Annual Number Of Hospitalizations Research Articles

Occurrence, virulence, and resistance genes in Salmonella enterica isolated from an integrated poultry company in Jordan

Salmonella is considered one of the most common foodborne pathogens worldwide. The annual number of hospitalizations and deaths related to zoonotic salmonellosis, which is transmitted from animals to humans and infects poultry and meat, is expected to be significant. Hence, the primary aims of this research were to isolate and characterize Salmonella species obtained from an integrated poultry company and identify some virulence, and antimicrobial resistance, with a specific concern about colistin resistance genes. A total of 635 samples collected from various sources in an integrated company in Jordan were screened for Salmonella species accompanying their virulence and antimicrobial resistance genes. Samples were collected from parent stock house drag swabs, broiler farms, premix, cecum at the slaughterhouse level, pre-chilling and post-chilling stages, and the final product. Salmonella species were detected in 3% (6\\200) of investigated parent stock house drag swabs, 13.8% (11/80) from cloacal swabs from broiler farms, 16.9% (11/65) from boiler farms premix, 24.4% (11/45) from the cecum at slaughterhouse level, 16.4% (9/55) from the pre-chilling stage, 37.8% (17/45) from the post-chilling stage and 53.3% (24/45) from the final product stage. No isolates were detected in feed mills (0/20), parents' premix (0/40), or hatcheries (0/40). Salmonella isolates were resistant to ciprofloxacin (91.0%), nalidixic acid (86.5%), doxycycline (83.1%), tetracycline (83.1%), sulphamethoxazole-trimethoprim (79.8%) and ampicillin (76.4%). Serotyping shows that S. Infantis was the predominant serovar, with 56.2%. Based on the minimum inhibitory concentration (MIC) test, 39.3% (35/89) of the isolates were resistant to colistin; however, no mcr genes were detected. Among antimicrobial-resistant genes, blaTEM was the most prevalent (88.8%). Furthermore, the spvC, ompA, and ompF virulence genes showed the highest percentages (97.8%, 97.8%, and 96.6%, respectively). In conclusion, Salmonella isolates were found at various stages in the integrated company. S. Infantis was the most prevalent serotype. No mcr genes were detected. Cross-contamination between poultry production stages highlights the importance of good hygiene practices. Furthermore, the presence of virulence genes and the patterns of antimicrobial resistance present significant challenges for public health.

Comparison of the General Characteristics of Patients with Severe Asthma Who Switched from Omalizumab to Mepolizumab versus Patients Who Responded to Omalizumab Treatment: A Real-Life Study

Introduction: Severe asthma is characterized by frequent recurrent airway symptoms and exacerbations, and these affect the quality of life. Biological agents can be used in the treatment of patients with severe asthma if the disease cannot be controlled with standard controller treatment. The aim of this study was to compare the clinical characteristics and laboratory data of patients with severe asthma who were switched from omalizumab to mepolizumab and patients with severe asthma who responded to omalizumab. Methods: The clinical characteristics and laboratory data of patients with severe asthma who responded to omalizumab and switched from omalizumab to mepolizumab were compared retrospectively. Results: Evaluation was made of a total of 79 patients, including 64 omalizumab responders and 15 who switched to mepolizumab from omalizumab. After omalizumab and mepolizumab treatment, the annual number of asthma attacks, the use of oral corticosteroid (OCS), the annual number of hospitalizations, and the eosinophil count significantly decreased (omalizumab: p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively; mepolizumab: p = 0.001, p = 0.001, p = 0.002, p = 0.001, respectively). After omalizumab treatment, the increase in forced expiratory volume in 1 s (FEV1) (%) and asthma control test (ACT) score were determined to be statistically significant (p < 0.001, p < 0.001, respectively). After mepolizumab treatment, the increase in ACT score was significant (p = 0.003). Drug allergy, chronic sinusitis with nasal polyps (CRSwNP), regular use of OCS, and high baseline eosinophil count (cells/µL) were associated with poor response to omalizumab treatment (odds ratio [OR] = 7.86, p = 0.003; OR = 52.92, p < 0.001; OR = 10.16, p = 0.004; OR = 0.99, p = 0.004, respectively). House dust mite sensitivity and high baseline FEV1 (%) were associated with good response to omalizumab treatment (OR = 0.29, p = 0.041; OR = 1.06, p = 0.03, respectively). The blood eosinophil count had diagnostic value in predicting the nonresponsiveness to omalizumab treatment (area under the curve [AUC]: 0.967, p < 0.001, cut-off: 510). Conclusion: A high pretreatment eosinophil count, concomitant CRSwNP, a history of drug allergy, and regular OCS use may be associated with poor response to omalizumab treatment in patients with severe asthma. Depending on the treatment response, treatment switching can be applied between biological agents. The results of the current study should be supported by multicenter studies.

