Respiratory syncytial virus (RSV) infection in adults causes lower respiratory tract disease (LRTD) encompassing lower respiratory tract infection (LRTI), and exacerbations of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF), yet RSV testing rates among these patients, especially among outpatients, are not well documented. This study evaluated RSV and influenza testing practices among United States (U.S.) adults seen in outpatient settings with LRTI, COPD exacerbation, or CHF exacerbation. We quantified RSV and influenza testing rates in a retrospective cohort of adults ≥ 18years old seen in outpatient settings for LRTI, COPD exacerbations, or CHF exacerbations from August 2017 to March 2024 using Optum® Electronic Health Records (EHR). The primary outcome was the occurrence of a standard-of-care RSV or influenza test. A total of 2,208,009 LRTI outpatient encounters, 396,891 COPD and 422,648 CHF exacerbation events from the Optum® EHR database were included in the analysis. The proportion of LRTI encounters with RSV testing increased from 0.6% in 2017 to 9.4% in 2024, but remained lower than influenza (7.1-31.7%). Viral testing among COPD and CHF exacerbation events followed similar trends. Of all eligible outpatient LRTI encounters, less than 3% (60,265/2,208,009) were tested for RSV whereas 15% (333,232/2,208,009) were tested for influenza. Exacerbation events for COPD (1.9% RSV, 6.0% influenza) were tested more frequently than CHF exacerbations (0.5% RSV, 1.1% influenza). Despite increases over time, RSV testing remains infrequent among U.S. adult outpatients. This is particularly true among adults with COPD or CHF exacerbations, where RSV should be part of the differential diagnosis. Infrequent testing may reflect lack of specific RSV treatment options.

Introduction: Takotsubo cardiomyopathy (TC) is a rare but clinically significant complication observed in patients undergoing chemotherapy. The relationship between TC and chemotherapy remains poorly understood. This study aimed to identify factors contributing to TC development and assess associated mortality risk. Methods: We analyzed data from the National Inpatient Sample (NIS, 2016-2022) for adults admitted for chemotherapy. TC cases were identified using ICD-10 code "I51.81." Demographics and comorbidities were compared between TC and non-TC cohorts, with associations established through multivariable regression models. All-cause mortality rates were calculated. A non-parsimonious multivariate logistic regression model was employed, followed by a doubly robust method to estimate adjusted odds ratios for mortality in a matched cohort. Analyses were adjusted for the complex survey design of the NIS. Results: Among 660,290 adults undergoing chemotherapy, 585 patients (89 per 100,000) developed TC. TC patients were older (mean age 60.4 vs. 54.3 years, p<0.01) and predominantly female, while non-TC patients were predominantly male. The TC cohort had higher prevalence rates of dyslipidemia, chronic kidney disease, frailty, valvular disease, and congestive heart failure (CHF)(Table 1). Female sex, frailty, and CHF were independent predictors of TC development(Table 2, Figure 1). Common complications in TC patients included acute kidney injury (29.06%), acute myocardial infarction (13.68%), mechanical ventilation requirement (15.38%), vasopressor use (6.84%), cardiogenic shock (5.98%), and ischemic stroke (4.27%). TC was associated with significantly higher all-cause mortality (12.82% vs. 1.44%; adjusted OR: 9.82, 95% CI: 4.34-22.55, p<0.01), prolonged hospital stay (16.85 vs. 7.26 days, p<0.01), and increased hospital charges ($335,897 vs. $108,704, p<0.01). Among TC patients, 29.06% required home health care services, while 45.30% had routine discharges. Conclusion: TC is a rare complication in chemotherapy patients but carries substantial clinical significance, with nearly ten-fold increased mortality risk, prolonged hospitalizations, and tripled healthcare costs. Female sex, frailty, and heart failure serve as independent risk factors for TC development. These findings underscore the importance of enhanced monitoring protocols for high-risk patients during chemotherapy treatment.

Predictors of surgical site infection following infrainguinal bypass surgery: An analysis of the Vascular Quality Initiative data.

