Days Of Hospital Admission Research Articles

Re-admission after early discharge from involuntary hospitalization of psychiatric patients

Abstract Background State psychiatrics in Public Health Departments in Israel can involuntary hospitalize patients (IHP) in psychotic status. IHP who are unsatisfied with the involuntary hospitalization can appeal to a Psychiatric Committee (PC) in the institution to ask to shorten their hospitalization. The PC can decide to discharge the patient to ambulatory treatment. This cohort study aimed to assess re-admission of IHP among patients who shortened their involuntary hospitalization in Tel-Aviv. Methods IHP whose involuntary hospitalization was shortened by PC (research arm) were compared to IHP patients who completed the entire hospitalization length, as was initially recommended by the psychiatrist (control arm). Re-admission was defined as hospitalization within one year after release by the PC/end of hospitalization. Results From 3,160 IHR between 2010 and 2015, 1,338 were re-hospitalized during a year after release, 317 (41.7%) from the research arm and 1,012 (42.6%) from the control arm, p < 0.7. Discharge of IHP by PC during first month of the involuntary hospitalization resulted in a higher re-admission rates than IHR from the control group (58.4% vs. 46.4%, respectively, p < 0.001). Yet, discharge of IHR by the PC after one month of hospitalization (or end of the hospitalization) resulted in lower re-admission rates (14.8% vs. 53.6%, respectively, p < 0.001). Risks factors for re-admission included male gender, Israeli born, single and diagnosis of schizophrenia. Conclusions Re-admission rates were higher in IHR who were released by the PC during the first month of hospitalization. The first month is important for mental and therapeutic stabilization of IHP. After 30 days, release of IHP can be re-assessed according to the patients’ situation. Early discharge of males who were diagnosed with schizophrenia should be carefully assessed. Key messages • Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia. • Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.

Correlation between Interleukin-6, CRP, and LDH in COVID-19 patients of Dr. Soetomo Teaching Hospital, Surabaya, Indonesia

This cross-sectional study was conducted from June 2020 to May 2021. This study recruited 86 patients with confirmed PCR positive for COVID-19 who were treated in the isolation ward of Dr. Soetomo Teaching Hospital, Surabaya, Indonesia. Examination of serum levels of IL-6, CRP, and LDH was performed on the first and the sixth day of hospital admission. Found on the first day of admission the same significant correlation between IL-6 and CRP on males and females with rs=0,475 (p<0,01) and rs=0,663 (p<0,01) respectively. Correlation between IL-6 and LDH on the first day of admission on both males and females were also significant with rs=0,403 (p<0,01) and rs=0,484 (p<0,01) respectively. IL-6 and CRP on the sixth day of admission showed significant correlation on males with rs=0,621 (p<0,01), but not on females with rs=0,120 (p=0,586). IL-6 and LDH on the sixth day of admission also showed significant correlation on males with rs=0,544 (p<0,01), but not on females with rs=0,030 (p=0,893). In conclusion, there were significant positive correlations between IL-6, CRP, and LDH on the first day of admission on both male and female subjects which showed that IL-6 was associated with inflammatory response on the acute phase of COVID-19. However, on the sixth day of admission, IL-6 showed significant positive correlations with CRP and LDH only on male subjects, but not on female subjects.

Pneumonia Associated with Mechanical Ventilation: Management and Preventive Aspects

Introduction: Ventilator-associated pneumonia (VAP) constitutes a real iatrogenic health problem, which can lead to a higher rate of hospital admission days associated with the morbidity and mortality that it could cause. Objective: To study and learn about the different preventive measures used to reduce the incidence of VAP, as well as to study the microorganisms that most frequently cause VAP. To determine the nursing staff’s knowledge of this phenomenon and the social and health care costs derived from the disease. Methodology: The bibliographic search of the existing literature was carried out between November 2021 and June 2022. In order to gather all the necessary information, different databases were searched. For this purpose, a search strategy was developed using keywords included in “DeCS” and “MeSH” and using boolean operators such as “AND and OR”, and all articles meeting the chosen inclusion criteria were included. Results: After applying the article selection criteria and assessing the quality of the methodology, a total of 33 articles were finally included for systematic review. The results show the usefulness of various preventive measures against the micro-organisms that most frequently cause this type of pneumonia, as well as the true cost associated with this pathology and the still insufficient knowledge of healthcare personnel about it. Conclusion: Although many advances have reduced the incidence and mortality of this pathology, further research, training of healthcare personnel and implementation of new protocols are still required.

