Electronic Hospital Information System Research Articles

Temporal trends in acute coronary syndrome by subtype

Abstract Funding Acknowledgements None. Introduction Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU). Methods We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data. Results Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p<0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p<0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= <0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= <0.001). Conclusion We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.

Clinical significance of elevated D-dimer in emergency department patients: a retrospective single-center analysis

IntroductionD-dimer is a marker of coagulation and fibrinolysis widely used in clinical practice for assessing thrombotic activity. While it is commonly ordered in the Emergency Department (ED) for suspected venous thromboembolism (VTE), elevated D-dimer levels can occur due to various other disorders. The aim of this study was to find out the causes of elevated D-dimer in patients presenting to a large ED in Saudi Arabia and evaluate the accuracy of D-dimer in diagnosing these conditions.MethodsData was collected from an electronic hospital information system of patients who visited the ED from January 2016 to December 2022. Demographic information, comorbidities, D-dimer levels, and diagnoses were analyzed. Statistical analysis was performed using the SPSS software. The different diagnoses associated with D-dimer levels were analyzed by plotting the median D-dimer levels for each diagnosis category and their interquartile ranges (IQR). The receiver operating characteristic (ROC) curves were calculated and their area under the curve (AUC) values were demonstrated. The optimal cut-off points for specific diseases were determined based on the ROC analysis, along with their corresponding sensitivities and specificities.ResultsA total of 19,258 patients with D-dimer results were included in the study. The mean age of the participants was 50 years with a standard deviation of ± 18. Of the patients, 66% were female and 21.2% were aged 65 or above. Additionally, 21% had diabetes mellitus, 20.4% were hypertensive, and 15.1% had been diagnosed with dyslipidemia. The median D-dimer levels varied across different diagnoses, with the highest level observed in aortic aneurysm 5.46 g/L. Pulmonary embolism (PE) and deep vein thrombosis (DVT) were found in 729 patients (3.8%) of our study population and their median D-dimer levels 3.07 g/L (IQR: 1.35–7.05 g/L) and 3.36 g/L (IQR: 1.06–8.38 g/L) respectively. On the other hand, 1767 patients (9.2%) were diagnosed with respiratory infections and 936 patients (4.9%) were diagnosed with shortness of breath (not specified) with median D-dimer levels of 0.76 g/L (IQR: 0.40–1.47 g/L) and 0.51 g/L (IQR: 0.29–1.06 g/L), respectively. D-dimer levels showed superior or excellent discrimination for PE (AUC = 0.844), leukemia (AUC = 0.848), and aortic aneurysm (AUC = 0.963). DVT and aortic dissection demonstrated acceptable discrimination, with AUC values of 0.795 and 0.737, respectively. D-dimer levels in respiratory infections and shortness of breath (not specified) exhibited poor to discriminatory performance.ConclusionThis is the first paper to identify multiple causes of elevated D-dimer levels in Saudi Arabia population within the ED and it clearly highlights their accurate and diagnostic values. These findings draw attention to the importance of considering the specific clinical context and utilizing additional diagnostic tools when evaluating patients with elevated D-dimer levels.

The relationship of the hemoglobin to serum creatinine ratio with long-term mortality in patients with acute coronary syndrome: A retrospective study.

Acute coronary syndrome (ACS) is an urgent clinical condition of cardiovascular diseases. The present study evaluated the predictive efficacy of the hemoglobin to serum creatinine ratio (Hgb/Cr) on long-term mortality in patients with ACS. The ratio, representing the proportion of the 2 values, is cheap, practical, and very easy to calculate at the bedside. Our study included 475 patients who were admitted to the coronary intensive care unit with a diagnosis of ACS and who underwent coronary angiography. The Hgb/Cr ratio was calculated by dividing the admission hemoglobin by the admission serum creatinine. All patient data were collected from the electronic hospital information system, patient files, and the hospital's archive. A comparison of the patients laboratory findings revealed that the Hgb/Cr ratios differed significantly between the survivor and non-survivor group [16.6 (7.7-49) vs 13.8 (4.91-32.8), respectively; P < .001]. A univariate Cox regression analysis showed that the Hgb/Cr ratio was statistically significant in predicting long-term mortality (0.836; 95% confidence interval [CI]: 0.781-0.895; P < .001). After adjusting the model by adding clinically and statistically significant variables, the Hgb/Cr ratio was still an independent predictor of long-term mortality (0.886; 95% CI: 0.815-0.963; P = .004). The Hgb/Cr ratio's discriminant ability was tested with an receiver operating characteristic curve analysis. The Hgb/Cr ratio's area under the curve value was 0.679 (95% CI: 0.609-0.750; P < .001). A survival analysis using the Kaplan-Meier curve of the 2 Hgb/Cr ratio groups (according to cutoff value) revealed that the low-Hgb/Cr group had a significantly higher mortality rate than high-Hgb/Cr group. The Hgb/Cr ratio was found to be an independent predictor of long-term mortality in ACS patients.

