Disease Hospital Research Articles

Adverse outcomes after partner bereavement in people with reduced kidney function: Parallel cohort studies in England and Denmark.

To investigate whether partner bereavement is associated with adverse cardiovascular and kidney-related events in people with reduced kidney function. Two parallel matched cohort studies using linked routinely collected health data. England (general practices and hospitals using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics) and Denmark (hospitals and community pharmacies using the Danish National Patient, Prescription and Education Registries and the Civil Registration System). Bereaved people with reduced kidney function (estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (England) or hospital-coded chronic kidney disease (Denmark)) and non-bereaved people with reduced kidney function similarly defined, matched on age, sex, general practice (England), and county of residence (Denmark) and followed-up from the bereavement date of the exposed person. Cardiovascular disease (CVD) or acute kidney injury (AKI) hospitalization, or death. In people with reduced kidney function, we identified 19,820 (England) and 5,408 (Denmark) bereaved individuals and matched them with 134,828 (England) and 35,741 (Denmark) non-bereaved individuals. Among the bereaved, the rates of hospitalizations (per 1000 person-years) with CVD were 31.7 (95%-CI: 30.5-32.9) in England and 78.8 (95%-CI: 74.9-82.9) in Denmark; the rates of hospitalizations with AKI were 13.2 (95%-CI: 12.5-14.0) in England and 11.2 (95%-CI: 9.9-12.7) in Denmark; and the rates of death were 70.2 (95%-CI: 68.5-72.0) in England and 126.4 (95%-CI: 121.8-131.1) in Denmark. After adjusting for confounders, we found increased rates of CVD (England, HR 1.06 [95%-CI: 1.01-1.12]; Denmark, HR 1.10 [95%-CI: 1.04-1.17]), of AKI (England, HR 1.20 [95%-CI: 1.10-1.31]; Denmark HR 1.36 [95%-CI: 1.17-1.58]), and of death (England, HR 1.10 [95%-CI: 1.05-1.14]; Denmark HR 1.20 [95%-CI: 1.15-1.25]) in bereaved compared with non-bereaved people. Partner bereavement is associated with an increased rate of CVD and AKI hospitalization, and death in people with reduced kidney function. Additional supportive care for this at-risk population may help prevent serious adverse events.

Cardiac evaluation in adults with dengue virus infection by serial echocardiography

BackgroundDengue virus infection (DVI) is a major health problem in many parts of the world. Its manifestations range from asymptomatic infections to severe disease. Although cardiac involvement has been reported in DVI, its incidence has not yet been well established.MethodsFrom July 2016 to January 2018, patients hospitalized at the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand, with dengue virus infection confirmed by positive NS1 or positive dengue immunoglobulin M findings, participated in the study. We characterized the incidence and change in cardiac function by serial echocardiography and levels of troponin-T and creatine kinase-myocardial band (CK-MB) on the day of admission, the day of defervescence, the first day of hypotension (if any), and at 2 week follow-up.ResultsOf the 81 patients evaluated, 6 (7.41%) exhibited elevated biomarker levels. There was no difference in clinical presentation amongst dengue fever, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), except for the amount of bleeding. Cardiac involvement was found in 22.2% of patients: 3 (3.70%) had left ventricular systolic dysfunction, 3 (3.70%) had transient diastolic dysfunction, 6 (7.41%) had increased levels of at least one cardiac biomarker (troponin-T or CK-MB), and 6 (7.41%) had small pericardial effusion. Myocarditis was suspected in only two patients (with DHF); thus, myocarditis was uncommon in patients with dengue virus infection. Three patients developed DSS during admission and were transferred to the intensive care unit.ConclusionCardiac involvement in adults with dengue infection was common, ranging from elevated cardiac biomarker to myocarditis. Abnormalities in cardiac function had resolved spontaneously by the day of follow-up, without specific treatment. We found that DHF was a significant risk factor for cardiac involvement. Echocardiography is the investigation of choice for evaluating the haemodynamic status of patients with DVI, especially in severe dengue.