The association of loneliness and social isolation with healthcare utilization in Denmark

Abstract Objectives The present prospective cohort study investigated the association of loneliness and social isolation (SI) with healthcare utilization (HCU) in the general population over time. Methods Data from the 2013 Danish “How are you?’ survey (n = 29,472) were combined with individual-level register data from the National Danish Patient Registry and the Danish National Health Service Registry over a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics and chronic disease. Results Loneliness measured at baseline was significantly associated with more GP contacts (incident-rate ratio (IRR) = 1.03, 95% confidence interval (CI) [1.02, 1.04]), more emergency treatments (IRR = 1.06, 95% CI [1.03, 1.10]), more emergency admissions (IRR = 1.06, 95% CI [1.03, 1.06]), and hospital admission days (IRR=1.05, 95% CI [1.00, 1.11]) across the 6-year follow-up period. No significant associations were found between social isolation and HCU with one minor exception, in which SI was associated with fewer planned outpatient treatments (IRR = .97, 95% CI [.94, .99]). Conclusions Our findings suggest that loneliness is a risk factor for certain types of HCU, independent of social isolation, baseline demographics, and chronic disease. Key messages

Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study.

Background:The post-acute burden of health care use after SARS-CoV-2 infection is unknown. We sought to quantify the post-acute burden of health care use after SARS-CoV-2 infection among community-dwelling adults in Ontario by comparing those with positive and negative polymerase chain reaction (PCR) test results for SARS-CoV-2 infection.Methods:We conducted a retrospective cohort study involving community-dwelling adults in Ontario who had a PCR test between Jan. 1, 2020, and Mar. 31, 2021. Follow-up began 56 days after PCR testing. We matched people 1:1 on a comprehensive propensity score. We compared per-person-year rates for health care encounters at the mean and 99th percentiles, and compared counts using negative binomial models, stratified by sex.Results:Among 531 702 matched people, mean age was 44 (standard deviation [SD] 17) years and 51% were female. Females who tested positive for SARS-CoV-2 had a mean of 1.98 (95% CI 1.63 to 2.29) more health care encounters overall per-person-year than those who had a negative test result, with 0.31 (95% CI 0.05 to 0.56) more home care encounters to 0.81 (95% CI 0.69 to 0.93) more long-term care days. At the 99th percentile per-person-year, females who tested positive had 6.48 more days of hospital admission and 28.37 more home care encounters. Males who tested positive for SARS-CoV-2 had 0.66 (95% CI 0.34 to 0.99) more overall health care encounters per-person-year than those who tested negative, with 0.14 (95% CI 0.06 to 0.21) more outpatient encounters and 0.48 (95% CI 0.36 to 0.60) long-term care days, and 0.43 (95% CI −0.67 to −0.21) fewer home care encounters. At the 99th percentile, they had 8.69 more days in hospital per-person-year, with fewer home care (−27.31) and outpatient (−0.87) encounters.Interpretation:We found significantly higher rates of health care use after a positive SARS-CoV-2 PCR test in an analysis that matched test-positive with test-negative people. Stakeholders can use these findings to prepare for health care demand associated with post-COVID-19 condition (long COVID).

The effect on women's health of extending parental leave: a quasi-experimental registry-based cohort study.