BackgroundHospital at home (HAH) programs offer acute care at home as a substitute for inpatient hospitalization, reducing health care costs while maintaining safety and care quality. Despite point-of-care ultrasound (POCUS) having been validated in inpatient and emergency settings, its role in HAH care remains underexplored. Common conditions treated in medical HAH programs, such as acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), acute decompensated heart failure (ADHF), and pneumonia, are highly amenable to POCUS integration into clinical decision-making and have been proven to improve health care use outcomes. The portability of POCUS makes it ideal for use in HAH; however, its feasibility remains to be proven given the need for health care provider training and use in online settings.ObjectiveThis study evaluates the feasibility and clinical utility of remotely interpreted lung and inferior vena cava (IVC) POCUS acquired by community paramedics to support real-time clinical decision-making for HAH patients with AE-COPD, ADHF, and pneumonia in Calgary, Alberta.MethodsThis randomized controlled trial compares usual HAH care (control) to lung and IVC POCUS–enhanced HAH care (intervention). Handheld POCUS devices captured images that were securely shared using a cloud-based application. This enabled real-time image sharing among the clinical team, facilitating immediate decision-making by remote physicians. A mixed methods approach will evaluate clinical outcomes, patient experiences, health care use, and health care provider perceptions of POCUS integration. The primary outcome is defined as the length of stay for the index HAH admission. Quantitative analysis will assess clinical efficacy and health care resource use, while qualitative methods, such as interviews and surveys, will capture patient and health care provider experiences.ResultsStudy funding began in April 2022, and data collection commenced in December 2023. Patient recruitment was finalized on December 31, 2024. This study included a 3-month follow-up for significant outcomes and will include a 1-year follow-up for long-term health care use, including admissions to long-term care. In total, 20 patients were enrolled (intervention group: n=10, 50%; control group: n=10, 50%). Initial results highlighted the feasibility and potential benefits of remotely acquired POCUS imaging in HAH. Full data analysis is in progress.ConclusionsThis study is the first randomized controlled trial to investigate remotely acquired POCUS by nonphysician practitioners for real-time lung and IVC remote decision-making in HAH care. Findings will provide insights into whether serial lung and IVC POCUS assessments improve ADHF, AE-COPD, and pneumonia outcomes in the HAH setting, enhancing understanding of the value of POCUS integration from a health care provider’s perspective. By assessing its clinical impact and feasibility, this research may inform future guidelines for incorporating POCUS into home-based care, ultimately improving patient care and optimizing health care resource use.Trial RegistrationClinicalTrials.gov NCT05423652; https://clinicaltrials.gov/study/NCT05423652International Registered Report Identifier (IRRID)DERR1-10.2196/76186

Pleural effusion is a pathology that affects 1.5 million people in the United States every year. The treatment for pleural effusion is typically thoracentesis, which has several risks, such as pneumothorax, that can be life threatening and can pose a significant financial burden on patients and their families. Isolating and identifying the risk factors associated with pneumothorax after thoracentesis will help improve patient safety. The research for this literature review came from the referenced peer-reviewed scholarly articles that included other literature reviews, research papers, and research studies. Numerous articles were initially reviewed and several were excluded from this review due to their date of publication. Identifying risk factors had a positive impact on patient outcomes. Pneumothorax following thoracentesis was associated with increased morbidity, mortality, and the length of hospital stay. Patients with pneumothorax were also more likely to require additional procedures such as invasive mechanical ventilation, hemodialysis, tracheostomy, and chest tube placement. Pathologies such as cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), malignancies, and congestive heart failure (CHF) can contribute to in increased risk of iatrogenic pneumothorax following thoracentesis. Intra-procedural ultrasound use, clinician experience, patient positioning, and needle gauge also affect the rate of pneumothorax. Proper risk management includes education, better training, use of ultrasound intra-procedurally and proper patient workups help minimize these risks. Pneumothorax is a significant complication of thoracentesis that warrants careful consideration. There is not enough research to narrow down actual risk factors, and research in this area would benefit mid-level providers such as physician assistants and radiology assistants who are becoming the main performers of these services. Keywords: Pleural effusion, thoracentesis, pneumothorax, iatrogenic