Long-term effects of angiotensin receptor neprilysin inhibitor therapy in heart failure patients with reduced ejection fraction: A retrospective cohort study.

Heart failure is an increasing public health issue with substantial morbidity and mortality rates. This study aimed to evaluate the efficacy, safety, and long-term outcomes of angiotensin receptor neprilysin inhibitor (ARNi) in the treatment of heart failure with reduced ejection fraction (HFrEF) 5 years after treatment initiation. This retrospective study analyzed a cohort of 75 patients diagnosed with HFrEF over a period of 5 years after the initiation of ARNi therapy. The initial clinical condition, laboratory and echocardiographic measurements including left ventricular ejection fraction (LVEF), New York Heart Association functional classes (NYHA-FC) and the prognostic nutritional index were compared to the corresponding values obtained after a 5-year period of ARNi therapy. In addition, the number of annual hospitalizations, mortality rates and any history of adverse effects during the follow-up period were recorded. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level, LVEF, and NYHA-FC values demonstrated significant improvement at the end of the 5-year follow-up period (all parameters, P < .001). Although the observed increase in the prognostic nutritional index was not statistically significant (P = .077), it is worth noting. A significant reduction in daily diuretic doses and hospitalizations due to heart failure was observed following the use of ARNi (all comparisons, P < .001). The prevalence of hypotension was around 16% (being symptomatic in 4%), making it the most frequently observed adverse event. The 5-year cardiovascular mortality rate was 17.3%. The use of ARNi in HFrEF patients was associated with a notable improvement in NYHA-FC, LVEF, and NT-proBNP levels in the long-term, while also leading to a better nutritional status and reduced need for diuretics and annual hospitalization. Additionally, ARNi usage has been associated with improved nutritional status, decreased reliance on diuretics, and reduced frequency of annual hospitalizations. These effects were associated with a lack of significant increase in adverse effects. These results may contribute to a better understanding of ARNi's long-term effects on patient outcomes.

Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991–2016

BackgroundMembers of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010.MethodsThe National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991–2016 (at least once in 2010–2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991–2000, Period2: 2001–2009, Period3: 2010–2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days.ResultsThe proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001).ConclusionsThe findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.

Association of Caregiver Depression Risk With Patient Outcomes in Parkinson Disease

Caregivers are integral to Parkinson disease (PD) care, but little information exists regarding how caregivers impact patient outcomes. To assess the association between caregivers reporting depression symptoms and patient quality of life (QOL), emergency department (ED) visits, and hospitalizations. This retrospective cohort study was conducted at 15 Parkinson's Foundation Centers of Excellence within the US. The Parkinson's Foundation Parkinson Outcomes Project registry was used to collect baseline data from January 1, 2016, to December 31, 2018, with subsequent annual study visits through July 31, 2020. Data were analyzed from August 5, 2020, to June 9, 2023. A convenience sample of 454 patients with PD and their caregivers was recruited during routine clinical visits with movement disorder specialists. Patients with a physician diagnosis of idiopathic PD who lived at home and had 1 or more follow-up study visits were included. Caregiver depression symptoms using the Center for Epidemiologic Studies Depression Scale. Patient health-related QOL (measured by the 39-item Parkinson Disease Questionnaire), number of annual ED visits, and number of annual hospitalizations were measured. The independent association between caregivers reporting depression symptoms and patient outcomes was assessed using linear mixed-effects and Poisson regression models. The a priori hypotheses were that a greater number of depression symptoms reported via the Center for Epidemiologic Studies Depression Scale would be associated with worse patient QOL and a greater number of ED visits and hospitalizations. Among 454 patient-caregiver dyads (patients: mean [SD] age, 67.3 [8.4] years; 320 men [70.5%]; caregivers: mean [SD] age, 65.9 [8.7] years; 326 women [71.8%]), the mean (SD) follow-up was 2.0 (1.4) study visits. Greater depression symptoms among caregivers were associated with worse patient QOL as measured by the Parkinson Disease Questionnaire (mean [SD] score, 33.78 [17.71], on a scale of 0-100, with higher scores indicating worse QOL, among patients with caregivers who had depression symptoms vs 24.50 [14.19] among patients with caregivers who did not have depression symptoms; β = 0.43; 95% CI, 0.28-0.58; P < .001) and more annual ED visits (β = 0.02; 95% CI, 0 to 0.04; P = .03) but not more hospitalizations (β = 0.02; 95% CI, -0.01 to 0.03; P = .10). In this cohort study, patients with PD who had caregivers at higher risk of depression were more likely to have worse QOL and higher ED use than patients who had caregivers not at higher risk of depression. Additional caregiving resources and interventions to reduce caregiver depression symptoms could potentially improve patient outcomes.