Parental leave policies have been hypothesized to benefit mothers' mental health. We assessed the impact of a 6-week extension of parental leave in Denmark on maternal mental health. We linked individual-level data from Danish national registries on maternal sociodemographic characteristics and psychiatric diagnoses. A regression discontinuity design was applied to study the increase in parental leave duration after 26 March 1984. We included women who had given birth between 1 January 1981 and 31 December 1987. Our outcome was a first psychiatric diagnosis following the child's birth, ascertained as the first day of inpatient hospital admission for any psychiatric disorder. We presented cumulative incidences for the 30-year follow-up period and reported absolute risk differences between women eligible for the reform vs not, in 5-year intervals. In all, 291 152 women were followed up until 2017, death, emigration or date of first psychiatric diagnosis. The median follow-up time was 29.99 years, corresponding to 10 277 547 person-years at risk. The cumulative incidence of psychiatric diagnoses at 30 years of follow-up was 59.5 (95% CI: 57.4 to 61.6) per 1000 women in the ineligible group and 57.5 (95% CI: 55.6 to 59.4) in the eligible group. Eligible women took on average 32.85 additional days of parental leave (95% CI: 29.20 to 36.49) and had a lower probability of having a psychiatric diagnosis within 5 years [risk difference (RD): 2.4 fewer diagnoses per 1000 women, 95% CI: 1.5 to 3.2] and up to 20 years after the birth (RD: 2.3, 95% CI: 0.4 to 4.2). In subgroup analyses, the risk reduction was concentrated among low-educated, low-income and single women. Longer parental leave may confer mental health benefits to women, in particular to those from disadvantaged backgrounds.

Neurofilament light chain and vaccination status associate with clinical outcomes in severe COVID-19

Blood neurofilament light chain (NFL) is proposed to serve as an estimate of disease severity in hospitalized patients with coronavirus disease 2019 (COVID-19). We show that NFL concentrations in plasma collected from 880 patients with COVID-19 within 5 days of hospital admission were elevated compared to controls. Higher plasma NFL associated with worse clinical outcomes including the need for mechanical ventilation, intensive care, prolonged hospitalization, and greater functional disability at discharge. No difference in the studied clinical outcomes between black/African American and white patients was found. Finally, vaccination associated with less disability at time of hospital discharge. In aggregate, our findings support the utility of measuring NFL shortly after hospital admission to estimate disease severity and show that race does not influence clinical outcomes caused by COVID-19 assuming equivalent access to care, and that vaccination may lessen the degree of COVID-19-caused disability.

Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children

There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C). To determine whether the use of steroids within 2 days of admission for non-MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence. This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non-MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry. Administration of steroids within 2 days of admission. Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching. A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators. Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.

SARS-CoV-2 vaccination and myocarditis in a highly vaccinated New Zealand population

Abstract Background A higher incidence of myocarditis has been reported in those who have recently received mRNA SARS – CoV-2 vaccination.1 Canterbury District Health Board (CDHB) serves 578,290 people, including 441,852 adults, with one large tertiary referral hospital offering specialist cardiology services. In 2021 97% of eligible adults received at least one dose and 92% two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech). During this time only 21 community cases of COVID-19 infection were reported. We investigated the incidence of myocarditis during the BNT162b2 mRNA vaccine rollout in comparison to the preceding 5 years assuming a stable population size. Methods All adult patients admitted to our hospital who received a diagnostic code of acute myocarditis (ICD10 codes I40, I41 and I51.4) during admission between 2016 and 2021 were included. Demographics and peak troponin concentration (hsTnI) were recorded. Vaccine-associated myocarditis was defined as that leading to admitted within 28 days of BNT162b2 vaccination. Myocarditis-associated mortality was defined as death occurring within 28 days of hospital admission. Incidence of myocarditis before and during COVID-19 vaccination was tested using ANOVA. Results Between 2016 and 2020 there were 178 total hospital admissions (annualised mean 35.6 [SD6.3] range 28–44) with myocarditis. The mean age was 47.8 [SD15.9] years, 38% were women, and median peak hsTnI 641 (IQR 95.25–8526) ng/L. One patient died within 28 days of admission. In 2021 there were 43 myocarditis admissions, mean age 49.7 [SD18] years, 42% women, with a median hsTnI 355 (IQR 106.5–1876.5) ng/L. Nine of these admissions were within 28 days of vaccination. They were 78% female, mean age 52.6 [SD24.8] years, median peak hsTnI 179 (IQR 52–528) ng/L. One patient died during admission. There was no variance in annual incidence of myocarditis during vaccine rollout (p=0.342). Conclusion In a highly vaccinated adult population largely free of COVID-19 infection there were few cases of myocarditis within 28 days of vaccination and no increase in incidence overall compared to the preceding 5 years. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Heart Foundation of New Zealand grant to C Greer