Type 2 diabetes mellitus (T2DM) is associated with hyperactivity of the renin-angiotensin-aldosterone system (RAAS), leading to increased aldosterone levels in the blood. This can result in the development and progression of chronic kidney disease (CKD) and congestive heart failure (CHF). High aldosterone levels, in turn, contribute to insulin resistance, microcirculatory disorders, mitochondrial dysfunction, oxidative stress, inflammation, dyslipidemia, and fibrosis. Additionally, in T2DM patients, persistent oxidative stress and hyperglycemia can trigger pathological activation of mineralocorticoid receptors, even in the absence of aldosterone or cortisol. This results in a vicious cycle of inflammation and fibrosis in the heart and kidneys.Therefore, targeting mineralocorticoid receptor (MCR) blockade is crucial for reducing fibrosis and other irreversible changes in CKD and CHF, as it can help break this cycle and reduce inflammation and fibrosis. However, spironolactone is not a highly selective MKR antagonist, which is one of the reasons for its many side effects. Eplerenone, with greater selectivity and lower affinity for the MKR, has a weaker cardioprotective effect due to its lower affinity. Finerenone, a first-in-class nonsteroidal mineralocorticoid receptor antagonist indicated for the treatment of CKD with albuminuria in adult patients with T2DM, provides the most significant anti-inflammatory and antifibrotic effects without the side effects associated with steroidal anti-inflammatory medications.The aim of this review is to evaluate the clinical trial results on the effects of finerenone on cardiovascular and renal outcomes in patients with T2DM. The review provides an up-to-date overview of the current literature on the impact of finerenone on these outcomes and systematically summarizes and describes additional positive cardioprotective benefits associated with its use.

ABSTRACTIn‐stent restenosis (ISR) following percutaneous coronary intervention (PCI) is a critical clinical issue, often arising from endothelial injury and impaired repair mechanisms. Endothelial progenitor cells (EPCs), derived from bone marrow, play a key role in vascular health, but their function diminishes with aging and exposure to oxidised low‐density lipoprotein (ox‐LDL). This study investigates the potential of Xin‐Mai‐Long (XML), a traditional Chinese medicine used for chronic congestive heart failure, to delay EPC senescence and dysfunction induced by ox‐LDL. Our findings demonstrate that XML administration significantly attenuates ox‐LDL‐induced EPC senescence and dysfunction. RNA sequencing identified Gria2 as a crucial gene downregulated by ox‐LDL and restored by XML. Overexpression of Gria2 in EPCs similarly protected against ox‐LDL‐induced damage. Further analysis using Gene Ontology (GO) and KEGG enrichment revealed that the cAMP signalling pathway is significantly activated in response to XML and Gria2 overexpression. Notably, inhibition of cAMP with cis‐Epoxysuccinic Acid (CESA) diminished the protective effects of XML and Gria2, underscoring the importance of this pathway. In vivo experiments using a rat carotid balloon injury model showed that both XML administration and transplantation of Gria2‐overexpressing EPCs reduced vascular damage. These results suggest that XML mitigates EPC senescence and dysfunction by upregulating Gria2 and activating the cAMP signalling pathway, offering a promising therapeutic strategy for managing ISR after PCI.

Chronic congestive heart failure with reduced ejection fraction (EF) significantly affects survival and hospitalization rates. This multicenter study analyzed the results of cardiac surgery in patients with heart failure. We used retrospective and prospective analyses and analyzed data from 199 patients with heart failure and EF < 50% who underwent various types of cardiac surgeries, including valve surgery, aortic surgery, and coronary artery bypass grafting. Outcome measures were postoperative heart function and survival rates. The in-hospital mortality rate was 1.0%, while the 2-year cardiac death rate was 8.5%. The freedom from cardiac death rates at 6, 12, and 24 months postoperatively were 97.0%, 94.5%, and 91.5%, respectively. The freedom from readmission from heart failure rates after 6, 12, and 24 months postoperatively were 97.0%, 93.5%, and 88.4%, respectively. In risk factor analysis for mortality at 24 months postoperatively, age (odds ratio [OR], 1.241; 95% confidence interval [CI], 1.083–3.155; p = 0.03), chronic kidney disease with renal replacement therapy (OR, 3.154; 95% CI, 1.333–7.158; p = 0.03), and preoperative lower EF (OR, 0.884; 95% CI, 0.429–0.919; p = 0.04) were significant risk factors. Analysis using linear mixed models demonstrated significant improvements in cardiac hemodynamics and New York Heart Association class postoperatively. In conclusion, cardiac surgery in patients with heart failure showed favorable outcomes with marked improvements in heart function and symptoms.