Gene Therapy Equity in Sickle Cell Disease: Distributional Cost-Effectiveness Analysis (DCEA) of Gene Therapy Vs. Standard-of-Care in Patients with Sickle Cell Disease in the United States

Introduction: Patients with sickle cell disease (SCD) face substantial mortality risks and decreased quality-of-life for every year lived with disease. Once approved in the United States (US), gene therapy treatment for patients with SCD would allow the possibility of lifelong disease remission and, unlike allotransplantation, do so without the concomitant risks of allotransplantation. While gene therapy has previously been projected to be cost-ineffective using traditional cost-effectiveness criteria in the US, this does not include a quantification of the health disparities present in the clinical care of patients with SCD. We sought to address this knowledge gap by conducting the first distributional cost-effectiveness analysis, a method that quantifies the tradeoffs between traditional cost-effectiveness outcomes and health equity, for gene therapy use in SCD. Methods: We built and validated a Markov simulation model of patients with a diagnosis of mild, moderate, or severe SCD to examine the cost-effectiveness of gene therapy versus patients treated with standard-of-care (SOC). Gender-, age-, and disease-severity-specific annual costs and transition probabilities between disease severities were informed by ten years of real-world data from commercially insured patients in the United States with SCD (2007-2017; Optum claims data). Disease severity was defined based on annual number of hospitalizations and SOC was inclusive of hydroxyurea, opioid therapy, antibiotics, vaccinations, blood transfusions, and stem cell transplantation. Quality-adjusted life-years (QALYs) were informed by published lifetime simulation of patients living with SCD and matched controls. These were originally derived from a polynomial fit linking Euroqual-5 Dimensions to the visual analog scale for pain in patients with SCD in several studies. Age-, gender- and disease-specific background mortality probabilities were employed. Traditional cost-effectiveness was quantified using an incremental cost-effectiveness ratio (ICER) and a cost-effectiveness threshold of $100,000/QALY. Base-case gene therapy was assumed to cost $2.1 million based on other recently approved indications, be 100% effective in achieving disease remission, and applied to a minimum eligibility age of 12, as studied in randomized, controlled trials. To account for health inequities in SCD we then conducted a distributional cost-effectiveness analysis (DCEA), which applies an inequality aversion parameter (i.e., equity weight) to the distribution of outcomes across relevant sub-groups. Specifically, we derived the threshold inequality aversion parameters needed for gene therapy to be favored over SOC and justify funding per DCEA standards. These were compared to prior estimates for commonly used equity weights in the US (range 0.5-3.0) and the United Kingdom (UK) (11.0-28.9). Results: Base-case gene therapy versus SOC treatment starting at age 12 yields 25.5 versus 16.0 discounted lifetime QALYs at costs of $2.4 and $1.1 million, respectively. The ICER of $144,000/QALY is not good value for money using traditional cost-effectiveness methods and a cost-effectiveness threshold of $100,000/QALY. When using DCEA that account for health disparities in SCD, the inequality aversion parameter threshold is 1.7. This implies a preference for reducing disparities in SCD care that is in line with prior estimates in the US and well below those of the UK, per DCEA standards to favor gene therapy over SOC. A corresponding price range for gene therapy for SCD across the range of commonly used equity weights in the US is $1.4-$3.0 million (Figure 1). Conclusion: Gene therapy can be an equitable therapeutic strategy for patients with SCD in the United States despite a projected minimum cost of $2.1 million once approved, based on commonly-used equity weight values used in DCEA. Equitable gene therapy use would include expanding eligibility to include patients with mild and moderate disease severity, in addition to those with severe SCD, assuming similar therapeutic efficacy of gene therapy across disease severity. Rather than relying on ranges of commonly-used equity weights, nationally representative surveys should be fielded to empirically deriving an inequality aversion parameter value for addressing this SCD-specific health disparity to further help inform an equitable price benchmark for gene therapy in the US. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The increased medical burden associated with frailty is partly attributable to household solid fuel: A nationwide prospective study of middle-aged and older people in China