The leuko-glycemic index can predict multivessel disease in the elderly acute myocardial infarction population? a retrospective cohort study

Aims: Cardiovascular diseases are still the leading cause of death, as the cause of approximately 30% of all deaths in the world and half of all deaths due to cardiovascular diseases also consist of individuals aged 70 and older. The leukoglycemic index (LGI) is a new parameter associated with mortality, complication, and prognosis in cardiovascular diseases. It can be applied easily at the bedside, has a low cost, and consists of a combination of leukocytes and glucose. In our study, we aimed to evaluate the predictive effect of leukoglycemic index on multivessel disease in elderly patients over 65 who were hospitalized with acute myocardial infarction.&#x0D; Methods: In our retrospective cohort study, patients over 65 who were hospitalized with the diagnosis of acute myocardial infarction were included. LGI was calculated with the formula: blood glucose × white blood cell/1000. All datas about patients were collected from the electronic hospital information system, patient files and our hospital’s archive.&#x0D; Results: The patients were divided into two groups: single-vessel disease and multivessel disease. The laboratory parameters of the patients were compared, and LGI (1532.5 (577.7-3770.3) vs 2077.9 (646.6-5301); p

German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients

BackgroundPatient Blood Management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood whilst promoting patient safety and empowerment. The effectiveness and safety of PBM over a longer period have not yet been investigated. MethodsWe performed a prospectively designed, multicentre follow-up study with non-inferiority design. Data were retrospectively extracted case-based from electronic hospital information systems. All in-hospital patients (≥18 yr) undergoing surgery and discharged between January 1, 2010 and December 31, 2019 were included in the analysis. The PBM programme focused on three domains: preoperative optimisation of haemoglobin concentrations, blood-sparing techniques, and guideline adherence/standardisation of allogeneic blood product transfusions. The outcomes were utilisation of blood products, composite endpoint of in-hospital mortality and postoperative complications (myocardial infarction/ischaemic stroke/acute renal failure with renal replacement therapy/sepsis/pneumonia), anaemia rate at admission and discharge, and hospital length of stay. ResultsA total of 1 201 817 (pre-PBM: n=441 082 vs PBM: n=760 735) patients from 14 (five university/nine non-university) hospitals were analysed. Implementation of PBM resulted in a substantial reduction of red blood cell utilisation. The mean number of red blood cell units transfused per 1000 patients was 547 in the PBM cohort vs 635 in the pre-PBM cohort (relative reduction of 13.9%). The red blood cell transfusion rate was significantly lower (P<0.001) with odds ratio 0.86 (0.85–0.87). The composite endpoint was 5.8% in the PBM vs 5.6% in the pre-PBM cohort. The non-inferiority aim (safety of PBM) was achieved (P<0.001). ConclusionsAnalysis of >1 million surgical patients showed that the non-inferiority condition (safety of Patient Blood Management) was fulfilled, and PBM was superior with respect to red blood cell transfusion. Clinical trial registrationNCT02147795.

Surgical site infection surveillance in German hospitals: a national survey to determine the status quo of digitalization

BackgroundSurveillance of surgical site infections (SSI) relies on access to data from various sources. Insights into the practices of German hospitals conducting SSI surveillance and their information technology (IT) infrastructures are scarce. The aim of this study was to evaluate current SSI surveillance practices in German hospitals with a focus on employed IT infrastructures.MethodsGerman surgical departments actively participating in the national SSI surveillance module “OP-KISS” were invited in August 2020 to participate in a questionnaire-based online survey. Depending on whether departments entered all data manually or used an existing feature to import denominator data into the national surveillance database, departments were separated into different groups. Selected survey questions differed between groups.ResultsOf 1,346 invited departments, 821 participated in the survey (response rate: 61%). Local IT deficits (n = 236), incompatibility of import specifications and hospital information system (n = 153) and lack of technical expertise (n = 145) were cited as the most frequent reasons for not using the denominator data import feature. Conversely, reduction of workload (n = 160) was named as the main motivation to import data. Questions on data availability and accessibility in the electronic hospital information system (HIS) and options to export data from the HIS for the purpose of surveillance, yielded diverse results. Departments utilizing the import feature tended to be from larger hospitals with a higher level of care.ConclusionsThe degree to which digital solutions were employed for SSI surveillance differed considerably between surgical departments in Germany. Improving availability and accessibility of information in HIS and meeting interoperability standards will be prerequisites for increasing the amount of data exported directly from HIS to national databases and laying the foundation for automated SSI surveillance on a broad scale.