Predictors of long term tricuspid regurgitation after pulmonary valve replacement: a single center study on the cohort of significant preoperative tricuspid regurgitation

Abstract Background Almost one-third of repaired tetralogy of Fallot (TOF) and pulmonary stenosis (PS) patients referred for pulmonary valve replacement (PVR) have at least moderate tricuspid regurgitation (TR). Predictors of long term TR in this population are not well defined and the role of Tricuspid Annuloplasty (TA) in addition to PVR in this setting is controversial. Purpose Patients with preoperative severe TR or moderate TR with dilated tricuspid annulus (&amp;gt;40mm) undergo TA at the time of PVR as per protocol in our instititution. The aim of this observational study was to evaluate the long term results of this approach and to identify predictors of significant TR at the end of follow-up. Material and methods We retrospectively reviewed 35 repaired TOF and PS patients who underwent surgical PVR with (n=17, group 1) or without (n=18, group 2) TA in a single tertiary hospital between June-2009 and June-2021. Pre- and postoperative echocardiographic and cardiac magnetic resonance data were assessed for TR severity and right ventricle size and systolic function. Baseline and clinical follow up data were collected. Uni- and multivariable tests were used to analyze predictors of at least moderate TR after PVR. Results Mean age at PVR and baseline image parameters were comparable between groups, except for TR grade (p 0.006), tricuspid annulus size (p 0.018) and right ventricle outflow tract diameter (p 0.04) which were greater in group 1. TA did not confer and increased risk of surgical and peroperative complications. Intensive care unit (p 0.94) and total hospital admission days (p 0.59) did not differ among groups. At one year, TR grade significantly improved regardless of TA. At the end of follow-up (5.29±2.9 years), the degree of TR increased in both groups with no differences between groups (p 0.38) (see table 1). In univariable analysis, two independent predictors of at least moderate TR at end of follow-up were identified; mixed TR mechanism (OR 12.5, p 0.006) and severe preoperative TR grade (OR 10.21, p 0.003). Mixed TR mechanism (OR 15.78, p 0.01) and a right ventricle ejection fraction below 45% (OR 1.47, p 0.01) were identified as risk factors of significant TR in multivariable analysis (see Table 2). Conclusions TA seems a reasonable approach at the time of PVR in patients with severe TR or moderate TR with dilated annulus. Mixed TR mechanism and a worse right ventricular function have been identified as independent predictors factors of long term significant postoperative TR in our study cohort. Funding Acknowledgement Type of funding sources: None.

Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals.

Bloodstream infections (BSIs) acquired in the ICU represent a detrimental yet potentially preventable condition. We determined the prevalence of BSI acquired in the ICU (ICU-onset BSI), pathogen profile, and associated risk factors. Retrospective cohort study. Eighty-five U.S. hospitals in the Cerner Healthfacts Database. Adult hospitalizations between January 2009 and December 2015 including a (≥ 3 d) ICU stay. Prevalence of ICU-onset BSI (between ICU Day 3 and ICU discharge) and associated pathogen and antibiotic resistance distributions were compared with BSI present on (ICU) admission (ICU-BSI POA ); and BSI present on ICU admission day or Day 2. Cox models identified risk factors for ICU-onset BSI among host, care setting, and treatment-related factors. Among 150,948 ICU patients, 5,600 (3.7%) had ICU-BSI POA and 1,306 (0.9%) had ICU-onset BSI. Of those with ICU-BSI POA , 4,359 (77.8%) were admitted to ICU at hospital admission day. Patients with ICU-onset BSI (vs ICU-BSI POA ) displayed higher crude mortality of 37.9% (vs 20.4%) ( p < 0.001) and longer median (interquartile range) length of stay of 13 days (8-23 d) (vs 5 d [3-8 d]) ( p < 0.001) (considering all ICU stay). Compared with ICU-BSI POA , ICU-onset BSI displayed more Pseudomonas , Acinetobacter , Enterococcus, Candida , and Coagulase-negative Staphylococcus species, and more methicillin-resistant staphylococci, vancomycin-resistant enterococci, ceftriaxone-resistant Enterobacter , and carbapenem-resistant Enterobacterales and Acinetobacter species, respectively. Being younger, male, Black, Hispanic, having greater comorbidity burden, sepsis, trauma, acute pulmonary or gastrointestinal presentations, and pre-ICU exposure to antibacterial and antifungal agents was associated with greater ICU-onset BSI risk after adjusted analysis. Mixed ICUs (vs medical or surgical ICUs) and urban and small/medium rural hospitals were also associated with greater ICU-onset BSI risk. The associated risk of acquiring ICU-onset BSI manifested with any duration of mechanical ventilation and 7 days after insertion of central venous or arterial catheters. ICU-onset BSI is a serious condition that displays a unique pathogen and resistance profile compared with ICU-BSI POA . Further scrutiny of modifiable risk factors for ICU-onset BSI may inform control strategies.