BackgroundFrail individuals often face a high medical burden, and household solid fuel use is associated with a range of functional declines or diseases, but evidence on the relationship between household solid fuel and frailty and the resulting medical burden is limited. We aim to investigate the effect of household solid fuel on frailty and further quantify how much of the increased medical burden associated with frailty is attributable to household solid fuel. MethodsThe prospective data were from the China Health and Retirement Longitudinal Study, 4685 non-frail participants at baseline were included. Inverse probability weighting was used to balance the covariates between groups. The modified Poisson regression was used to analyze the association of household solid fuel (including baseline and switching across three-wave survey) with frailty, and the generalized linear model was used to analyze the association of frailty with the change in medical burden. Further, the increased medical burden associated with frailty attributable to household solid fuel was quantified. ResultsUsing solid fuel for cooking (RR = 1.29, 95%CI, 1.07–1.57), heating (RR = 1.38, 95%CI, 1.09–1.73), or both (RR = 1.40, 95%CI, 1.05–1.86) had a higher risk of frailty than using clean fuel. In addition, the risk of frailty generally increases with the times of solid fuel use across the three-wave survey. Then, frailty participants had a greater increase in the annual number of hospitalizations (β = 0.11, 95%CI, 0.02–0.19) and annual costs of hospitalizations (β = 2953.35, 95%CI, 1149.87–4756.83) than those non-frailty. Heating coal caused the largest frailty-related increase in the annual number of hospitalizations and annual costs of hospitalizations, with 0.04 and 1195.40, respectively. ConclusionThe increased medical burden associated with frailty was partly attributable to household solid fuel, which suggested that intervention targeting household solid fuels can delay frailty and thus reduce individual medical burden.

The Spectrum of Malignant Neoplasms among Liver Transplant Recipients: Sociodemographic Factors, Mortality, and Hospital Burden.

Objective: To determine the nationwide prevalence of malignant neoplasms (excluding hepatocellular carcinoma-HCC) in hospitalized liver transplant recipients and to study the hospital utilization, and mortality to the incidence of malignancies. To the best of our knowledge, few epidemiological studies addressed outcomes in post-liver transplant patients, such as the annual number of hospitalizations, mortality, patient characteristics regarding malignancies.Methods: NIS database was queried between 2016 and 2018 to retrieve records of patients admitted with a principal or secondary diagnosis of liver transplant following the International Classification of Diseases, tenth Revision (ICD-10). The population was divided into case and control groups according to the presence and absence of malignant neoplasm (MN) except for HCC. We also compared the incidence of MN in LTX patients and non-LTX matched cohort.Results: A total of 7.28% admissions were associated with malignant neoplasms (except HCC) in LTX patients. Lymphomas, respiratory, gastrointestinal (excluding HCC), leukemia, and head/neck were commonest cancers with estimated admission rates of 0.97%, 0.90%, 0.80%, 0.53%, and 0.49%, respectively. Lung cancer was the most frequent malignant neoplasm among White and Black racial/ethnic groups (15.78% and 14.8%), whereas lymphoma was pervasive among Hispanics (20.3%). Lung cancer had the highest in-hospital mortality (10.55%), followed by the cancer of the nervous system (9.09%). The LTX and non-LTX cohort comparison showed that LTX patients are at increased risk of head and neck cancers, skin cancers, lymphomas, tumors, and Myelodysplastic syndrome. According to a multivariate analysis, a statistically significant association existed between malignant neoplasms in LTX patients and the following factors: increasing age (P < .001), higher mortality (P < .001), females with 29% lesser odds than males (P < .001), Black race and Hispanic ethnicity with 20% and 26% lesser odds as compared to White (P < .05). Clinical factors included smoking, Alcoholic cirrhosis, Hepatitis B, and Hepatitis C, were statistically significant risk factors of post-liver transplantation malignancies.Conclusions: Malignancies were frequent among elderly patients and predominantly in males. Lymphoproliferative diseases were the most prevalent malignancy types, followed by respiratory/lung cancer- which showed the highest mortality risk of all cancers. LTX patients are at increased risk of head and neck cancers, skin cancers, lymphoma, tumors, and Myelodysplastic syndrome compared to non-LTX patients.

Hospitalization for urinary tract infections in Japan, 2010\u20132015: a retrospective study using a national inpatient database