Nitrosamine (and /or Losartan/ Hydrochlorothiazide) Induced Pretibial Located Lentigo Maligna: First Reported Case in the World Literature

A 66-year-old Caucasian woman presented to the dermatology department with complaints of a pigmented lesion on the left shin. She first noticed the lesion in March 2020, several months prior to presentation but decided to seek medical advice after observing substantial growth in the size and shape of the lesion. She was diagnosed with type II arterial hypertension 6 years ago and was started losartan/hydrochlorothiazide 50 mg / 12.5mg half a tablet daily. The patient visits her general practitioner regularly and her hypertension is well controlled on these medications, had no other concomitant diseases and was relatively healthy for her age. No family history for dermatologic diseases was available. On dermatologic examination, a single superficially spreading pretibial lesion covering 1.8 cm wide and 1.2cm high was noted(Figure 1a). The light greyish-pink pigmented lesion was oval in shape with sharply demarcated borders and no elevation above the surrounding skin. Further laboratory work-up showed no signs of deviations. Based on the clinical and dermatoscopic evidence, the diagnosis of melanoma in situ, lentigo maligna type was made. She was sent for treatment at a specialised hospital for oncological diseases in June 2020 where a surgical excision was performed under local anaesthesia with 0.5cm clear/ negative margins in all directions. The defect was thereafter closed using a full-thickness mesh graft taken from the abdominal region(Figure 1b). The excised tumour was subsequently sent for histological evaluation and was keeping with the clinicopathological diagnosis of lentigo maligna. Immunohistochemical analysis also identified S100 positive nests of cells within the basal lamina, confirming the diagnosis.Postsurgical wound healing with the skin graft was poor due to inadequate graft transplantation whereby necrotic as well as macerated areas were observed leadingto bad cosmetic results (Figure 1c-h).After a multidisciplinary review and follow up, a second operation was performed a month later to remove the necrotic, together with the hypertrophic tissue and a new split skin mesh graft was utilised. Stringent post-operative care, including prophylactic antibiotic therapy was also provided to promote good wound healing which was achieved several months later (Figure 1i).

Scabies Among Health Care Workers in Sarhad Psychiatric Hospital Peshawar Khyber Pakhtunkhwa

Scabies is a neglected parasitic disease but of great importance in developing countries. It is endemic in tropic and sub-tropical countries. It is caused by a mite and transmitted through skin-to-skin contact Objective: The study will provide a better opportunity to adopt protective measures and thus reduce the disease burden in hospitalized patients Method: The aim of my study is to assess the scabies level of health care workers at Sarhad Hospital for Psychiatric diseases Peshawar regarding scabies. In our study, the respondents were doctors, Nurses, and junior clinical technicians of both sexes. Result: Rather than this, no such studies have been conducted in Pakistan. There have been some reported studies in different countries where an outbreak of scabies has been reported. Where health workers were also been affected as well as patients. Conclusion: Scabies outbreaks occur due to poor personal hygiene, poor environmental sanitation, low socioeconomic conditions, lack of basic healthcare facilities, over-crowding and illiteracy.

Частота развития и особенности клинического течения герпесвирусных менингитов у детей и взрослых по данным областной инфекционной клинической больницы города Тюмени

Aim. The objective is to explore the incidence rate and the specifics of the clinical course of herpesviral meningitis in children and adults. Materials and methods. The post-hoc analysis of 23 patients’ records has been carried out. The patients were admitted to State Budgetary Healthcare Institution of the Tyumen Region, Clinical Hospital for Infectious Diseases, City of Tyumen, during the period of 2018-2019 diagnosed with meningitis of herpesviral etiology. When analysing the data the following aspects were taken into account: age, sex, etiological agent, complaints at admission, results of clinical examination and laboratory findings. Results. Twenty-three (23) cases of herpesviral meningitis were registered during the period of two (2) years; mixed infection was detected in every fifth patient. Epstein Barr viral meningitis was diagnosed in most cases and was detected 3.5 times oftener in adults than in children. Herpes Simplex Virus meningitis was the second one in terms of detection rate and it affected only adults. Varicella Zoster Virus meningitis was detected two times rarer than Herpes Simplex Virus and only in adults. The herpesviral meningitis caused by human herpes virus type 6 was detected with the same rate as Varicella Zoster meningitis but was registered among children only. Cytomegaloviral meningitis was detected in one adult who was affected by severe immune deficiency. Conclusion. The detected specifics of the incidence of the herpesviral meningitis with respect to a patient’s age will enable a practitioner to suggest the possible meningitis etiology and to prescribe appropriate treatment thus improving the prognosis for the disease.

