Diagnosis Of IC Research Articles

Invasive Candidiasis in Adult Patients with COVID-19: Results of a Multicenter Study in St. Petersburg, Russia.

We studied the risk factors, etiology, clinical manifestations, and treatment outcomes of COVID-19-associated invasive candidiasis (COVID-IC) in adult patients admitted to six medical facilities in St. Petersburg. (November 2020-December 2022). In this retrospective study, we included 72 patients with COVID-IC with a median age of 61 years (range 29-96), 51% of whom were women. The predisposing factors for COVID-IC were a central venous catheter (CVC) for more than 10 days (the odds ratio (OR) = 70 [15-309]), abdominal surgical treatment performed in the previous 2 weeks (OR = 8.8 [1.9-40.3]), bacteremia (OR = 10.6 [4.8-23.3]), pulmonary ventilation (OR = 12.9 [5.9-28.4]), and hemodialysis (OR = 11.5 [2.5-50.8]). The signs and symptoms of COVID-IC were non-specific: fever (59%), renal failure (33%), liver failure (23%), and cardiovascular failure (10%). Candida albicans (41%) predominated among the pathogens of the candidemia. The multidrug-resistant Candida species C. auris (23%) and C. glabrata (5%) were also identified. Empirical therapy was used in 21% of COVID-IC patients: azole-93%, echinocandin-7%. The majority of COVID-IC patients (79%) received, after laboratory confirmation of the diagnosis of IC, fluconazole (47%), voriconazole (25%), echinocandin (26%), and amphotericin B (2)%. The 30 days overall survival rate was 45%. The prognosis worsened concomitant bacteremia, hemodialysis, and long-term therapy by systemic glucocorticosteroids (SGCs), bronchial colonization with Candida spp. The survival prognosis was improved by the early change/replacement of CVC (within 24 h), the initiation of empirical therapy, and the use of echinocandin. Conclusions: We highlighted the risk factors that predispose COVID-19 patients to candidiasis and worsen the survival prognosis. Their individual effects in patients with COVID-19 must be well understood to prevent the development of opportunistic co-infections that drastically lower chances of survival.

Ictal crying in epileptic seizures and psychogenic nonepileptic seizures: What are the hints to differentiate them?

ObjectivesIctal crying (IC) is a quite rare semiological manifestation of epileptic seizures (ESs) and it has been mostly reported in psychogenic nonepileptic seizures (PNESs). However, labeling IC as a pathognomonic sign of PNES can be harmful. We first aimed to investigate IC frequency in ES and PNES and highlight the differences of IC between ES and PNES. Secondly, we aimed to analyze etiology, detailed semiology, treatment options, and outcome of patients with IC in ES in more detail. MethodsWe retrospectively screened all video-EEG monitoring unit reports from Hacettepe University Hospitals’ Epilepsy Center over a 20-year period (1996–2017) for the diagnosis of IC. We included the patients with IC who had at least one documented seizure. Patients who had IC with both facial expression and vocalization compatible with crying with or without weeping and subjective feeling of sadness, were included in the study. We classified patients with IC as ES and PNES. Demographic, historical, clinical, neuroimaging, electrophysiological parameters, video-EEG data, treatment options, and prognosis of all patients were recorded. Demographic, clinical, and video-EEG data were compared between ES and PNES. ResultsDuring the study period, 1983 patients were investigated. Six patients (all female) with ES and 37 patients (33 female) with PNES were identified. When we compared patients with PNES and ES with IC, the number of ASMs taken and duration of disease were significantly higher in patients with ES than PNES. Longer duration of seizure, longer duration of crying component, late onset of crying component in seizure, early responsiveness after seizure, not occurring during sleep, accompanied by eye closure and weeping, were found significantly higher in patients with PNES. Besides, if we analyze ES group in more detail, all had medical treatment refractory focal epilepsy and two of them whose IC was seen as an early semiological manifestation of their seizures had good outcome after nondominant anterior temporal lobectomy (ATL)+amygdalohippocampectomy (AH). However, three patients had various cortical lesions apart from temporal lobe on MRI and one patient had focal epilepsy with frontal lobe semiology with negative MRI. ConclusionAlthough the most common etiology for IC is PNES and it is rarely seen in ES, it can be harmful to label ictal crying as a pathognomonic sign for PNES. We proposed that there are some semiological differences in terms of IC between PNES and ES. These differences may help to distinguish IC in PNES and ES in daily practice. Moreover, it can be speculated that nondominant temporal lobe involvement may be associated with IC in ES.

