Asploro Journal of Biomedical and Clinical Case Reports | ISSN: 2582-0370

Post-intubation hypotension is one of the causes of hemodynamic disorders after tracheal intubation, especially for emergency intubation in the emergency department or intensive care unit, due to the characteristics of these patients with serious conditions and time constraints. Therefore, early and rapid prediction of the risk of post-tracheal intubation hypotension and emphasis on early interventional measures are crucial. Therefore, it is crucial to predict the possibility of hemodynamic instability after emergency tracheal intubation in critically ill patients. According to existing studies, the risk factors for post-intubation hypotension include various factors such as the patient’s physiological parameters, drug induction before intubation, and variability in the skills of the healthcare team; however, due to the individual bias effect of some of these indicators and the difficulty of real-time detection, they cannot provide practical value to the clinic. In response to these existing problems, some studies have reported that ultrasonic measurements, a non-invasive, convenient, and dynamically evaluable parameter in real-time, can predict hypotension after tracheal intubation, providing evidence for clinical intervention to improve the prognosis of critical illness.

Objective: To investigate the risk factors and patient prognosis after the implementation of tracheal intubation in critically ill patients in the emergency department and to provide a theoretical basis for the development of clinical decisions for the treatment of critically ill patients in the emergency department.
Methods: According to the inclusion and exclusion criteria, the clinical data of tracheal intubation patients admitted to the Emergency Department of Huaxi Shangjin Nanfu Hospital during the period of 1 January 2020–2022 were collected and analyzed. The patients were divided into the hypotensive group and the normotensive group according to whether hypotension occurred after tracheal intubation. A univariate analysis was used to analyze the risk factors for the development of hypotension in patients after intubation, and a multifactorial logistic regression analysis was performed to determine the independent risk factors for hypotension after intubation. The efficacy of each variable in predicting the development of hypotension in intubated patients was analyzed using a subject’s work characteristics (ROC) curve. The 28-day mortality rate, number of days in the ICU, and number of days in the hospital were compared between the two groups.
Results: Hypotension occurred in 48 of 155 patients after tracheal intubation. Univariate analysis showed statistically significant differences between groups for 18 factors, including body mass index, preintubation systolic blood pressure, preintubation diastolic blood pressure, preintubation heart rate, postintubation diastolic blood pressure, postintubation heart rate, preintubation hemoglobin, preintubation creatinine, preintubation albumin, preintubation potassium, preintubation glucose, preintubation pH, postintubation neutrophil percentage, postintubation blood glucose, postintubation blood pH, postintubation PCO₂, postintubation HCO₃, and preintubation inducer use (P < 0.05). Logistic regression analysis showed that body mass index and pre-tracheal intubation systolic blood pressure were the independent risk factors for the development of hypotension in patients after tracheal intubation (P < 0.05). ROC analysis showed that the area under the curve (AUC) of body mass index predicting post-tracheal intubation hypotension was 0.734, with a 95% CI of 0.657–0.802 (P < 0.05), and the sensitivity and specificity of prediction were 52.08% and 84.11%, respectively. The area under the curve (AUC) of pre-tracheal systolic blood pressure predicting post-tracheal intubation hypotension was 0.894, with a 95% CI of 0.835–0.938 (P < 0.05), the optimal threshold was 90, the sensitivity of prediction was 87.50%, and the specificity was 83.18%. The area under the curve (AUC) of body mass index combined with preintubation systolic blood pressure to predict post-tracheal intubation hypotension was 0.934, with a sensitivity of prediction of 89.60% and a specificity of 83.20%. The 28-day mortality rate was significantly higher in the hypotensive group than in the non-hypotensive group (41.67% vs. 19.63%, P = 0.004), and the number of ICU days (4.804 ± 1.321 vs. 9.896 ± 2.868, P < 0.001) and the number of days of hospitalization (20.598 ± 5.297 vs. 25.354 ± 5.602, P < 0.001) were significantly prolonged in the hypotensive group compared with the non-hypotensive group.
Conclusion: Hypotension after tracheal intubation in critically ill patients is more common in patients with low body weight or low systolic blood pressure before intubation, and hypotension after intubation increases the number of days in the ICU, the number of hospitalization days, and the 28-day mortality rate.