BackgroundUrinary tract infections (UTI) are common and can have severe consequences. However, there are few recent large-scale studies about them. We aimed to determine the incidence of hospitalization for UTI and to elucidate patient characteristics, clinical practice, and clinical outcomes by drawing on a Japanese nationwide database.MethodsThis was a retrospective observational study using a national database that covers half the acute care inpatients in Japan. Patients aged ≥ 15 years who were hospitalized for UTI were eligible. We did not include patients with lower UTI such as cystitis. We investigated the annual number of patients hospitalized in Japan, those patients’ characteristics, and risk factors for in-hospital mortality.ResultsWe identified 232,396 eligible patients from 31 million records of discharge between April 2010 and March 2015. The average age was 73.5 years and 64.9% of patients were female. The estimated annual number of hospitalizations because of UTI was 106,508. The incidence was 6.8 per 10,000 for men and 12.4 for women. The median medical care cost was 4250 USD. In-hospital mortality was 4.5%. Risk factors of poor survival included male sex, older age, lower bed capacity, non-academic hospital, admission in winter, higher Charlson Comorbidity Index score, low body mass index, coma on admission, ambulance use, disseminated intravascular coagulation, sepsis, renal failure, heart failure, cerebrovascular diseases, pneumonia, malignancies, use of anti-diabetic drugs, and use of corticosteroid or immunosuppressive drugs.ConclusionsWe found that older patients of both sexes accounted for a significant proportion of those hospitalized for UTI. The clinical and economic burden of UTI is considerable.

Analysis Of The Achieved Quality Of Life In Patients With End-Stage Ckd Undergoing Online Hemodiafiltration

Online hemodiafiltration (OL-HDF), as a renal replacement therapy, has gained significant momentum in recent years due to the added benefit of increased clearance of middle molecules responsible for organ damage and the development of complications in patients with end-stage CKD (ESRD). The beneficial effect of OL-HDF on mortality from a variety of causes, as well as cardiovascular mortality and morbidity, has been reported by some clinical trials. Health-related quality of life (HRQOL) is an important component of care for hemodialysis patients and is of interest to both healthcare providers and patients. Improved quality of life in hemodialysis patients has been associated with a reduced rate of hospitalizations, morbidity and mortality, as well as higher self-esteem, well-being, and psychological comfort. Data on HRQOL in ESRD patients under OL-HDF are scarce and of negligible quality. In the Clinic of Nephrology and Dialysis at the St. Marina University Hospital, Varna, we performed a comparative analysis on 41 patients with HD with an average age of 58.6 ± 12 years (36–70), divided into two groups: Group 1—undergoing conventional HD, and Group 2—undergoing online HDF for a period of 6 months. The main research method is based on a standardized questionnaire on quality of life in kidney disease (KDQOL-SF36), containing 36 elements for assessing eight health concepts of HRQOL, as well as statistics on hospitalizations, morbidity and mortality in patients. The study shows that the use of OL-HDF is associated with a better quality of life related to health in both dimensions: the scale of the physical component and the scale of mental components. There is a reduction in the number of annual hospitalizations, a lower incidence of cardiovascular events, improvement in hypertension, chronic joint pain and stiffness, itching, and improved nutritional status and response to erythropoietin therapy.

Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR).

Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN. The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Efficacy and quality of life assessment in the use of subcutaneous immunoglobulin treatment for children with primary immunodeficiency disorder.

Introduction. Most patients with primary and secondary immunodeficiencies need regular Intravenous Immunoglobulin (IVIG) or Subcutaneous Immunoglobulin (SCIG) treatment. This study aimed to evaluate the serum IgG trough levels, frequency of mild and severe infections, frequency and duration of hospitalization, duration of absence of school, and quality of life in patients switching their IVIG therapy to SCIG administration. Materials. Twenty-nine patients with immunodeficiency on regular IVIG treatment and who agreed to receive SCIG treatment were included. Seven patients discontinued treatment after the first SCIG administration. We collected data regarding serum IgG levels, annual numbers of infections, hospital admissions, and adverse events prior to and following SCIG initiation. PedsQL tests such as Scale Total Score (STS), Physical Health Total Score (PHTS), Psychosocial Health Total Score (PsyHTS), emotional functionality, social functionality, school/work problems score were calculated separately for all patients and their parents. Results. In twenty-two cases who were diagnosed as primary immunodeficiency, the most common indication for initiation of SCIG treatment was the long transfusion period of IVIG treatments and the difficulty of access to the hospital. No systemic side effects were noted except local redness, pain, and swelling on the injection site. The median IgG value was 588.9 mg/dl during IVIG treatment and 872 mg/dl one year after SCIG treatment. Annual frequency of infections and absence to school/work decreased significantly in the SCIG group while the annual number of hospitalizations and hospital stay time did not change significantly. There was a significant increase in the "quality of life" scores of the patients and their families. Conclusions. SCIG treatment provides ideal and protective immunoglobulin levels and offers the comfort of treatment in their home environment, thus increasing the patient's satisfaction and quality of life.