USING A REAL TIME DASHBOARD TO SUPPORT POPULATION HEALTH IN INFLAMMATORY BOWEL DISEASE

Abstract The Phoenix Children’s Hospital (PCH) Inflammatory Bowel Disease (IBD) Clinic provides care for nearly 500 patients. As a group, PCH is part of the ImproveCareNow (ICN) network—a collaboration of over 100 centers worldwide to improve IBD care. Patient care has followed ICN guidelines including a weekly pre-visit planning (PVP) session. PVP is a time intensive process of manual chart review and data gathering for upcoming clinic patients. To improve this process and patient care, our group created a real-time IBD dashboard. OBJECTIVES: The aims of the dashboard were to identify and validate our patient population, improve efficiency by automating data gathering for PVP, and create a visual representation . Secondary aim, was to optimize processes including documentation, order entry and timely follow-up. METHODS: Data is sourced from the Allscripts electronic medical record (EMR). Data retrieval is contingent upon documentation. Our population of patients with IBD was identified based on a charted ICD-10 diagnosis of CD, UC or IC. PCH has a data warehouse of orders, results, Admission-Discharge-Transfer documentation, and flowsheets from the EMR and external data sources. Data is harvested and hosted using Microsoft Power BI for live review at weekly PVP. Once desired data points were hosted, focus was on process improvement (proper documentation, follow-up orders, and patient visits every 200 days). RESULTS: The dashboard hosts patients seen within the last 200 days, provider follow-up order placement, and physician global assessment (PGA) since January 2021. The percent of patients with follow-up orders placed was 61% in 2021. With dashboard enhancements and data visibility, this improved to 99% as of October 17, 2022. Physician global assessment (PGA) was recorded in 81% of encounters in 2021. Our most recent documentation rate is 92% on October 17, 2022. Our group had seen 82% of patients within the 200 days in 2021. Currently we have seen 89% of patients within 200 days as of October 17, 2022 (of these 91% of patients with active disease have been seen). We have instituted a work-flow process with schedulers to ensure patients are contacted and scheduled and not transitioned or moved. Figure 1 Historical Data from 1/2021-10/2021 Figure 2 Current Data as of 10/17/2022 CONCLUSIONS: With time, the IBD dashboard has proven to be a powerful tool in improving process measures. Our hope is these improvements will lend themselves to improved patient outcomes. With the ability to view data in real time in an automated fashion, staff hours have been saved and reallocated to other patient care needs. With continuous review of the data and introduction of accountability, we continue to see improvement. We now have the capacity to add additional metrics to the dashboard and our this can be viewed as a proof of concept for use in other specialties and chronic disease states.

Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months.

There are several patients with urination problems and urethral and pelvic discomfort. Usually, these patients’ symptoms are persistent and ambiguous; therefore, it is difficult to find underlying diseases associated with the patient’s symptoms. In addition, there are various conditions such as overactive bladder, cystitis, and interstitial cystitis/bladder pain syndrome (IC/BPS). Sometimes patients with other chronic disorders such as fibromyalgia, inflammatory bowel syndrome, and vulvodynia show urination problems and pelvic pain. Thus, a patient-centered approach is important to find the cause of chronic urination problems and pelvic pain. Moreover, IC/BPS should be considered during the diagnostic process because the clinical characteristics of IC/BPS are diverse. In this narrative review, we suggest an integral approach for the diagnosis and treatment of IC/ BPS.

Diagnosis of interstitial cystitis: practice-orientated diagnostic work-up

Interstitial cystitis is a chronic orphan disease of the urinary bladder characterised by its main symptoms of bladder pain, persistent urge to void and urinary frequency. Due to a variety of confusable diseases and different pathophysiologies, the diagnosis of IC is still a diagnosis of exclusion and remains a challenge for doctors and patients alike. Patients often experience misdiagnosis and unsuccessful treatment for years. Therefore, the primary goal for these patients with chronic pain must be a rapid diagnosis and initiation of adequate treatment. This article focuses on transferring the consensus-based recommendations of the current German S2k guideline "Diagnosis and Treatment of Interstitial Cystitis" (IC/BPS) (2018 AWMF register No.: 043/050) into a practice-orientated and structured diagnostic work-up process.