Research indicates that post-intubation hypotension (PIH) is the most frequent complication of intubation, potentially leading to acute myocardial infarction, renal failure, extended hospitalizations, and poor outcomes. Key physiological parameters such as age, body mass index, and baseline blood pressure are closely linked to PIH incidence. Induction drugs significantly influence the mechanisms of PIH, with varying drugs and administration methods impacting hemodynamic stability. Furthermore, the complexity of the intubation procedure exacerbates PIH by stimulating the vagus nerve and affecting cardiac output. Although current research aims to identify risk factors and physiological mechanisms of PIH, the absence of uniform diagnostic criteria impedes the comparability of results. Future studies should focus on establishing clear diagnostic standards, optimizing induction drug choices and procedural techniques, and integrating early warning indicators with personalized intervention strategies to decrease PIH incidence and enhance patient outcomes.

Adequate medical practice has been emphasized for the increasing elderly population. The authors have long provided Long-Term Acute Care (LTAC). Concerning clinical problems related to urinary tract infection (UTI), we propose the Gatch-up 45-degree positioning as a preventive measure for UTI. The case involves a 68-year-old female who underwent the Gatch-up procedure for 1 hour, twice a day, over a period of 1 month. Post-void residual (PVR) urine volume was measured and compared between the previous month and the intervention period. The average PVR significantly decreased from 245 mL to 80 mL (p < 0.05), representing a 67.3% reduction. This suggests further indications and potential future development for this procedure.

The American Diabetes Association (ADA) presented the Standards of Care in Diabetes-2025 online in December 2024. The authors immediately reviewed and provided perspectives on the latest developments regarding glucagon-like peptide-1 receptor agonists (GLP-1RA). Some newly added content about GLP-1RA is included, such as its application for heart failure with preserved ejection fraction (HFpEF), obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic dysfunction-associated steatohepatitis (MASH). Concurrent use of DPP-4 inhibitors (DPP-4i) with GLP-1RA (GIP/GLP-1RA) is not recommended due to a lack of additional glucose-lowering effects beyond GLP-1RA alone. GLP-1RA is expected to demonstrate various positive clinical effects.

Objective: To analyze the emergency treatment and triage strategies for patients involved in a mass bee sting incident at a school and to evaluate the effectiveness of optimizing emergency procedures through scoring-based assessment criteria. The aim is to reduce the incidence of severe complications and improve the efficiency of emergency response during mass casualty events.
Methods: A retrospective analysis was performed on the clinical data of 79 patients affected by bee stings during a mass incident at a school. Demographic information, clinical presentations, scoring results, classifications, and treatment measures were collected and analyzed. The severity of each patient’s condition was assessed using the Quick Sequential Organ Failure Assessment (qSOFA) score and an allergy response score. Based on these scores, patients were categorized as mild, moderate, or severe, with emergency treatment tailored accordingly. Mild cases presented with skin symptoms, moderate cases involved respiratory distress or mental disturbance, and severe cases showed multiple organ damage or anaphylactic shock. Emergency interventions, including triage labeling, intravenous access, anti-allergic medication, corticosteroid administration, and dynamic monitoring, were applied based on condition severity. Treatment outcomes and the value of the scoring system were subsequently analyzed.
Results: The application of scoring-based assessments made emergency triage more systematic and rational. Severe cases received priority interventions such as intravenous access, vasopressor administration, and oxygen therapy to maintain vital signs. Moderate cases were treated with anti-allergic medications and symptomatic management following intravenous access establishment, whereas mild cases were managed through observation and symptomatic relief. Most patients experienced significant symptom improvement after graded treatment, with a few severe cases requiring hospitalization, all of which exhibited favorable outcomes.
Conclusion: The implementation of scoring-based assessments for graded emergency treatment significantly enhances the efficiency of emergency responses in mass bee sting incidents and effectively reduces the risk of complications. This approach provides a scientific basis and a feasible strategy for managing similar mass casualty events in the future.