[Evaluation of the "TeleCOVID Hesse" project after 1 year in operation].

The SARS-CoV‑2 pandemic posed unexpected challenges for hospitals worldwide and in addition to the supply emergency, simultaneously caused ahigh pressure to innovate. Due to the high number of cases of COVID-19patients requiring intensive care, structured networking of hospitals gained particular importance. The tele-ICU communication platform TeleCOVID was developed to improve the quality of intensive care both by enabling teleconsultations and by supporting patient transfers. The present study aimed to survey user experiences with TeleCOVID. The study investigated the extent to which the app is used, the user experiences of the participating hospitals, and the resulting implications for the further development of the telemedicine application. Auser survey was conducted in May 2022 using an online questionnaire. The survey contained both closed and open questions with afree text field. It was sent via the Hessian Ministry of Social Affairs and Integration (HMSI). All 135 hospitals in Hesse were contacted by e‑mail and invited to participate in the study. The results of the closed questions were analyzed using descriptive statistics, and the results of the open questions were clustered and thematically summarized using qualitative content analysis. The study showed that TeleCOVID was used primarily for transfer requests, followed by the need for atreatment consultation without atransfer request. Most often, ECMO treatment or treatment in ahospital of ahigher care level was required. The content analysis showed that users particularly rated the possibility of adata protection-compliant and structured transfer of patient data as advantageous. It is also worth mentioning that in almost 25% of the cases atransfer of patients could be prevented by TeleCOVID. Disadvantages frequently mentioned by respondents were the lack of connection to the electronic hospital information system, the increased time required for the registration process, and the poor primary accessibility of contact persons. In afurther development of the application the connection to the electronic hospital information system should be considered particularly urgent. In addition, the time expenditure should be reduced by asimplified login process. Due to interface barriers, an alternative data infrastructure would also be conceivable to create interoperability. The introduction of aweb client could also increase usability. The main beneficiaries of hospital networking are physicians and patients in acontext associated with ahigh workload and specific medical issues. Continuation and expansion of the app to intensive care medicine and beyond are therefore recommended. In further studies on the project, personal interviews with decision makers could be useful to conduct amore targeted needs analysis.

[Treatment and factors associated with prognosis of hyperkalemia in the emergency department].

To survey treatment and prognosis of hyperkalemia patients in the emergency department and to analyze factors associated with all-cause in-hospital mortality. We implemented electronic hospital information system, extracted demographic characteristics, underlying diseases, laboratory findings, potassium lowering therapy and prognosis of hyperkalemia patients [age ≥ 18 years, serum potassium (K+) concentration ≥ 5.5 mmol/L] in the emergency department of Peking Union hospital in Beijing between June 1st 2019 to May 31st 2020. The enrolled subjects were divided into the non-survival group and the survival group according to their prognosis. Univariate analysis and Cox regression model were adopted to analyze factors affecting all-cause in-hospital mortality of hyperkalemia patients. A total of 579 patients [median age 64 (22) years; 310 men (53.5%) and 269 women (46.5%)] with hyperkalemia were enrolled, among which, 317 (54.7%), 143 (24.7%) and 119 (20.6%) were mild, moderate, and severe hyperkalemia, respectively. 499 (86.20%) patients received potassium-lowering therapy, forty-four treatment regimens were administered. Insulin and glucose (I+G, 61.3%), diuretics (Diu, 57.2%), sodium bicarbonate (SB, 41.9%) and calcium gluconate/chloride (CA, 44.4%) were commonly used for the treatment of hyperkalemiain the emergency department. The combination of insulin and glucose, calcium gluconate/chloride, diuretics and sodium bicarbonate (I+G+CA+Diu+SB) was the most favored combined treatment regimen of hyperkalemia in the emergency department. The higher serum potassium concentration, the higher proportion of administrating combined treatment regimen and/or hemodialysis (HD) (the proportion of administrating combined treatment regimen in mild, moderate, and severe hyperkalemia patients were 58.4%, 82.5% and 94.8%; the proportion of administrating HD in mild, moderate, and severe hyperkalemia patients were 9.7%, 13.3% and 16.0%, respectively). The proportion of achievement of normokalaemia elevated as the kinds of potassium lowering treatment included in the combined treatment regimen increased. The proportion of achievement of normokalaemia was 100% in the combined treatment regimen including 6 kinds of potassium lowering therapy. Among various potassium lowering treatments, HD contributed to the highest rate of achievement of normokalaemia (93.8%). 111 of 579 (19.20%) hyperkalemia patients died in hospital. Cox regression model revealed that complicated with cardiac dysfunction predicted higher mortality [hazard ratio (HR) = 1.757, 95% confidence interval (95%CI) was 1.155-2.672, P = 0.009]. Achievement of normokalaemia and administration of diuretics attributed to lower mortality (HR = 0.248, 95%CI was 0.155-0.398, P = 0.000; HR = 0.335, 95%CI was 0.211-0.531, P = 0.000, respectively). Treatment of hyperkalemia in the emergency department were various. Complicated with cardiac dysfunction were associated with higher mortality. Achieving normokalaemia was associated with decreased mortality.