Divergences between mHealth drug interaction checkers: a highlight on HIV hospitalized patients therapy

Introduction: Mobile health (mHealth) apps have been involved in contemporary clinical practice in potential drug-drug interactions (pDDIs) research. However, available pDDIs information may differ between apps, which could impact the success of patient's drug therapy. This study analyzed the performance of the mHealth apps in a context of pharmacotherapy prescribed to HIV/AIDS hospitalized patients. Methods: Cross-sectional study was conducted in a referral hospital for infectious diseases, central Brazil. Drug prescriptions were selected randomly by census. A pDDIs prevalence, severity classification as well the agreement of information and performance of different mHealth checkers were analyzed. Free access mHealth apps were selected: Drugs®, EpocratesRx®, and Micromedex® (considered as reference app). Analysis of sensitivity, specificity, positive or negative predictive values (PPV or NPV) was conducted. Results: The majority of 33 HIV/AIDS hospitalized patients was males, young adults, with opportunistic infections despite of a recent HIV diagnosis. 373 drugs were prescribed with 461 pDDIs identified by mHealth checkers. The pDDIs prevalence was 13.9% (12.4-15.6), 22.2% (20.1-24.5) and 24.8% (22.9-26.8) in Micromedex®, EpocratesRx® and Drugs®, respectively. Micromedex® classified most of pDDIs (71.2%) as major, while Drugs® (67.6%) and EpocratesRx® (84.8%) classified most of them as minor. In comparison with Micromedex®, Drugs® or EpocratesRx® showed none (K&lt;0.00) or little (K=0.11) agreement in identification of pDDIs, respectively. Performance analyzes showed that Drugs® presented greater sensitivity (75.4%), however, the results of specificity, PPV, NPV, and accuracy were similar by both apps when compared to the reference. Conclusion: The mHealth drug interaction checkers presented important divergences in the results of identification, classification of severity and prevalence rate of pDDIs.

Weather temperature and the incidence of hospitalization for cardiovascular diseases in an aging society

Weather temperatures affect the incidence of cardiovascular diseases (CVD), but there is limited information on whether CVD hospitalizations are affected by changes in weather temperatures in a super-aging society. We aimed to examine the association of diurnal weather temperature changes with CVD hospitalizations. We included 1,067,171 consecutive patients who were admitted to acute-care hospitals in Japan between April 1, 2012 and March 31, 2015. The primary outcome was the number of CVD hospitalizations per day. The diurnal weather temperature range (DTR) was defined as the minimum weather temperature subtracted from the maximum weather temperature on the day before hospitalization. Multilevel mixed-effects linear regression models were used to estimate the association of DTR with cardiovascular hospitalizations after adjusting for weather, hospital, and patient demographics. An increased DTR was associated with a higher number of CVD hospitalizations (coefficient, 4.540 [4.310–4.765]/°C change, p < 0.001), with greater effects in those aged 75–89 (p < 0.001) and ≥ 90 years (p = 0.006) than among those aged ≤ 64 years; however, there were no sex-related differences (p = 0.166). Greater intraday weather temperature changes are associated with an increased number of CVD hospitalizations in the super-aging society of Japan, with a greater effect in older individuals.

Evaluation of nutritional status in pediatric patients diagnosed with Covid-19 infection.

