Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998-2020.

BACKGROUND: Most sepsis patients could potentially experience advantageous outcomes from targeted medical intervention, such as fluid resuscitation, antibiotic administration, respiratory support, and nursing care, promptly upon arrival at the emergency department (ED). Several scoring systems have been devised to predict hospital outcomes in sepsis patients, including the Sequential Organ Failure Assessment (SOFA) score. In contrast to prior research, our study introduces the novel approach of utilizing the National Early Warning Score 2 (NEWS2) as a means of assessing treatment efficacy and disease progression during an ED stay for sepsis. OBJECTIVES: To evaluate the sepsis prognosis and effectiveness of treatment administered during ED admission in reducing overall hospital mortality rates resulting from sepsis, as measured by the NEWS2. METHODS: The present investigation was conducted at a medical center from 1997 to 2020. The NEWS2 was calculated for patients with sepsis who were admitted to the ED in a consecutive manner. The computation was based on the initial and final parameters that were obtained during their stay in the ED. The alteration in the NEWS2 from the initial to the final measurements was utilized to evaluate the benefit of ED management to the hospital outcome of sepsis. Univariate and multivariate Cox regression analyses were performed, encompassing all clinically significant variables, to evaluate the adjusted hazard ratio (HR) for total hospital mortality in sepsis patients with reduced severity, measured by NEWS2 score difference, with a 95% confidence interval (adjusted HR with 95% CI). The study employed Kaplan-Meier analysis with a Log-rank test to assess variations in overall hospital mortality rates between two groups: the "improvement (reduced NEWS2)" and "non-improvement (no change or increased NEWS2)" groups. RESULTS: The present investigation recruited a cohort of 11,011 individuals who experienced the first occurrence of sepsis as the primary diagnosis while hospitalized. The mean age of the improvement and non-improvement groups were 69.57 (± 16.19) and 68.82 (± 16.63) years, respectively. The mean SOFA score of the improvement and non-improvement groups were of no remarkable difference, 9.7 (± 3.39) and 9.8 (± 3.38) years, respectively. The total hospital mortality for sepsis was 42.92% (4,727/11,011). Following treatment by the prevailing guidelines at that time, a total of 5,598 out of 11,011 patients (50.88%) demonstrated improvement in the NEWS2, while the remaining 5,403 patients (49.12%) did not. The improvement group had a total hospital mortality rate of 38.51%, while the non-improvement group had a higher rate of 47.58%. The non-improvement group exhibited a lower prevalence of comorbidities such as congestive heart failure, cerebral vascular disease, and renal disease. The non-improvement group exhibited a lower Charlson comorbidity index score [4.73 (± 3.34)] compared to the improvement group [4.82 (± 3.38)] The group that underwent improvement exhibited a comparatively lower incidence of septic shock development in contrast to the non-improvement group (51.13% versus 54.34%, P < 0.001). The improvement group saw a total of 2,150 patients, which represents 38.41% of the overall sample size of 5,598, transition from the higher-risk to the medium-risk category. A total of 2,741 individuals, representing 48.96% of the sample size of 5,598 patients, exhibited a reduction in severity score only without risk category alteration. Out of the 5,403 patients (the non-improvement group) included in the study, 78.57% (4,245) demonstrated no alteration in the NEWS2. Conversely, 21.43% (1,158) of patients exhibited an escalation in severity score. The Cox regression analysis demonstrated that the implementation of interventions aimed at reducing the NEWS2 during a patient's stay in the ED had a significant positive impact on the outcome, as evidenced by the adjusted HRs of 0.889 (95% CI = 0.808, 0.978) and 0.891 (95% CI = 0.810, 0.981), respectively. The results obtained from the Kaplan-Meier analysis indicated that the survival rate of the improvement group was significantly higher than that of the non-improvement group (P < 0.001) in the hospitalization period. CONCLUSION: The present study demonstrated that 50.88% of sepsis patients obtained improvement in ED, ascertained by means of the NEWS2 scoring system. The practical dynamics of NEWS2 could be utilized to depict such intricacies clearly. The findings also literally supported the importance of ED management in the comprehensive course of sepsis treatment in reducing the total hospital mortality rate.

Exposure to ambient temperature and heat index in relation to DNA methylation age: A population-based study in Taiwan.

BACKGROUND: Climate change caused an increase in ambient temperature in the past decades. Exposure to high ambient temperature could result in biological aging, but relevant studies in a warm environment were lacking. We aimed to study the exposure effects of ambient temperature and heat index (HI) in relation to age acceleration in Taiwan, a subtropical island in Asia. METHODS: The study included 2,084 participants from Taiwan Biobank. Daily temperature and relative humidity data were collected from weather monitoring stations. Individual residential exposure was estimated by ordinary kriging. Moving averages of ambient temperature and HI from 1 to 180 days prior to enrollment were calculated to estimate the exposure effects in multiple time periods. Age acceleration was defined as the difference between DNA methylation age and chronological age. DNA methylation age was calculated by the Horvath's, Hannum's, Weidner's, ELOVL2, FHL2, phenotypic (Pheno), Skin & blood, and GrimAge2 (Grim2) DNA methylation age algorithms. Multivariable linear regression models, generalized additive models (GAMs), and distributed lag non-linear models (DLNMs) were conducted to estimate the effects of ambient temperature and HI exposures in relation to age acceleration. RESULTS: Exposure to high ambient temperature and HI were associated with increased age acceleration, and the associations were stronger in prolonged exposure. The heat stress days with maximum HI in caution (80-90°F), extreme caution (90-103°F), danger (103-124°F), and extreme danger (>124°F) were also associated with increased age acceleration, especially in the extreme danger days. Each extreme danger day was associated with 571.38 (95 % CI: 42.63-1100.13), 528.02 (95 % CI: 36.16-1019.87), 43.9 (95 % CI: 0.28-87.52), 16.82 (95 % CI: 2.36-31.28) and 15.52 (95 % CI: 2.17-28.88) days increase in the Horvath's, Hannum's, Weidner's, Pheno, and Skin & blood age acceleration, respectively. CONCLUSION: High ambient temperature and HI may accelerate biological aging.