Temporal progression of sepsis on critical care COVID-19 patients: a retrospective cohort study.

This study aimed to describe sepsis progression in critical COVID-19 patients using the SOFA score and investigate its relationship with mortality. Three researchers collected and analyzed retrospective clinical and laboratory data found in electronic health records from all patients admitted to a severe COVID-19 exclusive intensive care unit from March 2020 to October 2020. Mixed-effect logistic regression was used to evaluate SOFA (Sepsis-3) score variables as mortality prediction markers, while Kaplan-Meier survival curves were used to compare mortality between groups of patients. Cox proportional hazard models were used to further stratify mortality association between variants. A total of 73 patients were included. Temporal COVID-19-related sepsis progression analysis indicates difference in degrees and timing between different organ dysfunction over time. Sepsis-3 Cardiovascular Dysfunction characterized by severe hypotension added to the use of any vasopressor drugs was the only parameter associated with in-hospital death during the first 5 days of hospital admission (OR 2.19; 95%CI 1.14-4.20; p=0.01). Increased Sepsis-3 Cardiovascular Dysfunction score, characterized as hypotension associated with the use of vasopressor drugs in the first days of intensive care unit stay, is related to higher mortality in COVID-19 patients and may be a useful prognostic prediction tool.

Emphysematous Pyelonephritis, Emphysematous Cystitis, and Emphysematous Ureteritis: A Case Report

Emphysematous urinary tract infections (EUTIs) are rare, severe, and suppurative infections affecting various parts of the urinary tract. We report a case of a 75-year-old male presenting with hematuria and generalized weakness withuncontrolled diabetes mellitus (DM) and hypertension. He tested positive for COVID-19on the second day of hospital admission. A non-contrast-enhanced CT of the abdomen and pelvis revealed gas within the left renal parenchyma, walls of the left ureter, and urinary bladder, establishing the diagnosis of EUTIs. The patient was treated using intravenous antibiotics without any surgical intervention, and four weeks later was stable and transported tolong-term acute care (LTAC) facility. DM is the most common risk factor for the development of EUTIs and Escherichia coli is the most common causative pathogen.

Using laboratory parameters as predictors for the severity and mortality of COVID-19 in hospitalized patients.

The aim of this study was to explore association of initial laboratory parameters of hospitalized patients with COVID-19, with the severity and death incident. In this retrospective study, patients were classified based on mortality outcome (survivor and non-survivor) and disease severity (non-severe, severe, and critical). The initial laboratory data (within the first two days of hospital admission) were compared between these categories. Of 362 COVID-19 patients hospitalized between January-2021 and May-2021, 39.0% were non-severe, 32.2% severe, and 28.7% critical. 77.3% were lived and 22.7% died in hospital. Non-survivors were significantly older than survivors. There was a statistically significant association between exceeding the cut-points of laboratory parameters and the severity of the disease or even death. These laboratory parameters included D-dimer, C-reactive protein, prothrombin time, ferritin, white blood cells, neutrophil count, aspartate aminotransferase, creatinine, blood urea nitrogen, lymphocyte count, and albumin. Also, exceeding the cut-points of these parameters showed high odds of death. The highest odds ratio was reported for albumin <3.5 g/dL (OR=14.318 [4.784-42.851], p<0.001). The cut-points of the laboratory parameters could effectively be used as predictors to assess the severity and risk of death to improve the management of COVID-19 patients.

Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery

Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. However, the safety of perioperative gabapentin use among older patients remains uncertain. To examine in-hospital adverse clinical events associated with perioperative gabapentin use among older patients undergoing major surgery. This retrospective cohort study using data from the Premier Healthcare Database included patients aged 65 years or older who underwent major surgery at US hospitals within 7 days of hospital admission from January 1, 2009, to March 31, 2018, and did not use gabapentin before surgery. Data were analyzed from June 14, 2021, to May 23, 2022. Gabapentin use within 2 days after surgery. The primary outcome was delirium, identified using diagnosis codes, and secondary outcomes were new antipsychotic use, pneumonia, and in-hospital death between postoperative day 3 and hospital discharge. To reduce confounding, 1:1 propensity score matching was performed. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were estimated. Among 967 547 patients before propensity score matching (mean [SD] age, 76.2 [7.4] years; 59.6% female), the rate of perioperative gabapentin use was 12.3% (119 087 patients). After propensity score matching, 237 872 (118 936 pairs) gabapentin users and nonusers (mean [SD] age, 74.5 [6.7] years; 62.7% female) were identified. Compared with nonusers, gabapentin users had increased risk of delirium (4040 [3.4%] vs 3148 [2.6%]; RR, 1.28 [95% CI, 1.23-1.34]; RD, 0.75 [95% CI, 0.75 [0.61-0.89] per 100 persons), new antipsychotic use (944 [0.8%] vs 805 [0.7%]; RR, 1.17 [95% CI, 1.07-1.29]; RD, 0.12 [95% CI, 0.05-0.19] per 100 persons), and pneumonia (1521 [1.3%] vs 1368 [1.2%]; RR, 1.11 [95% CI, 1.03-1.20]; RD, 0.13 [95% CI, 0.04-0.22] per 100 persons), but there was no difference in in-hospital death (362 [0.3%] vs 354 [0.2%]; RR, 1.02 [95% CI, 0.88-1.18]; RD, 0.00 [95% CI, -0.04 to 0.05] per 100 persons). Risk of delirium among gabapentin users was greater in subgroups with high comorbidity burden than in those with low comorbidity burden (combined comorbidity index <4 vs ≥4: RR, 1.20 [95% CI, 1.13-1.27] vs 1.40 [95% CI, 1.30-1.51]; RD, 0.41 [95% CI, 0.28-0.53] vs 2.66 [95% CI, 2.08-3.24] per 100 persons) and chronic kidney disease (absence vs presence: RR, 1.26 [95% CI, 1.19-1.33] vs 1.38 [95% CI, 1.27-1.49]; RD, 0.56 [95% CI, 0.42-0.69] vs 1.97 [95% CI, 1.49-2.46] per 100 persons). In this cohort study, perioperative gabapentin use was associated with increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. These results suggest careful risk-benefit assessment before prescribing gabapentin for perioperative pain management.

Complications and Comorbidities in COVID-19 Patients: A Comparative study.