AimThe aim of this study was to evaluate the nutritional status, the nutritional effect on the risk of infection and the severity of the disease, and the contribution of nutrition to the course of the infection in pediatric patients diagnosed with coronavirus disease who required additional nutritional support after hospitalization.MethodsThe body weight, height, body mass index, upper arm circumference, and triceps skinfold thickness of 49 patients aged 1 month to 18 years and diagnosed with Covid-19 and then hospitalized at the Ankara City Hospital, Pediatric Health and Diseases Hospital, Pediatric Infection ward between 15 May and 15 June 2020 were measured. Total protein, albumin, prealbumin, selenium, zinc, ferritin, folate, and selenium, C, D, E, and B12 levels were studied from blood drawn simultaneously from the patients.ResultsA total of 49 patients aged 8–18 years were evaluated. The median age was 13 years (age range 8–18). The females made up 53% and the males 47% of the group. No patient needed intensive care admission. Only 3 patients received antibiotic treatment and the others were followed up without treatment. The weight was normal in 75% and the height was normal in 90%. Mid-arm circumference and triceps thickness were normal in 72% of the patients. Vitamin D deficiency was present in 82%, vitamin B12 deficiency in 18%, vitamin C deficiency in 17%, ferritin deficiency in 16%, folate deficiency in 15%, vitamin A deficiency in 13%, and vitamin E deficiency in 7%.ConclusionNo patient required intensive care admission. Only 3 patients received antibiotic treatment and the others were followed up without treatment. Malnourishment was present in 3% of the patients while 9% were obese. Vitamin D deficiency was the most common vitamin deficiency while vitamin B12, vitamin C, Ferritin, vitamin A, vitamin E, and Folate deficiency were less common. Selenium and zinc levels were normal in all patients. There was no correlation between anthropometric values and susceptibility to childhood COVID-19 infection or the clinical course. It is possible that vitamin D deficiency increases susceptibility to the infection.

Clinical manifestations, laboratory findings, antimicrobial susceptibility and outcomes of Enterococcus blood stream infection at Bach Mai Hospital and National Hospital for Tropical Diseases

Clinical manifestations, laboratory findings, antimicrobial susceptibility and outcomes of Enterococcus blood stream infection at Bach Mai Hospital and National Hospital for Tropical Diseases

P181 Long-term improvement in axial spondyloarthritis clinical outcomes following 2-weeks of intensive education and rehabilitation: results from the Bath residential rehabilitation programme

Abstract Background/Aims Axial spondyloarthritis (axSpA) is a chronic rheumatic condition, characterised by inflammatory back pain - often associated with impaired function and mobility, sleep disturbance, fatigue, and reduced quality of life. Despite the vast advances in pharmacological treatments for axSpA over the last few decades, physical activity and rehabilitation remain vital for effective disease management. At the Royal National Hospital for Rheumatic Diseases in Bath (RNHRD), the 2-week inpatient axSpA rehabilitation programme has been integral to axSpA care since the 1970’s. Prior research has demonstrated significant short-term improvements in spinal mobility (BASMI), function (BASFI) and disease activity (BASDAI) following course attendance. However, the long-term outcomes are yet to be evaluated in this unique cohort. Methods Since the early 1990’s, clinical measures of spinal mobility, function and disease activity have been routinely collected at the RNHRD at all clinical appointments through administration of the BASMI, BASFI and BASDAI, respectively. Dates of attending the axSpA course and standard clinical and treatment follow-up data were also collected. Multiple linear regression models were used to investigate the impact of course attendance on final reported BASMI, BASDAI and BASFI scores (final score=most recent). Length of follow-up was defined as time between first and last recorded BASMI. Results Of the 203 patients within the Bath SPARC200 cohort, 77.8% (158/203) had attended at least one rehabilitation course throughout follow-up. 70.0% (140/203) of patients were male. The mean duration of follow-up was 13.5 years (range 0-35 years); 28.1% (57/203) of individuals with 20+ years of follow-up. Course attendance (yes versus no) significantly reduced final BASMI score by 0.84 (p = 0.001, 95%CI -1.31 to -0.37) and final BASDAI score by 0.74 (p = 0.018, 95%CI -1.34 to -0.13). Although course attendance reduced final BASFI by 0.45 (95%CI -1.17 to 0.28), this relationship did not reach significance (p = 0.225). Whilst minimally clinically important difference (MCID) is, to our knowledge, yet to be defined for BASMI, MCIDs were achieved long-term for both BASDAI and BASFI - defined by van der Heijde and colleagues in 2016 as 0.7 and 0.4 for BASDAI and BASFI, respectively. Conclusion These results provide novel evidence to support the integral role of education, physical activity and rehabilitation in the management of axSpA. Future work should investigate additional outcomes of critical importance to patients and clinicians, such as fatigue, quality of life and work productivity. Furthermore, a greater understanding of the factors that confound these outcomes may provide insights into those patients who may most benefit from attending a 2-week rehabilitation course. In addition to facilitating identification of those patients who may require additional clinical support. Disclosure R. Barnett: None. A. McGrogan: None. M. Young: None. C. Cavill: None. M. Freeth: None. R. Sengupta: Honoraria; Biogen, Celgene, AbbVie, Novartis, MSD. Grants/research support; Novartis, UCB.