Antifungal stewardship in critical care: Implementing a diagnostics-driven care pathway in the management of invasive candidiasis

SummaryBackgroundInvasive candidiasis (IC) is the most common invasive fungal disease in patients admitted to critical care and is associated with high mortality rates. Diagnosis can be delayed by the poor sensitivity of culture-based methods, leading to unnecessary use of empirical antifungal therapy (EAFT). The fungal biomarker (1–3)-β-d-glucan (BDG) has been shown to aid in the diagnosis of IC in critical care and has been incorporated into antifungal stewardship (AFS) programmes.AimTo describe our experience using a diagnostics-driven AFS programme incorporating the fungal biomarker BDG, analyse its impact on antifungal therapy (AFT), and gain an improved understanding of the epidemiology of IC in our critical care unit (CrCU).MethodsAn AFS care pathway incorporating BDG was introduced in the CrCU in St James's Hospital, Dublin. Following an educational programme, compliance with the pathway was prospectively audited between December 1st, 2017 and July 31st, 2018.Results and ConclusionOne hundred and nine AFT episodes were included, of which 95 (87%) had a BDG sent. Of those with BDG results available at the time of decision-making, 38 (63%) were managed in accordance with the care pathway. In compliant episodes without IC, median EAFT duration was 5.5 days [IQR 4–7] and no increase in mortality or subsequent IC was observed. Although adopting a diagnostics-driven approach was found to be useful in the cohort of patients with BDG results available, the use of once-weekly BDG testing did not result in an observed reduction in the consumption of anidulafungin, highlighting an important limitation of this approach.

Invasive Candidiasis.

Invasive candidiasis (IC) is the most frequent health care associated invasive fungal infection. It is also associated with high morbidity, mortality, and cost. The most frequent etiologic agent is Candida albicans, but non-albicans species are increasing and associated with reduced antifungal susceptibility and outbreaks. Candida auris is an emerging multidrug-resistant species recently described. IC presents as a spectrum of disease, going from fungemia to deep-seated candidiasis, and to septic shock with multiorgan failure. Diagnosis of IC is challenging. Several biomarkers and molecular methods are available for improving diagnosis. Early initial treatment with echinocandins is the treatment of choice. Step-down therapy when antifungal susceptibility is available is possible. Several new antifungal agents for the treatment of IC are in clinical development.

Magnetic resonance cholangiopancreatography digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic

Objective To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic. Methods The clinical data of 41 patients with choledochal cyst type Ic, 47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital, PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed. The diameters of the common bile duct, the left and the right hepatic ducts were measured and compared. Results The maximum diameter of the left hepatic duct (LHD), right hepatic duct (RHD) and common bile duct (CBD) were significantly different (all P 0.05), while the ratios of CBD/LHD and CBD/RHD were significantly larger (P 0.05). The proportion of pancreaticobiliary maljunction (PBM) in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruction and simple gallstone or polyp (P<0.05). Conclusions For patients with choledochal cyst type Ic, their CBD shows obvious dilation, while there is no obvious dilation in LHD and RHD. It is helpful to conduct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios. Key words: Choledochal cyst; MRCP; Differential diagnosis; Digital quanlification

P6389Infection and type 2 myocardial infarction: a large observational study from emergency department

Abstract Background Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes). Results Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract (n=111), urinary tract (n=27), skin (n=15), digestive tract (n=9) or other or indefinite site (n=23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, p=0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality. Conclusions Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.

Diagnostic Performance of T2Candida Among ICU Patients With Risk Factors for Invasive Candidiasis.