Antithrombotics prescription pattern and clinical outcomes in atrial fibrillation patients with type 2 diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) and Diabetes mellitus (DM) often coexist. As DM is considered while calculating the thromboembolic risk for AF patients, little is known about the prescription pattern of antithrombotic therapies in patients with AF and DM and their clinical outcomes. Purpose In this subsidiary study, we examined the prescription patterns of antithrombotic therapies and clinical outcomes of AF patients with type 2 DM. Methods We analyzed data from a single-center cohort of patients with a primary diagnosis of AF in a tertiary cardiac referral hospital in Malaysia from 1st January 2018 to 31st December 2020. Patients' clinical data and information related to antithrombotic therapy were traced through electronic Hospital Information system. A data collection form was used for data collection. The primary endpoint of the study was a composite cardiovascular (CV) event which consists of all-cause mortality, acute coronary syndrome (ACS), ischemic stroke and transient ischemic attack (TIA). The safety endpoint of the study was a bleeding event, defined as hemoglobin drop more than 2 g/dl, blood transfusion and bleeding at critical area. Results Of the 1006 AF patients (59.2% male; mean age 64.2 (12.1) years), 400 (39.8%) had a history of DM. Of these, 45.8% (n=183) were using warfarin; 46.5% (n=159) used direct oral anticoagulant (DOAC), 54.0% (n=216) used a single antiplatelet, 11.5% (n=46) used a double antiplatelet, 8.0% (n=32) used triple therapy which consists of two antiplatelet agents with one anticoagulant. The use of single antiplatelet agent (54.0% vs 46.4%, p=0.018) and double antiplatelet agents (11.5% vs 7.1%, p=0.016) was significantly associated with AF with DM patients, whereas there was no association between anticoagulant use and AF patients with or without DM (85.5% vs 82.5%, p=0.209). There was no association in composite CV events between AF patients with or without DM (12.0% vs 10.4%, p=0.427). The proportion of subjects who reported having bleeding events were also did not differ by the presence of AF patients with or without DM. (4.5% vs 2.8%, p=0.151). Conclusion Diabetes was associated with increased use of antiplatelet agents; however, DM was not associated with increased risk of composite CV events and bleeding events in patients with concurrent AF. The lack of an association between diabetes and CV risk contrasts with previous research, which could be due to improved diabetes treatment in this cohort of patients with relatively low fasting sugar readings. Further study on the degree of blood glucose as measured by glycosylated hemoglobin (HbA1c) is needed to confirm the finding.

Survival Outcomes in the Patients of Ovarian Epithelial Carcinomas Treated with Fertility-Sparing Surgery: A Study from a Developing Country

Objective: To assess the outcomes of fertility-sparing surgery in patients with ovarian epithelial carcinoma treated at our centre.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital &amp; Research Center, Lahore Pakistan, from Jul 2001 to Aug 2015.&#x0D; Methodology: We studied 31 patients with ovarian epithelial carcinoma who underwent fertility-sparing surgery at Shaukat Khanum Memorial Hospital. The detail regarding patients and tumour characteristics, along with outcomes of the intervention, was obtained from secondary data kept in the electronic hospital information system.&#x0D; Results: A total of 132 patients with ovarian epithelial carcinoma were identified; 31 patients underwent fertility-sparing surgery (Stage-IA, n=19; Stage-IC, n=12). By histopathology, 14(45.0%) had mucinous cystadenocarcinoma, 7(22.6%) serous adenocarcinoma, 6(19.4%) endometroid, and 4(12.9%) with clear cell pathology. The mean duration of follow-up was 52.6±2.3 months (18-118 months) after fertility-sparing surgery. Five-year recurrence-free survival was 81.0%. (Three-year=89.0%), using the Kaplan-Meier graph. Three patients had successful pregnancies, with one having a twin pregnancy.&#x0D; Conclusion: Fertility-sparing surgery should be considered for children of early-stage epithelial ovarian carcinoma patients as it preserves fertility and endocrine function while avoiding recurrence.