BackgroundCOVID-19 has rapidly spread across the world at an unprecedented rate. The outbreak of COVID-19 infection has led to a significant health burden on infected patients, especially those with existing comorbidities. The aim of this study is to find the most prevalent symptoms, comorbidities, and complications developed during the course of the disease and outline the most prevalent symptoms among the baseline and clinical characteristics of the patients.MethodsThis is a retrospective study that was performed on the data obtained from medical records of 3999 COVID-19 patients from Prince Mohammed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia. Demographic data, clinical symptoms, and comorbidities were noted on the day of hospital admission. Complications developed during the COVID -19 infection were also observed.ResultsThe average age was 49.55 ± 14.75 years and 73.77% of the study population were male patients. The average Body Mass Index (BMI) of the patients was 29.48 ± 6.94. Fever and cough were the most common symptoms (85.85%) followed by shortness of breath (83.25%). Other reported symptoms were diarrhoea (17.43%), fatigue (16.2%), vomiting (15.38%), headache (15.23%), sore throat (9.3%), and nausea (8.5%) The most common comorbidity recorded was diabetes mellitus (DM) (39.51%), followed by hypertension (HTN) (33.91%), and asthma (9.45%). In COVID-19 patients with comorbidities, 61.90% developed complications of pneumonia, 8.73% had Acute Respiratory Distress Syndrome (ARDS), 7.25% developed pneumonia and ARDS concurrently, while 0.4% of the total patients had septic shock.ConclusionThe symptoms of fever, cough, and shortness of breath were higher in individuals with hypertension and diabetes mellitus, and more prevalent in complications of pneumonia, acute respiratory illness, and septic shock.

Assessment of Methemoglobin, Hemoglobin, Ferritin and Lactate dehydrogenase in COVID-19 Patients

Today world is trying to cope with the biggest pandemic caused by Coronavirus disease 2019 (COVID-19). The disease is graded as mild, moderate, serious and critical illness. Very few studies are done with methemoglobin along with other parameters for the assessment of the severity of COVID-19 disease. The objectives of the study were to estimate methemoglobin (Met-Hb), hemoglobin (Hb), ferritin and lactate dehydrogenase (LDH) levels in patients with COVID-19 disease and to investigate the interaction between these parameters and the severity of the disease. This observational study was conducted in three groups of COVID-19 patients- moderate, severe and critical, each group containing 30 patients, between June 2021 and September 2021 in the biochemistry department of a tertiary care hospital. For all patients, Met-Hb, Hb, ferritin, and LDH levels were estimated on the 2nd-3rd day of hospital admission. Patients in the critical group were older and had significantly high values of Met-Hb, ferritin and LDH and significantly low values of Hb (P&lt;0.05). In multivariate ordinal regression analysis, older age (OR-3.08; 95%CI:1.19-7.19;P-0.019), higher values of LDH (OR-8.66; 95%CI:2.53-29.5; P-0.001) and ferritin (OR-3.08; 95%CI:1.09-8.7;P-0.033) were independently associated with severity of the disease. A cut-off value of 410.50 U/L for LDH predicted the severity of the disease with 90% sensitivity and 88.3% specificity. In conclusion, higher levels of LDH and ferritin were related to the severity of the disease in COVID-19 cases. Although Met-Hb showed a minimal increase without any association with severity, it may be an underlying cause of hypoxia that may go unnoticed. So, monitoring of all these parameters should be done at intervals.

Intensive care unit versus high dependency care unit admission after emergency surgery: a nationwide in-patient registry study

BackgroundThe appropriate level of postoperative critical care for patients undergoing emergency surgery is unknown. We aimed to assess the outcomes of postoperative patients treated in the intensive care unit (ICU) and high dependency care unit (HDU) after emergency surgery. MethodsAnalysis of national in-patient registry data in Japan from July 2010 to March 2018, including patients undergoing one of 10 emergency surgeries on the day of hospital admission. The exposures were ICU or HDU admission on the day of surgery. The primary outcome was in-hospital mortality. We performed multivariable logistic regression analysis adjusted for patient and hospital characteristics. Results are presented as n (%) and odds ratios (ORs) with 95% confidence intervals. ResultsWe included 158 149 patients from 646 hospitals. Crude in-hospital mortality for each procedure ranged from 168/8583 (2.0%) for cholecystectomy to 2842/12 958 (21.9%) for patients undergoing surgery for traumatic brain injury. Compared with HDU admission, ICU admission was associated with lower in-hospital mortality among the cohorts for medium-mortality risk procedures (procedure-specific mortality 5–15%) (ICU: 8834/73 616 [12.0%] vs HDU: 2586/25 262 [10.2%]; OR=0.90 [0.85–0.96]; P=0.001), and high-mortality risk procedures (procedures-specific mortality >15%) (ICU: 3445/16 334 [21.1%] vs HDU: 996/4613 [21.6%]; OR=0.86 [0.78–0.96]; P=0.005). There were no differences in mortality for low-mortality risk procedures with procedure-specific mortality <5%. ConclusionsIn this national registry study, postoperative critical care in ICU was associated with lower in-hospital mortality than in HDU for patients undergoing medium-risk and high-risk emergency surgery. Further research is needed to understand the role of critical care for surgical patients.