Improvement of SCD morbimortality in children: experience in a remote area of an African country

BackgroundSickle cell disease (SCD) is a public health problem in the Democratic Republic of Congo. While reference sickle cell centers have been implemented in capital cities of African countries and have proven to be beneficial for SCD patients. In the Democratic Republic of Congo, they have never been set up in remote areas for families with low or very low sources of income.MethodA cohort of 143 children with SCD aged 10 years old (IQR (interquartile range): 6–15 years) (sex ratio male/female = 1.3) were clinically followed for 12 months without any specific intervention aside from the management of acute events, and then for 12 months with a monthly medical visit, biological follow-up, and chemoprophylaxis (folic acid/penicillin), adequate fluids and malaria prevention.ResultsThe median age of patients at the diagnosis of SCD was 2 years (IQR: 1–5). The implementation of standardized and regular follow-ups in a new sickle cell reference center in a remote city showed an increase in the annual mean hemoglobin level from 50 to 70 g/L (p = 0.001), and a decrease in the lymphocyte count and spleen size (p < 0.001). A significant decrease (p < 0.001) in the average annual number of hospitalizations and episodes of vaso-occlusive crises, blood transfusions, infections, and acute chest syndromes were also observed.ConclusionsThe creation of a sickle cell reference center and the regular follow-up of children with sickle cell disease are possible and applicable in the context of a remote city of an African country and represent simple and accessible measures that can reduce the morbimortality of children with sickle cell disease.

Trends in hospitalizations among patients with colorectal cancer: Results from the National Inpatient Sample (2007 through 2017).

135 Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States with a rising incidence, especially in young adults. Care for patients with colorectal cancer is associated with significant health care costs and expenditures. We analyzed trends in admissions and outcomes related to hospitalizations in patients with colorectal cancer. Methods: We retrospectively interrogated the National Inpatient Sample for admissions in patients with colorectal cancer from 2007 – 2017. Records were stratified based upon the anatomical site and were analyzed for various inpatient outcomes. SAS version 9.4 (SAS Institute Inc.) was used for statistical analysis. Results: A total of 1,962,705 admissions were identified. About 50.2% patients were males, 64.4% were white and median age was 67.7 (53.8-81.6). Majority (47.8%) of the admissions that were coded for anatomical location of malignancy were for ascending colon cancer. 60.7% of the admissions were non-elective and Medicare was the primary payer for 58.6% of admissions. Most patients admitted for colon cancer belonged to the lower income quartile (28.3%) and were concentrated in large (58.9%), urban teaching hospitals (53.4%) in Southern US (38.8%). Hypertension (53.6%) and diabetes mellitus (18.6%) were the most common co-morbidities (p &lt; 0.0001). Average in-hospital mortality was 4.9% and was lower in patients with ascending colon cancer (2.9, p &lt; 0.001). Median length of stay was 5 days, but was higher in patients with transverse colon cancer (9 days, p &lt; 0.0001). Median cost of hospitalization was found to be $12,295 and was significantly higher for patients with descending colon malignancy ($16,369, p &lt; 0.0001). The number of annual hospitalizations stayed steady overall; the number of annual hospitalizations increased by 98.6% for rectosigmoid cancer. Conclusions: Despite highest number of hospitalizations, patients with ascending colon cancer had lowest in-hospital mortality. Cost of hospitalization and median length of stay were highest for patients with descending colon and transverse colon respectively. Number of annual hospitalizations has significantly increased for rectosigmoid cancer. Our findings may help inform physicians and healthcare administrators to devise appropriate strategies to efficiently channelize healthcare resources in order to decrease the overall economic burden associated with hospitalizations in patients with colorectal cancer.

Hospitalizations in psychiatry during the month of Ramadan: A study at the Tunisian mental health hospital.

Muslims fast each year during the Holy Month of Ramadan. This rite has major socio-cultural consequences. The circadian rhythms, energy expenditure, body temperature and biological clock are also influenced by Ramadan fasting. The impact of fasting on patients with mental disorders has been little studied. The aim of this study was to assess the number of hospitalizations in psychiatry during Ramadan compared to the other months of the lunar year. A cross-sectional and retrospective study was conducted at Razi hospital, the psychiatric hospital in Tunis. The following data over the five lunar years (1434-1438) was checked for: The monthly and the annual number of hospitalizations in the different departments of Razi mental health hospital in Tunis as well as the monthly and annual rates of different legal modalities of admissions. An important decrease in the number of hospitalizations during Ramadan was observed each year followed by a constant increase during the following month.Ramadan was the only lunar month to have had a consistently below-average number of admissions. There has been a significant increase in the mean number of hospitalizations per month over the years. A general trend towards an increase in the proportion of enforced hospitalizations has been noted. Ramadan stands out not only on a religious but also on a social level. Our results add support to the usefulness of research on mental health and Ramadan in the psychiatric community.