Objective: To evaluate the predictive value of the Shock Index (SI) and Age-Adjusted Shock Index (AASI) for hypotension following tracheal intubation in critically ill patients, providing a theoretical basis for clinical decision-making.
Methods: Clinical data were retrospectively collected and analyzed for patients who underwent tracheal intubation in the Emergency Department of Chengdu Shangjin Nanfu Hospital from January 1, 2021, to December 31, 2022. Patients were divided into hypotension and non-hypotension groups based on post-intubation outcomes. Univariate analysis identified risk factors for post-intubation hypotension, and multivariate logistic regression determined the relationship between hypotension and these risk factors. Receiver Operating Characteristic (ROC) curves were used to determine the optimal thresholds for these risk factors.
Results: A total of 152 patients were included, with 35 experiencing hypotension after intubation. The hypotension group had significantly lower systolic blood pressure, diastolic blood pressure, oxygen saturation, hematocrit, hemoglobin, and albumin levels, while age, heart rate, SI (1.33±0.62 vs. 0.87±0.45), and AASI (83.23±49.62 vs. 50.72±30.01) were significantly higher (P < 0.05). Multivariate logistic regression revealed that systolic blood pressure, diastolic blood pressure, oxygen saturation, SI, and AASI were independent risk factors for post-intubation hypotension. ROC curve analysis showed that the area under the curve (AUC) for SI was 0.731 [95% CI (0.628, 0.835), P < 0.05], with a sensitivity of 62.9% and specificity of 78.6%. The AUC for AASI was 0.757 [95% CI (0.658, 0.856), P < 0.05], with a sensitivity of 65.7% and specificity of 79.5%.
Conclusion: SI and AASI have significant predictive value for hypotension following tracheal intubation in critically ill patients.

Background: Echocardiography is a non-invasive technique that provides information about cardiac structure, function, and hemodynamics. Therefore, the knowledge of the echocardiographic pattern is imperative for the effective planning and management of patients with cardiovascular diseases. Unfortunately, there is a lack of data on the pattern of echocardiographic findings among these patients in our locality. Consequently, there is a need for a study aimed at describing the pattern of findings in echocardiography of cardiovascular diseases in geriatric patients.
Methods: This retrospective study was conducted at the Federal Medical Centre, Asaba from January 2018 to March 2021. It involved 130 reports of cardiovascular disease patients selected using a random sampling technique. Only geriatric patients’ echocardiography reports were included in the study and reports with incomplete information were excluded. Data collected were the patient’s age, sex, indications and echocardiography findings.
Results: Out of 130 reports collected, 70 (53.8%) were female while 60(46.2%) were male. The age range of 71-75 years was the most occurring (27.8%) while 96-100 years were the least (0.6%). Also, hypertensive heart disease was the most common indication (34.6%) for echocardiography examination and the most frequent echocardiographic finding (56.8%). Mitral stenosis was the least occurring finding (0.6%). Echocardiographic findings showed a negative correlation with gender but a positive correlation with age, although all are statistically insignificant (p > 0.05).
Conclusions: Hypertensive heart disease represents the most prevalent indication for echocardiography and the most common echocardiographic finding.

Background: Acute diffuse phlegmonous esophagitis is a relatively rare bacterial inflammation of the esophagus. It is characterized by an acute, diffuse, purulent infection involving the submucosal and serosal layers, resulting in phlegmonous-like features. There are only a few case reports in the medical literature, and early diagnosis of this condition presents challenges.
Case Presentation: This report presents a 73-year-old male patient with a history of type 2 diabetes, hypertension, gout, and chronic alcohol use, with poorly controlled blood glucose. The patient presented with upper abdominal pain, fever, shortness of breath, and dysphagia. Initial symptoms included severe upper abdominal pain, fever, and respiratory distress. Chest and abdominal enhanced CT scans revealed thickening and swelling along the entire esophagus, with narrowing of the lumen. After contrast enhancement, the esophagus showed ring-like enhancement. Upper gastrointestinal endoscopy showed mucosal swelling. There was no ulceration or perforation. The diagnosis of acute diffuse phlegmonous esophagitis was considered after excluding other common acute abdominal and chest pain conditions. The condition progressed rapidly, leading to septic shock. Next-Generation Sequencing of blood was positive for hypervirulent Klebsiella pneumoniae (hvKp). Despite active treatment, the patient’s condition was initially controlled; however, a follow-up chest CT showed multiple air pockets around the esophagus. The patient subsequently developed septic shock again and died despite active treatment.
Conclusion: Hypervirulent Klebsiella pneumoniae infection causing acute diffuse phlegmonous esophagitis involving the entire esophagus is a rapidly progressing condition that can quickly lead to septic shock. This report aims to alert clinicians to this rare disease and emphasizes the need for heightened awareness in cases of severe upper abdominal pain, where atypical abdominal pain may mask potentially fatal chest pain conditions. Early and accurate diagnosis and timely treatment are essential.