P177 Management of patients with axSpA: an audit against the NICE diagnosis and management of adults with spondyloarthritis quality standard, QS170, and clinical practice guidelines

Abstract Background/Aims The Royal National Hospital for Rheumatic Diseases in Bath is a tertiary centre for axial spondyloarthritis (axSpA). Our objective was to perform an audit to establish compliance with NICE QS170: patients with no radiographic evidence of axSpA receive an MRI scan; patients with axSpA undergo a structured exercise programme from a specialist physiotherapist; and patients receive information about their axSpA and its management. The aim was to identify opportunities for improvements in the care given to people using our service. Methods A retrospective case note review was performed for 300 patients with axSpA who commenced biologic disease-modifying anti-rheumatic drug (bDMARD) therapy between 2011 and 2018, selected at random from 539 patients in our database using systematic random sampling. Using NICE QS170 and clinical practice guidelines for reference, the audit explored the frequency and nature of imaging examination (X-ray or MRI) as part of the diagnostic work up; dissemination of patient information and education regarding their condition; nature and sequence of administered treatments; monitoring for adverse events; and response to treatment. Results 269 patients met the inclusion criteria for the audit. The majority (n = 177; 65.8%) were male, white (n = 242; 90.0%) and had a diagnosis of ankylosing spondylitis (n = 222; 82.5%). Non-radiographic axSpA was diagnosed in 42 (15.6%) patients, reactive arthritis in 4 (1.5%) and psoriatic spondyloarthritis in 1 patient (0.4%). Thirty-one patients did not have a date recorded for symptom onset and for the remaining 238 patients, median (min, max) time from symptom onset to diagnosis was 6.26 (0, 50) years. Baseline median (min, max) BASDAI score was 6.7 (0, 9.7). Of 225 patients with suspected axSpA who had imaging data recorded, 19 had X-rays showing no sacroiliitis and of these, 18 (94.7%) underwent MRI using an inflammatory back pain protocol. Of 267 patients with data regarding education on axSpA, most (n = 228; 85.4%) received education via a leaflet, the National Axial Spondyloarthritis Society website or attendance of a 2-week rehabilitation programme. Regarding exercise education, most (217/259; 83.8%) had evidence of referral to a structured exercise programme. Of 248 patients with data on medical management, 246 (99.2%) received first-line non-steroidal anti-inflammatory drugs (NSAIDs), as recommended in guidelines. Renal function was monitored 6-monthly in 80.3% of patients on NSAIDs. Twelve-week assessment of bDMARD treatment response (BASDAI scoring) occurred for 85.0% of patients (198/233), 74 patients stopped treatment before this timepoint and 3 patients had no BASDAI scores available. Conclusion Performing this audit ensured that we benchmarked our service against NICE QS170 and clinical practice guidelines, to identify deficient care aspects and enable action plans to be developed to improve patient care. Disclosure R. Sengupta: Honoraria; RS has received honoraria/expenses/research grants from AbbVie, Biogen, Celgene, Lilly, MSD, Novartis, Pfizer, UCB. M. Savino: Grants/research support; MS received expenses for data collection within this study from Novartis. E. Reilly: Grants/research support; ER has received research grants from Actelion and Celgene Corporation outside of this work. ER has also received expenses from Novartis, Celgene, UCB, Pfizer. C. Cavill: Grants/research support; CC has received research grants from Abbott, Celgene, Lilly, Novartis, Janssen and Pfizer.