The potential benefits and underlying mechanisms of Vagus Nerve Stimulation (VNS) in the treatment of Chronic Congestive Heart Failure (CHF) remain insufficiently elucidated. Therefore, this study aims to investigate the therapeutic potential and mechanisms of VNS in treating CHF. In this study, models of CHF and VNS were established prior to performing echocardiography, H&E staining, and flow cytometry to evaluate the effects of VNS on pathological damage associated with CHF and myocardial mitochondrial dysfunction. Multi-omics analysis was conducted to identify changes in metabolites, gut microbiota, and gene expression following VNS treatment. Finally, QPCR was applied to measure levels of essential genes at the mRNA levels. VNS effectively enhances cardiac function, improves metabolic processes, and reduces inflammatory factor levels in dogs with CHF. VNS alleviates myocardial pathological damage, prevents the accumulation of ROS, and increases mitochondrial membrane potential. Multi-omics analysis identified five key metabolites, four key microorganisms, and sixty key genes. Furthermore, combined multi-omics analysis revealed key therapeutic targets, including three metabolites, four microorganisms, and sixteen genes. VNS significantly downregulates the mRNA expression levels of FSTL3, TNFRSF12A, and HBEGF. In summary, VNS has demonstrated effectiveness in the treatment of CHF. Key therapeutic targets identified include Kamahine C, FSTL3, TNFRSF12A, and HBEGF.

Impact of depression status and antidepressant use on mortality rates and clinical outcomes following acute myocardial infarction.

Moderate-to-Severe Preoperative Anemia is Associated with Increased Postoperative Myocardial Infarction and Mortality in Patients Undergoing Transcarotid Artery Revascularization.

BackgroundRecent studies have identified a co-occurrence of chronic obstructive pulmonary disease and congestive heart failure in ICU patients. Abnormal red cell distribution width (RDW) frequently manifests in critically ill patients, but its clinical significance remains a subject of debate. This study aims to investigate the relationship between RDW and in-hospital mortality in patients with concurrent congestive heart failure and chronic obstructive pulmonary disease.MethodsWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC) IV version 2.0 database. RDW levels were assessed within 24 h of admission. The impact of RDW at ICU admission on in-hospital mortality was analyzed through multivariable logistic regression models, generalized additive models, and subgroup analysis.ResultsWe enrolled 6,309 patients with congestive heart failure and concomitant chronic obstructive pulmonary disease, with an in-hospital mortality rate of 12.4% (783/6,309). The fully adjusted model revealed a positive association between RDW and in-hospital mortality in congestive heart failure patients with concurrent chronic obstructive pulmonary disease, even after accounting for confounding factors (OR = 1.07, 95% CI: 1.03–1.12, p < 0.001). When comparing the highest quartile (Q4) to the lowest quartile (Q1), the odds ratio (OR) was 1.62, with a 95% confidence interval (CI) of 1.17–2.22, p = 0.003. We observed a linear relationship between RDW and in-hospital mortality, which remained consistent in subgroup analysis.ConclusionsOur data suggest that RDW is positively associated with in-hospital mortality in patients with both congestive heart failure and chronic obstructive pulmonary disease. At the same time, large prospective research and longer follow-up time are required to further validate the findings of this study.

Objective: Integrating navigation technologies into spine surgery has improved precision and safety; however, traditional free-hand techniques are still widely used in anterior cervical discectomy and fusion (ACDF). This study utilized the National Inpatient Sample database to compare free-hand versus navigation-guided ACDF, analyzing complications, costs, mortality, and hospital stays.Methods: Data from 2016 to 2019 identified 85,085 ACDF patients, including 560 navigation-guided operations. Propensity score matching was performed to balance the cohorts for demographics and comorbidities.Results: Navigation-guided operations showed higher total costs (p&lt;0.001) and differences in rates of chronic anemia and congestive heart failure. The length of hospital stay was similar between groups, but navigation-guided operations had higher mean total charges and increased rates of acute kidney injury and pulmonary embolism.Conclusion: While navigation may improve surgical precision, it is associated with higher costs and certain risks. Further research is needed to evaluate the long-term benefits and cost-effectiveness of navigation-guided ACDF.

Severe community-acquired pneumonia in immunosuppressed patients admitted to the ICU.