Factors associated with in-hospital mortality from community-acquired pneumonia in Portugal: 2000\u20132014

BackgroundCommunity-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide, often leading to hospital admissions. In Portugal, the factors associated with in-hospital mortality due to CAP are not fully documented. The aim of this study was to characterize the trends of CAP hospitalization in all age groups and the factors associated with their mortality between 2000 and 2014.MethodsWe conducted a cross-sectional study using CAP hospitalization data in all age groups, in Portugal Mainland. Logistic regression was used to identify the factors associated with in-hospital mortality.ResultsBetween 2001 and 2011, CAP hospitalization rate increased from 2.8 to 4.3 per 1000 population. Hospitalization rates were higher in the extreme ages ( ≤ 4 and ≥ 75 years). However, a decrease in the hospitalization rate and its mortality was observed, in the younger ages.A total of 548,699 hospitalization CAP episodes, between 2000 and 2014, were analyzed, with male (56.2%) and elderly ≥65 years (91.7%) predominance, resulting in 101,740 deaths (18.5%). Men had a significantly lower mean age (64.3 ± 26.4 years versus 67.9 ± 27.5 years; p < 0.001). During the studied 15 years, there was an increase of 45.2% in the number of annual hospitalizations, concomitant with the admission increase of individuals aged over 75 years. Since 2012 a decrease in hospitalizations and associated deaths were detected.The increase in age represented a progressive and significant rise in the probability of death, except for the age group 1–4 years. The age group ≥85 years old (Adjusted OR = 124.256; 95%CI: 97.838–157.807) and males (Adjusted OR = 1.261; 95%CI: 1.243–1.280) were significantly associated with death risk for CAP hospitalization. After 2010, this risk decreased (Adjusted OR = 0.961; 95%CI: 0.940–0.982). The main factors affecting mortality were age, sex, unemployment rate, number of performed procedures and admission quinquennia.ConclusionsDespite a trend of decrease in CAP hospitalizations and associated death since 2012, the numbers of in-hospital mortality showed, in the 15 years under analysis, an overall increase over time, mainly associated with age, in particular very old people ( ≥ 75 years), males and a higher parish unemployment rate. Therefore, the implementation of CAP preventive measures should be reinforced in these vulnerable groups.

Gastrointestinal Hemorrhage in Acute Kidney Injury Patients on Hemodialysis.

BackgroundGastrointestinal bleeding (GIB) has been reported to be more common in patients with chronic renal failure and end-stage renal disease requiring hemodialysis with higher mortality than in the general population. Limited epidemiological data exist on the annual number of hospitalizations, demographic variation, cost of care, and outcomes for GIB in patients with acute kidney injury (AKI) requiring and not requiring hemodialysis (HD). The main objective of this study was to analyze the trends of GIB in patients with AKI requiring HD and those not requiring HD during hospitalization.Methods and ResultsWe analyzed the National (Nationwide) Inpatient Sample (NIS) database for all subjects with a discharge diagnosis of AKI as the primary or secondary diagnosis during the period from 2001 to 2011. Subjects with a discharge diagnosis of hemodialysis and GIB were then identified from the pool and trends were analyzed. A significant rise in the annual number of hospitalizations with AKI was found with a greater proportion being discharged without HD. From 2001 to 2011, there were 19,393,811 hospitalizations with a discharge diagnosis of AKI of which 1,424,692 (7.3%) received HD (HD group), whereas 17,969,119 (92.7%) did not receive HD (non-HD group) (p < 0.0001). The male gender was more commonly affected by GIB than the female gender in both groups (p < 0.0001). The cost of care per hospitalization for GIB patients in the HD group increased over the study period with average found to be $61,463 (adjusted for inflation, p < 0.0001), whereas for GIB patients in the non-HD group, it showed a slight decrease in trend with the average found to be $28,419 (p < 0.0001). All-cause mortality was higher for GIB patients in the HD group (38.1%) than in the non-HD group (25.1%) (p < 0.0001).ConclusionsGIB is more common and associated with higher all-cause inpatient mortality in patients receiving HD in comparison to non-HD patients.