Một số yếu tố nghề nghiệp liên quan tới stress sau sang chấn ở nhân viên y tế tại một số bệnh viện khu vực phía Bắc Việt Nam trong thời kỳ Covid-19

Background: Covid-19 pandemic had an enormous impact on the social economy globally, especially on the mental health of health care staffs Objectives: To identify some social factors related to post-traumatic stress disorders in health care staff from some hospitals in the North of Vietnam during the Covid-19 pandemic Methods: It is a cross-sectional study with a combination of quantitative and qualitative methods. PSS-SR scale was applied to 400 health care staff who directly treated and cared for patients infected by Covid-19. These staffs were from the National Hospital for Tropical Diseases and Ninh Binh General Hospital. Occupational factors were considered, including working department, duration of working hours, and time to interact with infected patients. Results: PTSD in health care staffs had related significantly with working in ICU (OR = 3.84: 95% CI: 1.22-12.04); Department of treatment (OR = 5.39; 95%CI: 1.82-15.34); working more than 8 hours per day (OR = 2.16; 95%CI: 1.22-3.81) and work more than 5 hours for Covid-19 patients care (OR = 2.29; 95%CI: 1.1- 4.75)

Latest Comprehensive Medical Resource Consumption in Robot-Assisted versus Laparoscopic and Traditional Open Radical Prostatectomy: A Nationwide Population-Based Cohort Study.

Simple SummaryFew studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups.Background: Few studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups. Purpose: To estimate long-term medical resource consumption among patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). Patients and Methods: Participants were men enrolled in the Taiwan Cancer Registry with localized PC diagnosis who received radical prostatectomy. After adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the number of urology outpatient clinic visits required, proportion of patients being hospitalized for urinary diseases or surgical complications, and medical reimbursement for urinary diseases or surgical complications following ORP, LRP, or RARP in the first, second, and third years. Results: No differences were observed in the median number of urology outpatient clinic visits between the three types of surgical modalities up to the second year after ORP, LRP, and RARP (median: 15, 10, and seven visits, respectively; p < 0.001), but significant differences were observed in the third year. Similarly, with RARP (10.9% versus 18.7% in ORP and 9.8% in LRP; p = 0.0014), the rate of hospitalization for urinary diseases or surgical complications decreased in the third year. Medical reimbursement for urinary diseases or surgical complications reduced after RARP compared with that for ORP and LRP, with approximately 22% reduction in the first year (p = 0.0052) and 20–40% reduction in the third year (p value = 0.0024). Conclusions: Medical resource consumption in the RARP group was less compared with those in the ORP and LRP groups.

The relationship between T-CD4 recovery and HIV disclosure status among HIV-infected patients on first-line antiretroviral therapy at the Hospital for Tropical Diseases in Ho Chi Minh City

Objective: Establishes a relationship between T-CD4 recovery and patient’s HIV disclosure status. Methods: Cross-section and clinical record review study on 151 HIV-infected patients who were 18 years old or above on first-line antiretroviral therapy (1) for 18 to 36 months at the Hospital for Tropical Diseases in Ho Chi Minh city (HCMC) in 2019. Participants are selected by convenient method. Research conducted face-to-face interviewing participants by structured questionnaire and collected data directly from each participant's respective medical record, including duration of ART, number of T-CD4 at the beginning of ART, number of current T-CD4. Results: The results showed that within patients who revealed HIV infection to other people, the patients who revealed to their brothers and sisters recovered T-CD4 were 1.45 times more effective (95% CI: 1.09 – 1.93) compared with patients who did not disclose to siblings (p = 0.010). Conclusion: Family members, especially siblings need to care and share so that HIV-infected patients can disclose their status. In particular, wife, husband or partners need to help and motivate patients more to make the patient's treatment better. Keywords: ART, T-CD4, recovery, HIV, disclosure.