Patients parameters and results of the tilt table test depending on referrals

Abstract Introduction The tilt table examination (TTT) is used to investigate patients with syncope for 50 years, and was downgraded by the 2018 Guidelines of the European Society of Cardiology for syncope-evaluation from class I to II a/b. Aim Aim of the study was to assess changes in the referrals for TTT from 2014 to 2018. In addition, it was examined if there were differences in the history, clinical findings, and results of the TTT among patients depending on the referral for TTT. Patients and methods Included in the retrospective cohort study were 205 patients, 49% females, mean age 52 (15–82) years, in whom TTT was carried out between 2014 and 2018 in a cardiology department. Information from the discharge letters and electronic hospital information system was collected. Results Referrals for TTT were suspected orthostatic hypotension (OH) (n=53), suspected reflex syncope (n=98), and unexplained syncope (n=54). By TTT the diagnosis of OH was established in 32%, reflex syncope in 27%, and postural orthostatic tachycardia syndrome in 16%. There was an increase of positive TTT findings from 2016 to 2018 (54 to 79%, p=0.039). The referrals for unexplained syncope decreased from 2014 to 2018 (33 vs. 14%, p=0.039). Compared to patients with suspected reflex syncope, patients with unexplained syncope suffered more from coronary artery disease (CHD) (19 vs. 5%, p=0.011) and arrhythmias (24 vs. 10%, p=0.032), were more often taking beta-blockers (26 vs. 7%, p=0.002) and more often had ST-segment abnormalities (11 vs. 1%, p=0.008). Compared to patients with suspected OH, patients with unexplained syncope suffered more from palpitations (11 vs. 8%, p=0.0024). Compared to patients with suspected reflex syncope, patients with suspected OH had more comorbidities such as CHD (17 vs. 5%, p=0.036), hypertension (45 vs. 18%, p=0.01), diabetes mellitus (25 vs. 3%, p=0.0) and synucleinopathies (6 vs. 0%, p=0.042) and took more antidiabetic (23 vs. 4%, p=0.001), antithrombotic (42 vs. 12%, p=0.0), diuretic (15 vs. 2%, p=0.004), beta blocking (23 vs. 7%, p=0.009), anticonvulsant (6 vs. 0%, p=0.042), antiparkinsonian (6 vs. 0%, p=0.042), antidepressant agents (26 vs. 11%, p=0.022) and statins (26 vs. 8%, p=0.004). Compared to patients with suspected OH, patients with suspected reflex syncope suffered more from prodromes like flushing (17 vs. 2%, p=0.001) and nausea (33 vs. 8%, p=0.004). Conclusions If patients are referred for appropriate reasons, the TTT has a high diagnostic value. The results confirm other studies indicating that unexplained syncope may suggest a cardiac origin. Funding Acknowledgement Type of funding sources: None.

Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India.

Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previously published studies show that NIT failure might delay endotracheal intubation and invasive mechanical ventilationand results in worse outcomes in patients with hypoxemic respiratory failure. Early prediction of failure of NIT, will help in early decision-making in initiating invasive mechanical ventilation. We retrospectively studied the predictors for NIT failure in patients with moderate to severe COVID-19. Adult patients (>18 years) admitted to the intensive care unit (ICU) with moderate to severe COVID-19 ARDSand received NIT [HFNO and CPAP non-invasive ventilation (NIV)] were included in this study. Baseline clinical and laboratory data were collected retrospectively from the electronic hospital information system. NIT failure was defined as the need for invasive mechanical ventilation after the initiation of NIT in the ICU. Univariate and multivariate logistic regression analyses were used to find out the possible predictors of NIT failure. Out of 254 patients admitted to ICU, 127 patients were initiated NIT at admission to ICU. During the course of the ICU stay, 33 (26%) patients subsequently required invasive mechanical ventilation (NIT failure). Respiratory rate-oxygenation index (ROX index) of <2.97 at two hours and <3.63 at six hours of ICU admission predicted NIT failure in our cohort of patients with a high positive predictive value. Patient selection is crucial for successful NIT in COVID-19. Application of ROX index measured in the first six hours of ICU admission helps in the identification of patients at risk of NIT failure with moderate to severeCOVID-19 ARDS.

