entered parameters were shown to be accurate predictors of SBL. Moreover, only 4.3% of variances were explainable by this model. CONCLUSION: Although we found a weak positive association between height and SBL, this association lacked clinical practicality.

Mortality patterns in patients with Staphylococcus aureus bacteremia during the COVID-19 pandemic: Predictors and insights.

Objectives: This paper aims to determine the Staphylococcus aureus bacteremia (SAB) in-hospital mortality rate and its associated risk factors during the COVID-19 pandemic. Methods: A total of 167 SAB samples were collected between March 2020 and March 2022 at a teaching hospital in Tehran, Iran. The patient's baseline data and antibiograms were collected. The outcome of the study was in-hospital mortality. Results: The overall in-hospital mortality rate was 41.9 %, with higher mortality observed in patients over 60 years old (P = 0.032), those with community-acquired Staphylococcus aureus bacteremia (P = 0.010), and those admitted to the ICU (P = 0.016). Antibiotic resistance profiles indicated a higher mortality in resistant S.aureus strains but only significant for ciprofloxacin (P = 0.001), methicillin (P = 0.047), and sulfamethoxazole (P = 0.023). Multivariate analysis identified age, sex, ICU admission, and the source of bacteremia as independent predictors of mortality, while COVID-19 coinfection and resistance to antibiotics were not found to be significant predictors. Conclusion: SAB remains a challenging infection that is amplified by the pandemic. Older age and ICU admission are significant mortality predictors. In settings with a high prevalence of MRSA, factors like age, sex, and quality of care outweigh pathogen-related factors such as antibiotic resistance.

"Y" anastomosis, a solution in doubtful venous anastomosis: a case report and review of the literature.

BACKGROUND: Lower lip squamous cell carcinoma is a significant subtype of head and neck cancer, constituting about 25-30% of cases. Traditional surgical methods, like primary closure, have limitations in managing large resections of lip tumors. Recent advancements in surgical techniques, particularly free flaps, have shown promising results in addressing these challenges. The Y-shaped anastomosis is an innovative approach aimed at enhancing the efficiency of microvascular free flap surgeries for improved lip cancer reconstruction outcomes. CASE PRESENTATION: A 77-year-old Persian male with lower lip squamous cell carcinoma underwent tumor resection with a 2 cm safety margin, bilateral neck dissection, and lip reconstruction using the right radial forearm free flap. The surgery incorporated a Y-shaped anastomosis to improve venous pedicle outcomes. CONCLUSION: In this case, it was decided not to open the first anastomosis but to add the second end to the side one to provide two vascular supports for the venous anastomosis. Y anastomosis makes the surgery easier and decreases complications resulting from vascular size mismatch.