BackgroundInvasive candidiasis (IC) comprises candidemia and deep-seated candidiasis. Blood culture (BC) is the gold standard test, but sensitivity is low. T2Candida is a new diagnostic test. We investigated the performance of T2Candida, BC, and Candida mannan antigen (MAg) for detection of IC in a high-risk intensive care unit (ICU) population.MethodsOne-hundred twenty-six ICU patients at high risk of IC with sepsis despite 3 days of broad-spectrum antibiotics were included. Paired BC, T2Candida, and MAg were obtained twice weekly (334 sets). Patients were classified into proven, likely, possible, or unlikely IC based on patient record review.ResultsAt enrollment, 92 (77%) patients were receiving antifungal therapy (mainly fluconazole 66%). Fifteen (11.9%) patients were positive by BC (n = 4), T2Candida (n = 11), or MAg (n = 10). The T2Candida species distribution at inclusion (Candida albicans/Candida tropicalis: 8/11 [72.3%] and Candida glabrata/Candida krusei: 3/11 [27.3%]) was supported by the identification of BC or colonizing isolates in 10/11 cases. Patients were classified with proven (11), likely (6), possible (11), and unlikely (98) IC. Defining IC as proven/proven&likely/proven&likely&possible, respectively, the sensitivity was as follows: T2Candida (55%/59%/39%), BC (45%/29%/ 8%), and MAg (36%/41%/32%). The negative predictive value was similar across the tests for proven vs others and proven/likely vs others (94%–96% and 90%–95%, respectively). For test combinations including T2Candida, the sensitivity increased to 64%–65%, without hampering the positive predictive value.ConclusionsIn conclusion, although the diagnostic performance was modest for all the tests, the combination of T2Candida and BC seemed to have the best diagnostic performance, and thus implementation of T2Candida may improve the diagnosis of IC.

Infection and type 2 myocardial infarction: A large observational study from emergency department

Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality in patients admitted to an EU with AI and elevated troponin. Among the medical records of all the patients admitted from 2014 to 2016 in a university hospital EU ( N = 82,543), patients with a diagnosis of AI and elevated troponin Ic (≥ 0.10μg/L)( N = 714) were systematically adjudicated as T2MI in the presence of symptoms of myocardial ischemia (typical chest pain and/or ECG changes). Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract ( N = 111), urinary tract ( N = 27), skin ( N = 15), digestive tract ( N = 9) or other or indefinite site ( N = 23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, P = 0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent predictors of mortality. Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, especially in the absence of temperature elevation, renal insufficiency or history of COPD, but is not an independent factor of in-hospital mortality.

Infection and type 2 myocardial infarction: A large observational study from emergency department.

Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin. Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU ( n = 82,543), patients with a diagnosis of AI and elevated troponin Ic (≥ 0.10 μg/L)( n = 714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes). Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract ( n = 111), urinary tract ( n = 27), skin ( n = 15), digestive tract ( n = 9) or other or indefinite site ( n = 23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) [OR (95% CI): 0.53 (0.30–0.96)], high temperature [OR: 0.86 (0.74-0.99) per °C] and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs. 23%, P = 0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality. Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.

Expression of nerve growth factor in urine of patients with interstitial cystitis and its clinical significance

Objective Evaluate the clinical value of nerve growth factor (NGF) in patients with interstitial cystitis for diagnosis and predicting the prognostic. Methods From January 2013 to January 2017, 22 cases of interstitial cystitis patients , including 20 female cases and 2 male cases, were collected. Their mean age was (48.5±12.8) years old. The average frequency of urination was 25.4±4.6 before treatment. The average frequency of nocturia was 4.6±0.5. The average maximal bladder volume was (223.4±39.5)ml. Their IPSS and QOL scores were 17.3±1.2, 12.7±1.7, respectively. Meanwhile, 22 healthy volunteers, including 18 female cases and 4 male cases, were collected. Their mean age was (40.2±8.7) years old. The average frequency of urination was 4.2±2.6 before treatment. The average frequency of nocturia was 1.1±0.4. Urine NGF of these patients were collected before and after sodium hyaluronate bladder perfusion treatment, and the levels of NGF were detected by ELISA method. The correlationship between NGF and the severity of the symptoms were evaluated before and after treatment. Results After 1, 3 and 6 months’treatment, the levels of NGF were dropped from (243.5±37.8) ng/L to (187.3±28.7)ng/L, (141.5±21.3)ng/L and (123.1±15.9) ng/L, which was positively associated with the degree of clinical symptom. The number of urination droppted from 25.4±4.6 to 21.7±5.2, 17.2±3.9 and 14.6±3.8. The number of nocturia was dropped from 4.6±0.5 to 3.8±0.6, 3.0±0.8 and 1.7±1.1. The maximum volume of bladder increased from (223.4±39.5) ml to (258.7±40.2)ml, (289.6±37.1)ml and (305.2±40.4) ml. The IPSS scores dropped from 17.3±1.2 to 15.1±2.4, 12.4±1.82and 9.8±1.4. The QOL scores dropped from 12.7±1.7 to 10.6±1.2, 8.5±1.5 and 7.1±1.3(P<0.05). The logistic regression analysis showed the level of NGF in IC patients has positive relationship with frequency of urination, nocturia, QOL scores, IPSS scores and maximal bladder volume (P<0.05). Conclusions The level of NGF in urine is associated with IC symptom severity and NGF has the potential to be used as a marker for the diagnosis of IC. Key words: Interstitial cystitis; Nerve growth factor; Clinical significance