Post-operative neutrophil-to-lymphocyte ratio and outcome after thrombectomy in acute ischemic stroke.

BackgroundNeutrophil to lymphocyte ratio (NLR) is a novel inflammatory marker to predict adverse cardiovascular events. However, there is a lack of data on hemorrhagic transformation (HT) and neurological outcome after mechanical thrombectomy in acute ischemic stroke (AIS). We investigated whether NLR before and after thrombectomy for patients with AIS was associated with HT and neurological outcomes.MethodsWe performed a retrospective analysis of consecutive patients with anterior circulation AIS who underwent thrombectomy. HT was evaluated by CT within 24 h after thrombectomy. Clinical data had been collected retrospectively; laboratory data were extracted from our electronic hospital information system. NLR was obtained at admission (NLR1) and immediately after thrombectomy (NLR2). The main outcomes were post-interventional intracranial hemorrhage and unfavorable functional status (modified Rankin scale scores of 3–6) 3 months post-stroke.ResultsA total of 258 patients with AIS, according to the NIHSS (median 14), were included. NLR2 was higher in patients who developed HT after thrombectomy and unfavorable neurological outcomes 3 months post-stroke (p < 0.001) than in those without HT or favorable outcomes, even after correction for co-factors [Odds Ratio (OR) 1.35 for HT, 95% confidence interval (CI)1.16–1.57, p < 0.001, and 1.85 for unfavorable outcome, 95%CI 1.57–2.17, p < 0.001]. The optimal cutoff value for the NLR2 as an indicator for auxiliary diagnosis of HT and the unfavorable outcome was 8.4 and 8.8, respectively.ConclusionNLR immediately after thrombectomy is a readily available biomarker of HT and neurological outcomes in patients with AIS.

Evaluation of Outcomes of Mucinous Ovarian Cancer Treated at a Tertiary Care Cancer Hospital in Pakistan.

Syed Abdul Mannan HamdaniObjective  To evaluate the clinicopathological features and survival outcomes of mucinous ovarian cancer (MOC) patients in an Asian population. Study Design  Descriptive observational study. Place and Duration of Study  Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from January 2001 to December 2016. Methods  Data of MOC were evaluated for demographics, tumor stage, clinical characteristics, tumor markers, treatment modalities, and outcomes from electronic Hospital Information System. Results  Nine-hundred patients with primary ovarian cancer were reviewed, out of which 94 patients (10.4%) had MOC. The median age was 36 ± 12.4 years. The most common presentation was abdominal distension 51 (54.3%), while the rest presented with abdominal pain and irregular menstruation. Using FIGO (The International Federation of Gynecology and Obstetrics) staging, 72 (76.6%) had stage I, 3 (3.2%) stage II, stage III in 12 (12.8%), and 7 (7.4%) had stage IV disease. The majority of patients 75 (79.8%) had early-stage (stage I/II), while 19 (20.2%) presented with advanced-stage (III & IV). The median follow-up duration was 52 months (range 1-199 months). Among patients with early-stage (I&II), 3- and 5-year progression-free survival (PFS) was 95%, while for advanced stage (III&IV), PFS was 16% and 8%, respectively. The overall survival (OS) in early-stage I&II was 97%, while for advanced stages III & IV, the OS was 26%. Conclusion  MOC is a challenging and rare subtype of ovarian cancer requiring special attention and recognition. Most patients treated at our center presented with early stages and had excellent outcomes, while advanced-stage disease had dismal results.

Perioperative stroke in patients undergoing spinal surgery: a retrospective cohort study

BackgroundThe incidence of perioperative stroke following spinal surgery, including ischemic and hemorrhagic stroke, has not been fully investigated in the Chinese population. Whether specific spinal or emergency/elective procedures are associated with perioperative stroke remains controversial. This study aimed to investigate the incidence of perioperative stroke, health economic burden, clinical outcomes, and associated risk factors.MethodA retrospective cohort study using an electronic hospital information system database was conducted from Jan 1, 2015, to Jan 1, 2021, in a tertiary hospital in China. Patients aged ≥18 years who had undergone spinal surgery were included in the study. We recorded patient demographics, comorbidities, and health economics data. Clinical outcomes included perioperative stroke during hospitalization and associated risk factors. The patients’ operative data, anesthetic data, and clinical manifestations were recorded.ResultA total of 17,408 patients who had undergone spinal surgery were included in this study. Twelve patients had perioperative stroke, including seven ischemic stroke (58.3%) and five hemorrhagic stroke (41.7%). The incidence of perioperative stroke was 0.07% (12/17,408). In total, 12 stroke patients underwent spinal fusion. Patients with perioperative stroke were associated with longer hospital stay (38.33 days vs. 9.78 days, p < 0.001) and higher hospital expenses (RMB 175,642 vs. RMB 81,114, p < 0.001). On discharge, 50% of perioperative patients had severe outcomes. The average onset time of perioperative stroke was 1.3 days after surgery. Stroke history (OR 146.046, 95% CI: 28.102–759.006, p < 0.001) and hyperlipidemia (OR 4.490, 95% CI: 1.182–17.060, p = 0.027) were associated with perioperative stroke.ConclusionThe incidence of perioperative stroke of spinal surgery in a tertiary hospital in China was 0.07%, with a high proportion of hemorrhagic stroke. Perioperative stroke patients experienced a heavy financial burden and severe outcomes. A previous stroke history and hyperlipidemia were associated with perioperative stroke.