Background: BRASH syndrome (Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia) is an increasingly recognized but still underdiagnosed condition, particularly in elderly patients with multiple comorbidities and those taking AV nodal blocking agents. It represents a synergistic interplay between these factors, leading to a potentially life-threatening state of cardiovascular collapse. This case report aims to highlight the clinical presentation, diagnostic challenges, and successful management of BRASH syndrome in an elderly female patient. Case presentation: A 65-year-old female with a history of stage 4 chronic kidney disease and congestive heart failure (ejection fraction of 65%) presented to the emergency department with worsening vomiting over the past week, generalized weakness, dizziness, and palpitations. Her medication list included amlodipine, bisoprolol, candesartan, nitrokaf, furosemide, and aminoral. On examination, she was hypotensive with a blood pressure of 90/60 mmHg and bradycardic with a heart rate of 40 beats per minute. An electrocardiogram (ECG) revealed a junctional escape rhythm with a heart rate of 38 beats per minute and a left bundle branch block. Laboratory investigations showed severe hyperkalemia (potassium 8.1 mmol/L), hyponatremia (sodium 113 mmol/L), elevated creatinine (4.06 mg/dL), and urea (112.3 mg/dL). Conclusion: This case underscores the importance of recognizing BRASH syndrome as a distinct clinical entity, especially in elderly patients with pre-existing cardiac and renal conditions who are on AV nodal blocking medications. Prompt diagnosis and management, focusing on correcting hyperkalemia, discontinuing offending medications, and providing supportive care, can lead to favorable outcomes and prevent potentially fatal complications. Increased awareness and further research are crucial for establishing standardized guidelines for the diagnosis and management of this underrecognized syndrome.

There are extreme psychosocial, environmental, and behavioral risks to the health and well-being of persons experiencing homelessness. Within this complex and hazardous environment, there is an opportunity to gain clearer perspective into the role of accelerating cardiovascular disease (CVD) progression alongside the aging cohort effect in this population. Utilizing 2021 and 2022 data from the Harris County Medical Examiner, investigators analyzed CVD-associated deaths for excess mortality and impact of age-related factors specific to persons experiencing homelessness. All medicolegal deaths involving CVD were examined to determine relative frequencies of secondary causes of death and the influence of age between housed individuals and individuals experiencing homelessness. The examination of the CVD mortality cases among persons experiencing homelessness in 2021 (n = 52) and 2022 (n = 71) revealed important trends. The mean age for CVD deaths for persons experiencing homelessness was 58.6 and 60.6 years in 2021 and 2022, respectively. Despite this slight, recent increase, the average age for CVD death among persons experiencing homelessness is dramatically lower than the housed, medicolegal CVD deaths, and the general population. Top-associated conditions were hypertension and atherosclerosis, regardless of housing status. However, chronic obstructive pulmonary disease and congestive heart failure were more common in CVD deaths of people experiencing homelessness. These findings reemphasize the uniqueness and complexity of the risks for premature mortality in people experiencing homelessness. This underscores the call for social services and healthcare systems to be more responsive to the challenges faced by persons experiencing homelessness, with more integrated and targeted health and aging care interventions to address the specific needs of these marginalized individuals.

Type 2 cardiorenal syndrome (Type 2 CRS) describes a relationship in which chronic congestive heart failure causes a progressive and permanent chronic kidney disease. Heart failure (HF) and chronic kidney disease (CKD) share similar cardiovascular risk factors and have a bi-directional relationship. A comprehensive approach including early screening of HF patients for CKD as well as management involving the nephrologist and cardiologist will most definitely reduce morbidity and mortality. The aim of this study was to determine the prevalence of and correlates for Type 2 CRS among HF patients in JUTH, Jos-Nigeria. A hospital-based cross-sectional descriptive study carried out in JUTH involving 120 patients with chronic HF recruited consecutively. History, physical examination and laboratory investigations including urinalysis using albustix were performed on all subjects. CKD was determined using estimated glomerular function rate (eGFR) and persistent albuminuria. The data were analyzed using Epi Info (CDC, Atlanta GA) and p-values <0.05 were considered statistically significant. The mean age of the participants was 52.00 ± 11.44 years, majority of whom were females consisting of 58.3%. The prevalence of CRS was 37.5%. Majoity (66.7%) of the patients had mild CRS, while 26.7% had moderate CRS, and only 6.7% had the severe CRS. The predictors of CRS were diabetes (OR=6.230; CI=2.094-19.093), New York heart Association (NYHA) grading I (OR=0.017; CI=0.002-0.142) and II (OR=0.089; CI=0.016-0.483), raised jugular venous pressure (JVP) (OR=7.099; CI=2.671-18.865), loud pulmonary component of the second heart sound (P2) (OR=3.769; CI=1.726-8.232), systolic dysfunction (EF<45%) (OR=3.316; CI=1.487-7.395), anaemia (OR=5.091; CI=1.657-15.640), albuminuria (OR:0.014, CI=0.004-0.052), rural/suburban dwelling (OR=2.875; CI=1.335-6.192) and increased cardiothoracic ratio (CTR) (OR=3.237; CI=1.019-10.278). The frequency of Type 2 CRS among CHF patients in JUTH was high. The predictors of chronic CRS include diabetes mellitus, NYHA grade, raised JVP, loud P2, systolic dysfunction, anaemia, albuminuria, rural/suburban dwelling and increased CTR. These findings highlight the urgent need to incorporate screening for CKD among stable heart failure patients at regular intervals, and early referral to the nephrologist to prevent further deterioration to ESRD.