Diagnosis of invasive fungal disease in hospitalized patients with chronic obstructive pulmonary disease

BackgroundThe role of culture-independent techniques (galactomannan, (1-3)-β-d-glucan) in the early diagnosis of invasive fungal diseases (IFD) is well assessed in hematological patients, but there are no clear conclusions in patients with chronic obstructive pulmonary disease (COPD). AimsTo study the usefulness of nonculture-based techniques in the diagnosis of IFD in COPD-patients at risk for IFD. MethodsA prospective observational study based on monitoring COPD patients at risk for IFD during 2007–2010 was carried out. The presence of galactomannan, (1-3)-β-d-glucan and an indirect immunofluorescence of Candida albicans germ tube specific antibodies (CAGTA) were performed. ResultsAmong 43 COPD patients, 16 (37.2%) were diagnosed with IFD: seven cases were proven IFD (five invasive candidemia – IC, one invasive aspergillosis – IA and a rhinocerebral zygomycosis) and nine probable IFD (seven IA and two IC). In the diagnosis of IC and IA, the negative predictive value (NPV) of (1-3)-β-d-glucan was 100%. Regarding CAGTA in IC, NPV was 96.2%. Finally, NPV of galactomannan in IA was 91.2%. The area under the ROC curve for (1-3)-β-d-glucan in IC and for the rest of the IFD cases was 0.86 (95% CI, 0.79–0.93) and 0.60 (95% CI, 0.43–0.77), for CAGTA in IC was 0.83 (95% CI, 0.74–0.91) and for galactomannan in IA was 0.71 (95% CI, 0.56–0.85). Positive (1-3)-β-d-glucan preceded the growth of Candida (average of 1.7 days) in blood culture. ConclusionsIn COPD patients at risk for IFD the assayed techniques are especially useful to rule out the presence of IFD.

Treatment effectiveness in interstitial cystitis/bladder pain syndrome: Do patient perceptions align with efficacy-based guidelines?

We sought to determine if patients' perceptions of success or failure of interstitial cystitis/bladder pain syndrome (IC/BPS) therapies proposed in treatment guidelines align with the evidence from available clinical trial treatment data. A total of 1628 adult females with a self-reported diagnosis of IC completed a web-based survey in which patients described their perceived outcomes with the therapies they were exposed to. Previously published literature, used in part to develop IC/BPS guidelines, provided the clinical trial data outcomes. Patient-reported outcomes were compared to available clinical trial outcomes and published treatment guidelines. Based on patient perceived outcomes (benefit:risk ratio), the most effective treatments were opioids, phenazopyridine, and alkalizing agents, with amitriptyline and antihistamines reported as moderately effective. The only surgical procedure with any effectiveness was electrocautery of Hunner's lesions. In order of efficacy reported in the literature, the therapies for IC/BPS with predicted superior outcomes should be: cyclosporine A, amitriptyline, hyperbaric oxygen, pentosan polysulfate plus subcutaneous heparin, botulinum toxin A plus hydrodistension, and L-arginine. While some of the guideline recommendations aligned with patient-reported effectiveness data, there was a general disconnect between guidelines and effectiveness reported in clinical practice. There is a disconnect between real-world patient perceived effectiveness of IC/BPS treatments compared to the efficacy reported from clinical trial data and subsequent guidelines developed from this efficacy data. Optimal therapy must include the best evidence from clinical research, but should also include real-life clinical practice implementation and effectiveness.