Prenatal chlorpyrifos exposure in association with PPARγ H3K4me3 and DNA methylation levels and child development.

BACKGROUND: Chlorpyrifos, one of the most widely used pesticides, can penetrate the placenta and affect fetal growth and neurodevelopment. Epigenetic regulation of peroxisome proliferator-activated receptor gamma (PPARγ), such as DNA methylation and trimethylation of lysine 4 of H3 (H3K4me3), may provide a potential mechanism for how fetal growth and development are impacted by chlorpyrifos exposure. The aims of the study were to investigate whether prenatal chlorpyrifos exposure was associated with H3K4me3 and DNA methylation levels of the PPARγ gene in the placenta and the related effects on birth outcomes and neurodevelopment. METHODS: Among 425 mother-infant pairs from the Taiwan Birth Panel Study, chlorpyrifos levels were measured in cord blood by using online SPE-LC/HESI/MS/MS; placental PPARγ H3K4me3 and DNA methylation levels were measured by ChIP-qPCR and pyrosequencing, respectively; the neonates' health outcomes were extracted from the medical records; and childhood neurodevelopment was evaluated by using the Comprehensive Developmental Inventory for Infants and Toddlers in 2-year-old children. Multivariable regression models were used to adjust for potential confounders. RESULTS: After controlling for potential confounders, each unit increase in the natural log-transformed prenatal chlorpyrifos exposure level was associated with an increase in the PPARγ DNA methylation level (adjusted ß (aß) = 0.77, p = 0.032) and poorer performance in the cognitive and language domains at 2 years old, especially in boys (aß = -1.66, p = 0.016, and aß = -1.79, p = 0.023, respectively). PPARγ H3K4me3 levels were positively associated with gestational age (aß = 0.16, p = 0.011), birth weight (aß = 30.52, p = 0.013), birth length (aß = 0.18, p = 0.003 and aß = 0.15, p = 0.042), and gross-motor performance (aß = 1.67, p = 0.036). CONCLUSIONS: Our findings suggested that prenatal chlorpyrifos exposure affected PPARγ DNA methylation levels and performance in the cognitive and language domains.

Prevalence of Pediculus capitis in schoolchildren in Battambang, Cambodia.

BACKGROUND/PURPOSE: Pediculus capitis is the most common human ectoparasite. When it feeds on the blood through the scalp of its host, the anticoagulant in its saliva causes scalp inflammation and itching, and consequent scratching by the host causes further inflammation from bacterial infection. P. capitis infestation is currently a common parasitic dermatosis and a critical public health concern in underdeveloped countries. METHODS: Through naked eye inspection of P. capitis on or in the hair from 323 school children in Cambodia. RESULTS: A total of 143 children (44.3%) were found to have P. capitis infestation. Univariate analysis revealed that girls had a significantly higher infection rate than boys. Overall, young aged schoolchildren (10 yrs old ≤) showed significantly higher infection rate than old aged schoolchildren (>10 yrs old). Groups stratified by time revealed that schoolchildren studied at the afternoon classes than morning classes in Tuol Prum Muoy Primary School had a significantly higher risk in acquisition of P. capitis infestation. Multivariate analysis results indicated that relative to the boys, the girls were at a significantly higher risk of contracting P. capitis infection. When stratified by inspection time with the Tuol Prum Muoy Primary School morning classes as the reference, the Tuol Prum Muoy Primary School afternoon classes exhibited a significantly higher risk of P. capitis infection. CONCLUSION: Primary school children in Cambodia have a high P. capitis infection rate and thus require effective treatment and prevention measures to treat symptoms and lower the infection rate.

Prevalence and Risk Factors for Intestinal Parasitic Infection in Schoolchildren in Battambang, Cambodia.

Most intestinal parasitic infections (IPIs), commonly endemic in tropical resource-poor developing countries, are neglected tropical diseases. Parasitic infections and malnutrition are most commonly found in children. We determined the prevalence of IPIs and the risk factors in Battambang Province, northwestern Cambodia, from August to September 2015. This study collected 308 valid questionnaires and specimens from Dontri (173, 56.2%) and Kon Kaêk (135, 43.8%) primary schools. All stool samples were examined using Chang's Feces Examination Apparatus through the merthiolate-iodine-formaldehyde technique. Headache (259, 84.1%), recurrent cough (249, 80.8%), and abdominal pain (235, 76.3%) were the most common symptoms as detected from questionnaire investigation. A total of 155 students were positive for any parasite type; a single parasite type was observed in 97 students (31.5%), two types in 40 students (13.0%), three types in 14 students (4.6%), and four types in four students (1.3%). Nine gastrointestinal parasite species (three helminths and six protozoa) were identified in the stool samples. The most common parasites in schoolchildren were Giardia intestinalis (31.5%) and Entamoeba histolytica/dispar (17.5%). This is the first IPIs study, and more than half of the schoolchildren were infected with parasite species in Moung Russey District of Battambang Province. We found nine parasite species, including helminths and protozoa, and pathogenic protozoa were the main source of IPIs. Improving the detection method, sanitation facilities, and personal hygiene as well as utilizing combined drugs are all important measures to greatly reduce IPIs in Cambodian schoolchildren.