A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis

BackgroundCatheter-associated urinary tract infections (CAUTIs) are the main cause of health care–associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient.ObjectiveThe primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services.MethodsWe will conduct a multicenter interrupted time-series analysis—a strong study design when randomization is not feasible—consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards’ requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients’ perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers.ResultsTo reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when P<.05.ConclusionsOur protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care–related decision-making and to increase the quality of care.Trial RegistrationNetherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178International Registered Report Identifier (IRRID)DERR1-10.2196/28314

Neurocognitive Trajectories After 72 Weeks of First-Line Anti-retroviral Therapy in Vietnamese Adults With HIV-HCV Co-infection.

Background: Long-term neurocognitive outcomes following first-line suppressive anti-retroviral therapy (ART) remain uncertain for individuals with HIV and hepatitis C (HCV) co-infection. The study examined neurocognitive performance before and after 72 weeks of ART using repeated multivariate analyses and latent trajectory models.Methods: One hundred and sixty adults with chronic, untreated HIV infection (n = 80 with HCV co-infection and n = 80 HIV mono-infected) and 80 demographically similar healthy controls were recruited from the Hospital for Tropical Diseases in Ho Chi Minh City and the surrounding community, respectively. Neurocognitive measures (adapted for use in Vietnam) and liver enzyme tests were compared across groups at baseline. Repeated multivariate and group-based trajectory analyses (GBTA) examined neurocognitive subgroup profiles of the co-infected individuals after 72 weeks of de novo efavirenz- (n = 41) or raltegravir-based (n = 39) ART.Results: Baseline analyses revealed worse motor function in HIV-HCV co-infected individuals compared to both comparison groups. Longitudinal analyses revealed improved neurocognitive performance by week 48 for most participants regardless of treatment arm. GBTA identified a subgroup (35% of HIV-HCV sample) with persistent motor impairment despite otherwise successful ART. Higher HIV viral load and lower CD4+ T cell count at baseline predicted persistent motor dysfunction. Liver indices and ART regimen did not predict neurocognitive outcomes in HIV-HCV co-infected individuals.Conclusions: Most HIV-HCV co-infected individuals achieve normative neurocognitive performance after 48 weeks of de novo suppressive ART. However, individuals with more severe HIV disease prior to ART exhibited motor impairment at baseline and 72 weeks after otherwise successful treatment. Interventions aimed at improving motor symptoms at the time of HIV treatment onset may improve long-term clinical outcomes in HIV-HCV co-infected adults.

Epidemiologia wybranych chorób nowotworowych wśród dzieci i młodzieży w województwie śląskim w latach 2010-2019

Introduction. The causes of malignant neoplasms occurring in both children and adolescents remain unknown, however epidemiological and genetic studies allow a partial elucidation of the origin of these tumors. In the first year of life, neuroblastoma, nephroblastoma and retinoblastoma are the most common. Between the ages of 2 and 5, acute lymphoblastic leukemia is at its peak. Brain tumors are most common in children under 5 years of age. On the other hand, adolescents aged 10-14 years suffer from lymphomas and bone tumors. Aim. The aim of the article is to discuss the epidemiology of selected neoplastic diseases (morbidity and hospitalization) in children and adolescents from the Silesian Voivodeship in 2010-2019. The article includes: lymphocytic leukemia (C91), myeloid leukemia (C92), cancer of the brain and central nervous system (D43) and non-Hodgkin’s lymphoma (C82-85). Material and methods. In March 2021, data on the incidence and hospitalization (absolute numbers) of

Chikungunya Manifestations and Viremia in Patients WhoPresented to the Fever Clinic at Bangkok Hospital for Tropical Diseases during the 2019 Outbreak in Thailand.