The Risk Predictive Values of ACG Classification in a Cohort of Colon Ischemia: Refining the Definition of Mild Disease

Introduction: Although most cases of colon ischemia (CI) are mild and self-limiting, when severe it implies high mortality rates. We aimed to evaluate the risk predictive value of the classification proposed by American College of Gastroenterology (ACG) guidelines (2015), created to provide a management algorithm. Methods: A retrospective multicenter study was conducted on adult patients with definite CI (clinical, endoscopic, pathologic and culture criteria), between 2013 and 2016. Data was collected on clinical presentation, including comorbidities, organ failure, management and outcome. Cases were evaluated according to ACG risk factors (RF) (gender, systolic blood pressure, heart rate, abdominal pain without rectal bleeding, BUN, Hb, LDH, serum sodium, WBC). Cases were classified as mild (0 RF), moderate (1-3 RF) and severe (>3 RF or any of the following: peritoneal signs, pneumatosis or portal venous gas, gangrene, pan-colonic or isolated right-colon ischemia). Results: 349 cases with the clinical diagnosis of IC were analyzed. 193 met inclusion criteria of definitive diagnosis (63% females; mean age 72 years (±13). ACG classification of mild, moderate and severe disease was attributed respectively to 21% of patients (0 intra-hospital deaths), 45% (2 deaths) and 34% (12 deaths). The number of ACG RF was: 40% with 0 RF, 8% with 1, 9% with 2, 15% with 3, 16% with 4, 8% with 15%, 4% with 6 and 1% with 7. No patient with 0 or 1 RF died. Only 1 patient with 2 RF died. The remaining 13 deaths were verified with at least 3 RF. The univariate analysis revealed a statistical correlation between RF and intra-hospital or 30-day mortality as well as the need for surgery (P<0.001, P<0.001, and P=0.006, respectively). ACG classification presented high predictive accuracy for in-hospital and 1-month mortality with an AUROC of 0.78 and 0.79 (P<0.001), respectively. For a cutoff of 2 ACG RF, the sensibility (SE) for death was 100%, specificity (SP) was 52%, with a positive predictive value (PPV) of 14% and negative predictive value (NPV) of 100%. For 3 ACG RF the results were: SE 93%, SP 61%, PPV 16% and NPV 99%. Three or more RF had an OR of 20.2 (95%CI: 2.59-158) for intra-hospital and 18.4 (95% CI: 2.34-144) for 1-month mortality. Conclusion: No patient in this cohort with less than 2 ACG RF died, suggesting that mild disease of ACG classification may include 0 and 1 RF without changing prognosis. Short-term mortality risk increases significantly in patients with at least 3 ACG RF.Figure: ROC curve comparing the sensitivity of prediction of mortality at 1 month using the ACG classification, ACG classification adjusting mild disease until 1 RF and the number of ACG RF.

Prevalência do Diagnóstico de DPOC em Pacientes internados com Cardiopatia Isquêmica em um Hospital Universitário no interior do Estado do Rio Grande do Sul

Justificativa e objetivos: A Doença Pulmonar Obstrutiva Crônica (DPOC) é um problema de saúde pública e tem recebido crescente atenção nos últimos anos. Buscouse avaliar qual a proporção dos pacientes que internaram por cardiopatia isquêmica (CI) tinham história de exposição a fatores de risco e/ou haviam sido diagnosticados como portadores de DPOC. Métodos: estudo transversal, observacional, do tipo prospectivo. Foram selecionados todos os pacientes, acima de 18 anos, lúcidos e que concordaram em participar do estudo, internados no período de setembro de 2014 a junho de 2015, com o diagnóstico de CI. Os dados analisados foram analisados no programa SPSS 22.0. Resultados: foram incluídos 69 pacientes que internaram com diagnóstico de CI nos anos de 2014 e 2015. A média de idade dos pacientes foi de 65 anos e destes, 35 (50,7%) eram do sexo masculino. A média da duração de internação desses pacientes foi de 3 dias. Os pacientes que apresentavam diagnóstico de DPOC e estavam em tratamento eram 6 (8,69%), e os que haviam realizado espirometria prévia totalizavam 5 (7,24%). Quanto às manifestações respiratórias nos pacientes com CI, 25 pacientes (64,1%) apresentavam tosse, expectoração ou dispneia. Houve um relato de 8,7% dos pacientes já terem sido diagnosticados previamente como portadores de DPOC. Conclusões: Apesar da alta prevalência de sintomas respiratórios e exposição a fatores de risco, pacientes com DPOC tem maior número de eventos e maior mortalidade por cardiopatia isquêmica, nosso estudo sugere que existe uma alta porcentagem de subdiagnóstico de DPOC em pacientes internados por cardiopatia isquêmica em nosso meio.portadores de DPOC. Conclusões: Apesar da alta prevalência de sintomas respiratórios e exposição a fatores de risco, pacientes com DPOC tem maior número de eventos e maior mortalidade por cardiopatia isquêmica, nosso estudo sugere que existe uma alta porcentagem de subdiagnóstico de DPOC em pacientes internados por cardiopatia isquêmica em nosso meio.