Predictors of ICU admission associated with gastrointestinal endoscopy in medical inpatients: A retrospective cohort study.

Gastrointestinal (GI) endoscopic procedures are commonly performed in medical inpatients. Limited prior research has examined factors associated with intensive care unit (ICU) admission after GI endoscopy in medical inpatients. This retrospective cohort study was conducted using routinely-collected clinical and administrative data from all general medicine hospitalizations at five academic hospitals in Toronto, Canada between 2010 and 2020. We describe ICU admission and death within 48h of GI endoscopy in medical inpatients. We examined adjusted associations of patient and procedural factors with ICU admission or death using multivariable logistic regression. Among 18290 medical inpatients who underwent endoscopy, 900 (4.9%) required ICU admission or died within 48h of endoscopy. Following risk adjustment, ICU admission or death were associated with the following procedural factors: endoscopy on the day of hospital admission (aOR 3.16 [2.38-4.21]) or 1day after admission (aOR 1.92 [1.51-2.44]) and esophagogastroduodenoscopy (EGD) procedures; and the following patient factors: Charlson comorbidity index of two (aOR 1.38 [1.05-1.81]) or three or greater (aOR 1.84 [1.47-2.29]), older age, male sex, lower hemoglobin prior to endoscopy, increased creatinine prior to endoscopy, an admitting diagnosis of liver disease and certain medications (antiplatelet agents and corticosteroids). ICU admission or death after endoscopy was associated with procedural factors such as EGD and timing of endoscopy, and patient factors indicative of acute illness and greater comorbidity. These findings can contribute to improved triage and monitoring for patients requiring inpatient endoscopy.

Impact of comorbidities on survival following major injury across different types of road users

BackgroundWhile comorbidities and types of road users are known to influence survival in people hospitalised with injury, few studies have examined the association between comorbidities and survival in people injured in road traffic crashes. Further, few studies have examined outcomes across different types of road users with different types of pre-existing comorbidities. This study aims to examine differences in survival within 30 days of admission among different road user types with and without different pre-existing comorbidities. MethodRetrospective cohort study using data for all major road trauma cases were extracted from the NSW Trauma Registry Minimum Dataset (1 January 2013 – 31 July 2019) and linked to the NSW Admitted Patient Data Collection, and the NSW Registry of Births, Deaths and Marriages - death dataset. Pre-existing comorbidities and road user types were identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and Charlson Comorbidity Index in the Trauma Registry, hospital admission, and death datasets. Logistic regression was used to assess the associations between six types of road users (pedestrian, pedal cycle, two- and three-wheel motorcycle, car and pick-up truck, heavy vehicle and bus, and other types of vehicle) and death within 30 days of hospital admission while controlling for comorbidities. All models used ‘car and pick-up truck driver/passenger’ as the road user reference group and adjusted for demographic variables, injury severity, and level of impaired consciousness. ResultsWithin 6253 traffic injury person-records (all aged ≥15 years old, ISS>12), and in final models, injured road users with major trauma who had a history of cardiovascular diseases (including stroke), diabetes mellitus, and higher Charlson Comorbidity Index score, were more likely to die, than those without pre-existing comorbidities. Furthermore, in final models, pedestrians were more likely to die than car occupants (OR: 1.68 – 1.77, 95CI%: 1.26 – 2.29 depending on comorbidity type). ConclusionsThis study highlights the need to prioritize enhanced management of trauma patients with comorbidities, given the increasing prevalence of chronic medical conditions globally, together with actions to prevent pedestrian crashes in strategies to reach Vision Zero.