1253-P: High Health-Care Utilization (HCU) and Costs Associated with Diabetes Mellitus (DM) and Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis (NAFLD/NASH) in Medicare Patients

Background: One of the common comorbidities in NAFLD/NASH patients is DM. This study evaluated HCU and costs in NAFLD/NASH patients with varying liver disease severity by DM status. Methods: This was a retrospective study from 2007-2015 of a 20% sample of U.S. Medicare beneficiaries and included NAFLD/NASH patients (ICD codes) with and without DM (ICD codes/medications). Mean annual healthcare costs were reported in 2015 USD and stratified by NAFLD/NASH only, compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplant (LT), and hepatocellular carcinoma (HCC) and presence of DM. Results: This study identified 260,950 NAFLD/NASH patients, of which 144,862 (55.5%) also had comorbid DM. NAFLD/NASH CC patients with DM had high rates of additional metabolic comorbidities: 77.5% with cardiovascular disease and 87.5% with both hypertension and hyperlipidemia. Mean annual number of hospitalizations in NAFLD/NASH only with DM was 0.6, which significantly increased in CC (0.8) and DCC (2.2) DM patients. Mean annual healthcare costs were significantly higher in those with comorbid DM (except HCC) (Figure). Conclusions: Comorbid DM among NAFLD/NASH patients is associated with high metabolic comorbidity burden and significantly higher HCU and healthcare costs in U.S. Medicare patients. Disclosure S. Gordon: Consultant; Self; Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc. J. Fraysse: Employee; Self; Gilead Sciences, Inc. S. Li: Consultant; Self; Gilead Sciences, Inc. A. Ozbay: Employee; Self; Gilead Sciences, Inc. Stock/Shareholder; Self; Gilead Sciences, Inc. R. Wong: Advisory Panel; Self; Gilead Sciences, Inc. Consultant; Self; Gilead Sciences, Inc. Research Support; Self; Gilead Sciences, Inc. Speaker's Bureau; Self; Gilead Sciences, Inc.

Mental health comorbidities and cost/utilization outcomes in head and neck cancer patients

Purpose: Examine the relationship between mental health comorbidities and health services outcomes in non-elderly adults with head and neck cancer (HNC).Design: Retrospective, cross-sectional.Sample: Non-elderly adults with a primary diagnosis of HNC in U.S. Department of Defense (TRICARE) administrative claims data for fiscal years (FY) 2007–2014.Methods: Linear regression and generalized linear models were used to examine predictors of reimbursed cost and healthcare utilization, respectively.Findings: On average, there were 2944 HNC patients each year, the majority age 55–64, male, military retirees or family members of retirees, cared for in civilian facilities, and residing in the U.S. southern region. Between FY2007 and FY2014, there were slight increases in prevalence rates for diagnosed depression (12.4%–13.1%), anxiety (8.2%–11.9%), adjustment disorders (3.7%–5.8%), and drug use disorders (10.3%–19.4%), and a slight decrease in alcohol use disorders (12.3%–11.4%). In the cost regression model, depression and anxiety were the seventh and eighth strongest predictors (p < .001), behind hospice use, treatment modalities, chronic physical conditions, and tobacco use. In the utilization regression models, depression, adjustment disorder, and anxiety ranked seventh, ninth, and eleventh as the strongest predictors for the number of ambulatory visits; anxiety, depression and substance use disorder ranked fifth, sixth, and eighth in the model examining predictors of the number of annual hospitalizations; and anxiety and depression ranked fifth and sixth in the model examining predictors of the annual number of bed days.Conclusions: We found strong evidence that mental health comorbidities impact cost and utilization among HNC patients, independent of other factors.Implications for Psychosocial Providers or Policy: Addressing mental health comorbidities among HNC patients may reduce cost and improve resource efficiency.

Incidence, mortality and bleeding rates associated with pulmonary embolism in England between 1997 and 2015

BackgroundImprovements in availability and accuracy of diagnostic testing in pulmonary embolism (PE) in the last 20 years have more recently been paralleled by the introduction of additional anticoagulation agents and treatment strategies. These developments are likely to shape potentially important changes in PE incidence, associated mortality and treatment complications. MethodsWe investigated trends in PE incidence, PE-related mortality and bleeding risk by analysing Hospital Episodes Statistics for England. ResultsBetween 1997 and 2015, 464,046 patients (53.9% female) were hospitalized with PE in England. The annual number of hospitalizations with an associated diagnosis of PE more than doubled over this period (24,366 in 1998 vs. 53,108 in 2014), with a corresponding increase in PE hospitalization rate (50.2 to 97.8 per 100,000 population/year), evident in all age categories. Mortality at 1 and 3 months decreased over the study period and was significantly associated with age, treatment era and comorbidities. The risk of bleeding resulting in hospitalization or death within 3 and 12 months after the index PE admission increased over the study period (4.3%/5.1% for 1998–2004 versus 6.1%/7.2% for 2010–2014, p < 0.001 for both comparisons). ConclusionsThe incidence of PE doubled in England between 1997 and 2015, likely attributable to raised awareness and ability to diagnose less severe cases. While PE-associated mortality decreased, there was an increase in bleeding risk. Renewed efforts directed at reducing the incidence of bleeding, including consideration of anticoagulation regimens and investigation of anticoagulation requirement in patients with low-risk features, are needed.