Differences of Lipid Profile Among Ischemic and Hemorrhagic Stroke Patients in a Tertiary Hospital in Riyadh, Saudi Arabia: A Retrospective Cohort Study.

ObjectiveThis study aims to compare the serum lipid profiles of patients with ischaemic and hemorrhagic strokes.Study designThis was a retrospective, comparative study.Place and duration of the studyThe study was conducted at Military Hospital, Riyadh, from January 1, 2018, to December 31, 2020.MethodologyPatients with a diagnosis of stroke who presented to the emergency department and was confirmed to have ischemic or hemorrhagic strokes by computed tomography (CT) from January 1, 2018, to December 31, 2020. This study was based on data extracted from an electronic hospital information system (BESTCare) of patients presenting to King Abdulaziz Medical City, National Guard Health Affairs, which is a tertiary medical center in Riyadh, Saudi Arabia. Patients who lack lipid profile reading within six months before the incident or had a traumatic hemorrhagic stroke were excluded from the study. All these variables were included in the study: age, gender, height, weight, date of the incident, date of last lipid profile results, type of stroke, comorbidities, on a statin or not, and lipid profile including (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides). Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA) was used for data entry and data cleaning, and Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY) was used for data analysis and visualization of the results.ResultsThe mean age of presentation of stroke was 68±13, 59% of patients were males, and 41% were females. BMI ranged from 30±8. Obesity (BMI 30 or above) was predominant in both stroke subtypes. Among all patient comorbidities, hypertension was the most predominant. Diabetes was present in 71% of the population. Of the participants in this study, 114 had ischemic stroke and 87 had a hemorrhagic type. A comparison of the serum lipid profile of two categories of strokes showed no statistical significance in serum values of total cholesterol, triglycerides, and LDL-C in ischemic and hemorrhagic stroke patients.

Nodular Lymphocytic Predominant Hodgkin Lymphoma (NLPHL); Treatment Outcome Study in a Tertiary Care Cancer Hospital in Pakistan

Objective: To determine the demographics, clinical characteristics and treatment outcomes of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) patients treated at our hospital.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from 1996 to 2016.&#x0D; Methodology: We collected clinical data of all the cases of HL diagnosed over twenty years (between 1996 and 2016) from our electronic hospital information system (HIS). A total of 3426 HL patients were identified, out of whom the pathologically confirmed diagnosis of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) was identified.&#x0D; Results: In this study, eighty-four patients were studied. The majority of the patients were male (80%). B symptoms were present in 35%. There were 24% patients in stage-I (n=20/84), 33% in stage-II (n=28/84), 12% in stage III (n=10/84) and 31% in stage IV (n=26/84). Hence, early-stage was seen in 57% (n=48/84) and advanced stage was 43% (n=36/84) respectively. The Median follows up time was 30 months (range: 1-60 months). Patients were treated with chemotherapy in most cases (48%), radiotherapy alone in 14% cases, and combined modality (chemotherapy and radiotherapy) was used in 38% patients. The estimated 5–year disease-free survival was 73% and overall survival was 86%. Autologous stem cell transplant was done in only one patient whose disease had transformed from NLPHL to T-rich cell B cell lymphoma.&#x0D; Conclusion: This study confirmed the divergent features of NLPHL with a comparatively good long-term prognosis. Most patients achieved an excellent response to first-line therapy. There was...

Characteristics and Types of Urolithiasis in the Eastern Region of Saudi Arabia: A Single-Center Retrospective Study.