The American Diabetes Association (ADA) announced the Standard of Care (SoC)-2025 in January 2025. It included useful information about the low-carbohydrate diet (LCD), chronic kidney disease (CKD), and Metformin. Historically, the ADA has re-evaluated LCD in 2008, 2011, 2013, and 2019. Authors have developed LCD medically and socially through the Japan LCD Promotion Association (JLCDPA). From the latest report of post hoc analysis, Metformin may have a beneficial effect on CKD cases with an eGFR of less than 30 ml/min/1.73 m². For diabetic nephropathy (DN), impressive findings have been observed for major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE).

Vibration always exists in macrosystems, including all living things, human beings, and the cell microenvironment. The vestibulo-ocular reflex (VOR) is a reflex that moves the eyes in the opposite direction when the head moves. Based on VOR and the vestibular-emotional reflex (VER), VibraImage research has been found to be our charisma analysis method. Three subjects, 42-, 67-, and 70-year-old males, received a charisma test, in which the frequency histogram showed three different patterns. These included two peaks suggesting a worrying heart in Case 1, one peak with a symmetric wide distribution suggesting a stable heart in Case 2, and one peak with a narrow distribution for the charisma level in Case 3.

The healthcare sector, with its intricate web of patient care, medical procedures, and administrative tasks, is one of the most critical and complex industries in the world. Beyond the skilled surgeons, attentive nurses, and state-of-the-art facilities, there’s a diligent team that ensures healthcare institutions run like well-oiled machines—the Human Resources department, which is managed by the hospital administrator. In this review article, we will discuss the basic principles of management, the functions of the hospital administrator, and the various management techniques that a hospital administrator adopts so that the healthcare facility operates at full potential.
Workforce shortage is a challenge faced by hospital administrators, which, if not tackled, may lead to an increased workload for existing staff, burnout, medical errors, and reduced quality of patient care. Hospital administrators are often involved in navigating the complex web of healthcare regulations and ensuring that their facility complies with state laws, which frequently change and require meticulous documentation. Evolving and increasing patient demands and expectations, managing costs while providing quality care, technology integration, patient safety, and building strong relationships with the community are the various challenges that hospital administrators face.

Background: Preoperative exercise has emerged as a promising approach to reducing the risk of postoperative pulmonary complications (PPCs) in patients undergoing surgery. However, its effectiveness in lung cancer surgery remains a topic of debate, largely due to varying results across studies. This meta-analysis aims to clarify the role of preoperative exercise in preventing PPCs among lung cancer patients.
Methods: We conducted a comprehensive search of randomized controlled trials (RCTs) in databases including PubMed, Medline, Embase, and the Cochrane Central Register of Controlled Trials, covering research published up to November 8, 2023. The primary focus was on the incidence of PPCs, while secondary outcomes included postoperative lung infections, atelectasis, pleural effusion, respiratory failure, and the length of hospital stay. We also performed subgroup analyses based on factors such as age, type of exercise, and the duration of the preoperative exercise program.
Results: A total of eleven studies, involving 949 patients, were included in our analysis. The results showed that preoperative exercise significantly reduced the incidence of PPCs (Relative Risk [RR] = 0.41, 95% Confidence Interval [CI]: 0.32–0.51). It also decreased the rates of postoperative lung infections (RR = 0.76, 95% CI: 0.61–1.00), atelectasis (RR = 0.43, 95% CI: 0.28–0.65), and respiratory failure (RR = 0.31, 95% CI: 0.12–0.80). Additionally, patients who participated in preoperative exercise programs had a shorter hospital stay, with a mean reduction of 2.67 days (95% CI: –3.59 to –1.76). Subgroup analysis showed no significant differences in outcomes based on age or the specific type of exercise.
Conclusions: Our findings suggest that preoperative exercise can effectively reduce PPCs and shorten hospital stays in lung cancer surgery patients. We propose integrating preoperative exercise into enhanced recovery after surgery (ERAS) protocols.

The term “AGEs” is an acronym derived from “Advanced Glycation End Products (AGEs).” The medical community has been focusing on AGEs in recent years. So, what exactly is “glycation”? Glycation refers to the reaction in which monosaccharides such as glucose or fructose directly bind to proteins or other substances. AGEs produced in the body cause diabetic complications. AGEs have garnered attention because they are now considered a primary cause of various diabetic complications. The processes involved are diverse, but the most straightforward example is when AGEs accumulate in the inner walls of blood vessels, leading to atherosclerosis. Depending on which part of the blood vessels is affected by atherosclerosis, the resulting diabetic complications vary, but it is no exaggeration to call them all vascular diseases. AGEs in the vessel walls are like an unpayable debt, often referred to as the “memory of high blood sugar.”