Abstract Background Community-acquired pneumonia (CAP) remains the leading cause of infectious mortality worldwide. Regarding its etiology, Staphylococcus aureus has been associated with its development and a higher mortality risk than other microbiological etiologies. Current recommendations allow empiric use with either vancomycin or linezolid in patients with risk factors for MRSA, although no consensus exists on which therapy is more beneficial. This study aims to determine if there is a difference in mortality and survival between patients treated with these antibiotics. Comparison between general characteristics of patients receiving vancomycin and linezolid. Methods Data from adult patients with CAP and ICU admission with either linezolid or vancomycin administration for at least 72 hours were extracted from the prospective MIMIC-IV database. A univariate analysis was employed to determine the differences between the patients who received each treatment. Subsequently, a survival analysis adjusted by infection severity using a Cox proportional hazards model was conducted. Survival analysis for both in-hospital and one-year mortality. A. Kaplan-Meier for One-year Survival Probability; B. Kaplan-Meier for In-hospital 28-day mortality Results A total of 2457 adult patients were included, with 98% (2412/2457) receiving vancomycin and 2% (45/2457) Linezolid. The mean age was 68 (56-79), and 56.5% (1389/2457) were male. The most frequent comorbidities in both treatment groups included chronic pulmonary disease (40.9% vs 51.1%; p= 0.169) and congestive heart failure (37.9% vs 42.2%; p=0.55). Both groups presented similar severity of infection, physiological values at admission, and outcomes (Table 1). Survival analysis demonstrated a higher one-year survival probability in the patients receiving Linezolid group. Cox regression analysis revealed a significant association between SAPS II score and mortality (HR = 1.024, 95% CI: 1.02 - 1.028, p &amp;lt; 0.001) (Figure 1). However, when adjusting the survival analysis by disease severity, we did not find ny statistical differences. Conclusion While there is no definitive consensus regarding the superiority of empirical anti-MRSA treatments, these results support the idea that linezolid is associated with better outcomes in terms of mortality in patients with sCAP. However, this protective effect was not observed after adjusting by disease severity. Further prospective studies are needed to support these conclusions. Disclosures All Authors: No reported disclosures

The determinants of varicella-zoster virus (VZV)-associated central nervous system (CNS) infection have not been fully elucidated. This study aimed to investigate the incidence and risk factors, including immunosuppression, for different manifestations of VZV-associated CNS infection. Patient registers were used to include adults diagnosed with VZV-associated CNS infections between 2010 and 2019 in Sweden. Nationwide registers covering specialized care, and regional registers covering primary care, were used. Controls without a VZV diagnosis during the study period were matched by age and sex. Risk factors were calculated using multivariable logistic regression. A total of 1488 adult cases with VZV-associated CNS infection were identified, yielding an incidence of 1.92/100 000 person-years, which increased over the study period. Meningitis was the most frequent (45%), followed by encephalitis (38%), and Ramsay Hunt syndrome (17%). The highest incidence was observed in individuals over 70 years of age (4.15/100 000 person-years), in whom encephalitis was most common. Statistically significant risk factors for VZV-associated CNS infection were HIV, hematological cancer, treatment with specific immunosuppressants or glucocorticoids, chronic obstructive pulmonary disease, diabetes, solid cancer, stroke, and congestive heart failure. Encephalitis was associated with older age, more immunosuppressive conditions, and more comorbidities than other manifestations. In conclusion, VZV is a common cause of adult viral CNS infection, for which elderly individuals with immunosuppressive or comorbid conditions are at the highest risk. The strongest risk factors found were HIV, hematological cancer, and treatment with specific immunosuppressants or high-dose glucocorticoids.

Advantages of Introduction of Machine Learning into Patient-Controlled Anesthesia in Chronic Obstructive Pulmonary Disease and Congestive Heart Failure