Chikungunya virus is an Alphavirus belonging to the family Togaviridae that is transmitted to humans by an infected Aedes mosquito. Patients develop fever, inflammatory arthritis, and rash during the acute stage of infection. Although the illness is self-limiting, atypical and severe cases are not uncommon, and 60% may develop chronic symptoms that persist for months or even for longer durations. Having a distinct periodical epidemiologic outbreak pattern, chikungunya virus reappeared in Thailand in December 2018. Here, we describe a cohort of acute chikungunya patients who had presented to the Bangkok Hospital for Tropical Diseases during October 2019. Infection was detected by a novel antigen kit and subsequently confirmed by real-time RT-PCR using serum collected at presentation to the Fever Clinic. Other possible acute febrile illnesses such as influenza, dengue, and malaria were excluded. We explored the sequence of clinical manifestations at presentation during the acute phase and associated the viral load with the clinical findings. Most of the patients were healthy individuals in their forties. Fever and arthralgia were the predominant clinical manifestations found in this patient cohort, with a small proportion of patients with systemic symptoms. Higher viral loads were associated with arthralgia, and arthralgia with the involvement of the large joints was more common in female patients.

“ADULTING” WITH IBD: A NOVEL, VIRTUAL INFLAMMATORY BOWEL DISEASE TRANSITION PROGRAM FOR TEENS AND CAREGIVERS

Abstract Introduction: Rates of newly diagnosed inflammatory bowel disease (IBD) in pediatric patients increased by 133% from 2007–2016. With the rise comes an increase in patients ultimately transitioning from pediatric to adult GI care. While pediatric care is family-centered and multi-disciplinary adult care is patient-centered with expectation for autonomy. However, less than 15% of patients are fully responsible for their IBD care by late adolescents. The transition period is marked by adverse health outcomes including decreased compliance and increased disease activity and hospitalization. Our data recognized up to 74% of IBD youth reported not having discussed transition at home or with their GI providers, and a desire to receive information in person. Without guidance from the GI team patients may not have adequate time to plan for successful transition. Methods: A one-day 3.5-hour transition preparedness workshop was developed to address the demonstrated need in a pediatric GI clinic. Recruitment letters were distributed to 134 IBD youth ages 15–19. Eighteen consenting participants completed measures prior to and following the workshop (at 3 and 12 months). Assessment tools included previously validated self- and parent-reports: Patient Health Questionnaire-8, General Anxiety Disorder-7), Transition Readiness Assessment Questionnaire, IBD Self Efficacy Scale; and Helping for Health Inventory. Results: While the workshop was designed for in person the pandemic required shift to virtual had strengths and potential drawbacks. Youth across 300 miles were able to attend, as well as IBD young adult peers sharing their personal transition experiences. It is hypothesized pre-workshop data will demonstrate low levels of transition readiness and IBD self-efficacy, with increases in 3- and 12-month post-workshop data. Transition readiness is also presumed to correlate with measures of IBD self-efficacy and miscarried helping by parents. We will present program effectiveness data with factors known to both facilitate and obstruct successful transition from pediatric to adult IBD care. Conclusion: There remains a paucity of literature evaluating the efficacy of IBD transition programs. This research informs such programs by evaluating the efficacy of a one-day virtual workshop on skill development and knowledge. Assessment data and follow up after transition to adult care will provide important information to guide development of evidence-based transition planning for IBD patients.

Kambakutaisoto Treatment for Children With Night Crying and Arousal Parasomnias Developed During Prolonged Hospitalization for Hematological and Oncological Diseases.

The lack of an established treatment standard prompted an examination of whether kambakutaisoto, an herbal formula, is effective for non-rapid eye movement (NREM)-related parasomnias and night crying (provisionally defined as an infantile form of arousal parasomnia). This study included 137 children aged median 4.1 years (range, 0.02-18.5) who were admitted for hematological and oncological diseases. Of 137, 3 children developed recurrent episodes of NREM-related parasomnias, and 3 developed night crying. The proportion of children with night-crying/parasomnia receiving invasive procedures was significantly higher than those without (100% vs. 47%, P = .013). All 6 children with night crying/parasomnia received kambakutaisoto at a dose of 0.13-0.22 g/kg per os and responded from the start of administration with a significant reduction in the number of episodes. No adverse effects were observed. Kambakutaisoto may be a safe and promising therapy for night crying and NREM-related parasomnias in children.