Utility of Serial β-d-Glucan Levels in Patients with High Risk for Invasive Candidiasis: A Potential Tool for Antifungal Stewardship

BackgroundInvasive candidiasis (IC) is a severe infection in which diagnosis is challenging and often made late in the course of infection. Patients with delayed initiation of antifungals have high mortality risk; physicians tend to start empiric therapy at earliest clinical suspicion of IC. Excessive use of antifungals worsens selection pressure for resistance. Thus, alternative ways to aid antifungal stewardship are highly relevant. We aimed to evaluate performance of (1–3)-β-d-glucan (BDG) serial testing for antifungal stewardship to improve antifungal prescribing and to stop unnecessary use without compromising care.MethodsThis was a prospective observational study on patients at high risk of IC. Adults with recent intra-abdominal surgery, admitted to surgical intensive care unit (ICU), and prescribed an antifungal for suspected IC were included. Blood samples were taken at start of and days 3, 7, 10, 14, and weekly thereafter until antifungal is stopped, for BDG quantification with Fungitell assay. Medical records were reviewed for patient characteristics, antifungal regimen and outcomes. BDG was evaluated against clinical and microbiological outcomes. Sensitivity, specificity, positive and negative predictive values of BDG and Candida score were evaluated.ResultsWe included 15 patients and 74 BDG levels. Patients with confirmed IC from cultures had a median BGD of >500 pg/mL and candida score of 3, compared with 55.5 pg/mL and score of 2 in those without confirmed IC. BGD assay anticipated diagnosis of IC with a sensitivity and specificity of 100% and 66.7%, with a positive and negative predictive value of 62.5% and 100% respectively. Of the five patients with confirmed IC, two had declining BDG, corresponding to clinical response to therapy. Their BDG were <80 pg/mL on day 7 and 14 of therapy, respectively, and were disharged from ICU, but one later had septic shock with Klebsiella pneumoniae bacteremia and demised. Repeat fungal cultures were negative. The remaining three had persistently high BGD of >500 pg/mL and eventually demised. No obvious trend was observed in those without confirmed IC.ConclusionWe were able to characterise BDG levels in patients at high risk of IC. There is utility in BGD serial testing as a tool for antifungal stewardship, however more data is required to confirm findings.Disclosures All authors: No reported disclosures.

MMPI-2-RF characteristics of individuals with interstitial cystitis

ObjectivesThis study aimed to describe the psychological functioning of interstitial cystitis/bladder pain syndrome patients utilizing MMPI-2-RF scoring. MethodsThe MMPI-2 was administered to 60 individuals who reported a diagnosis of IC. Responses were scored in the MMPI-2-RF format. Fifty-one protocols were deemed valid. ResultsElevations were discovered on scales FBS-r (symptom validity), RC1 (somatic complaints), and MLS (malaise). Participants were split into two groups based on extreme elevations on RC1; the high RC1 group produced higher scores on 39 scales including clinically significant elevations on 17 scales. ConclusionOver 25% of this sample had an emotional component to their physical concerns. This knowledge about the psychological characteristics of IC patients may have clinical utility for physicians and other treatment providers. The results argue strongly for psychological evaluation as a component of IC diagnosis and treatment. Those with significant emotional overlay to their somatic complaints may be best managed through psychological interventions and minimally invasive treatments.

1678 Treatment of Infantile Colic with Lactobacillus Reuteri and the Relationship with Postpartum Depression: A Randomized Controlled Trial Study

Background and AimInfantile colic (IC) is a common behavioural syndrome within the first 3 months of life. We aimed to compare the effectiveness of Lactobacillus reuteri (L.reuteri) and herbal drop...