IntroductionUrolithiasis is one of the most common conditions encountered in clinical practice with the prevalence increasing globally in the last few decades. Urolithiasis has been found to be more common in areas with a hot climate, such as Saudi Arabia. The aim of this study was to determine the characteristics and the types of urolithiasis most frequently found in the Eastern Region of Saudi Arabia.MethodsThis was a single-center retrospective cohort study based on data extracted from an electronic hospital information system (BESTCare) of all patients diagnosed with urolithiasis at King Abdulaziz Hospital, a tertiary care center in Saudi Arabia's Eastern Region. From January 2013 to December 2016, all adult patients aged 18 and up who presented with urinary calculi (renal and ureter) were included in the study.ResultsA total of 235 patients were reviewed, with a mean age of 48.52 years. Renal calculi were more prevalent in males (74.5%). Calcium oxalate was the predominant type (76%), followed by uric acid calculi (18%) and cystine calculi (4.8%). A small proportion (1.2%) was calcium phosphate calculi. The most frequently associated comorbidity was hypertension (17.9%). The majority (78.5%) had a stone removal through a ureteroscopy and 8.2% by percutaneous nephrolithotomy (PCNL). The mean stone size was 12.2 ± 9.91 mm, with a mean stone Hounsfield unit (HU) of 789.9. The mean urinary PH at stone incident was 6.77, and the mean creatinine level was 92.4mmol.ConclusionThis study showed that males were more affected by urolithiasis, compared to females in the Eastern Region. Furthermore, calcium oxalate was the predominant type. These findings are consistent with the literature and they highlighted the necessity for further studies in this area, to provide insight into the pathophysiology and incidence of renal calculi for improving patient care.

ICD-11 Morbidity Pilot in Kuwait: Methodology and Lessons Learned for Future Implementation.

This paper reports on the first ICD-11 morbidity pilot for inpatient discharges in a public general hospital. We detail the pilot methodology, lessons learned in terms of facilitators and challenges, physician-reported opinion, and considerations for future implementation. The pilot included: engaging stakeholders; selecting the setting; building a common understanding of the discharge process; evaluating and preparing IT infrastructure; ICD-11 training; small-scale pre-pilot testing; implementing the pilot while providing on-site support and collecting data for analysis including a brief user-experience survey. Overall, physicians were satisfied with the experience. Facilitators for success included national health system influence, leadership commitment, a multidisciplinary team approach, physician-tailored training, using social media for training, and providing on-site support. Challenges included potential IT problems, and difficulties relating to training and engaging physicians. Issues to consider include DRG system requirements, and comparability of ICD-11 pilot results from different countries. In conclusion, ICD-11 can be successfully implemented for documenting diagnoses by physicians in a public hospital by installing the coding tool on the electronic hospital information system. Pilots can improve ICD-11 content by using the online proposal mechanism. Implementing ICD-11 requires effective change management, stakeholder-tailored communication, and innovative ideas for training to match the electronic nature of ICD-11 and its potential new users, physicians.

Nephrotoxic Medications and Risk Factors of Acute Kidney Injury in Medical Wards: A Single-Center Study

Acute kidney injury (AKI) is a medical complication that can arise from various causes. This study aimed to determine the incidence of AKI and the predictors for the development of AKI in the medical wards of a tertiary hospital. A prospective cohort study was conducted on patients admitted to the medical wards from November 1 to December 31, 2017. Relevant data were obtained from the electronic hospital information system and medication charts. AKI was defined as an increase in serum creatinine (SCr) by ≥0.3 mg/dL (≥26.5 μmol/L) within 48 h, or increase in SCr to ≥1.5 times baseline, within the last seven days. Fisher's exact test or Pearson's Chi-square test was used to determine the association between characteristics of the patients and AKI. Logistic regression was used to determine possible predictors of AKI. A total of 260 patients [mean age 54.7 (19.0) years, 50.8% male] were included. Of these, 23% (n = 60) developed AKI. About 81% (n = 210) of the patients were exposed to nephrotoxic medications. Predictors of AKI were number of comorbidities [adjusted odds ratio (aOR): 4.3; 95% confidence interval (CI): 1.8-10.3; P = 0.001], diuretics (aOR: 2.8; 95% CI: 1.2-6.3; P = 0.015), proton pump inhibitors (aOR: 2.9; 95% CI: 1.4-5.8; P = 0.004), and cephalosporin (aOR: 4.5; 95% CI: 2.2-9.1; P <0.001). Mortality rate during hospitalization was similar between AKI and non-AKI patients (12% vs. 3.5%; aOR: 1.9; 95% CI: 0.5-6.7; P = 0.324). The risk of AKI is high in patients with multiple comorbidities and exposure to nephrotoxic medications. Further studies are needed to establish the role of nephrotoxic medications in causing AKI and its clinical implications.