Electronic Medical Reports Research Articles

The role of body mass index in high- and low-velocity trauma causing knee injury associated with popliteal artery lesions

BackgroundAmong arterial traumas, osteoarticular traumas are particularly dangerous, and those involving the popliteal artery are associated with a high amputation rate. Despite representing a minority of arterial traumas, with an incidence that varies considerably by population and geographic location, traumatic lesions of the popliteal artery are challenging. This study aimed to verify the impact of body mass index (BMI) on arterial trauma damage and patient outcomes.MethodsData were retrospectively collected from the electronic medical reports of all patients with osteoarticular and vascular associated lesions treated in the emergency operating room at our institution between 1 January 2005 and 1 May 2022. Forty-one patients presented with lower limb arterial trauma (43.2%); popliteal artery lesions occurred in 11 of these patients (26.8%), who were eligible for inclusion in the study. The lesion mechanism was dislocation by high-velocity trauma in 9 patients and dislocation by low-velocity trauma in 3 patients. All 7 males (63.6%) experienced high-velocity trauma, and 2 of the 3 females experienced low-velocity trauma. Only one patient had an isolated popliteal artery lesion associated with fractures in the leg or the contralateral limb. Patients with low-velocity trauma were older than 54 years, while those with high-velocity trauma were aged 22 to 71 years.ResultsIn 10/11 patients (90.9%), revascularization was performed after osteoarticular stabilization and reduction of the dislocation or fracture. Intraoperative angiography was selectively used. Two patients required above-the-knee amputation after the procedure: one due to infection of the surgical access point and the other due to severe soft tissue injury. One patient died during hospitalization due to trauma-related complications and comorbidities.ConclusionsHigh-velocity trauma and low-velocity trauma in patients with a body mass index > 35 kg/m2 and knee lesions are associated with popliteal artery lesions. Revascularization success is not associated with high- or low-velocity trauma.

Sex and age significantly modulate cardiovascular disease presentation in type 2 diabetes: a large population-based cohort study.

We aimed to describe and compare the incidence of the first cardiovascular event and its major subtypes, coronary heart disease (CHD), cerebrovascular disease, heart failure (HF), or peripheral artery disease (PAD), according to age and sex in a population-based cohort of individuals with type 2 diabetes (T2D) from a Mediterranean region. We used linked primary care electronic medical reports, pharmacy-invoicing data, and hospital admission disease registry records from the SIDIAP database, which contains linked data for 74% of the Catalonian population. We selected individuals with T2D aged 30 to 89 years free of cardiovascular disease (CVD). The primary outcome was the first presentation of CVD. The study cohort included 247,751 individuals (48.6% women, 66.8 ± 11.9 years). During a 6.99-year follow-up, the cumulative incidence of the first cardiovascular event was 23.4%. Men were at higher risk for CVD (hazard ratio [HR]: 1.47 95%CI: 1.45-1.50), CHD (HR: 1.52 95%CI: 1.47-1.57), cerebrovascular disease (HR:1.07 95%CI: 1.03-1.10) and PAD (HR: 2.30 95%CI: 2.21-2.39) than women but at a lower risk for HF (HR:0.70 95%CI: 0.68-0.73). CHD and PAD were the most frequent CVD presentations among men (28.1% and 27.5%) and HF (40.1%) in women. CHD predominated among young participants of both sexes, while HF predominated among women older than 65 and men older than 75. In individuals with T2D, the overall risk and the type of first CVD manifestation largely varied by sex and age. This epidemiological evidence should be considered in clinical practice.

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

ObjectivesPotentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) utilisation persists at undesirable rates worldwide. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in...

Hepatocellular Carcinoma: Surveillance, Diagnosis, Evaluation and Management.

Hepatocellular carcinoma (HCC) ranks fourth in cancer-related deaths worldwide. Semiannual surveillance of the disease for patients with cirrhosis or hepatitis B virus allows for early detection with more favorable outcomes. The current underuse of surveillance programs demonstrates the need for intervention at both the patient and provider level. Mail outreach along with navigation provision has proven to increase surveillance follow-up in patients, while provider-targeted electronic medical record reminders and compliance reports have increased provider awareness of HCC surveillance. Imaging is the primary mode of diagnosis in HCC with The Liver Imaging Reporting and Data System (LI-RADS) being a widely accepted comprehensive system that standardizes the reporting and data collection for HCC. The management of HCC is complex and requires multidisciplinary team evaluation of each patient based on their preference, the state of the disease, and the available medical and surgical interventions. Staging systems are useful in determining the appropriate intervention for HCC. Early-stage HCC is best managed by curative treatment modalities, such as liver resection, transplant, or ablation. For intermediate stages of the disease, transarterial local regional therapies can be applied. Advanced stages of the disease are treated with systemic therapies, for which there have been recent advances with new drug combinations. Previously sorafenib was the mainstay systemic treatment, but the recent introduction of atezolizumab plus bevacizumab proves to have a greater impact on overall survival. Although there is a current lack of improved outcomes in Phase III trials, neoadjuvant therapies are a potential avenue for HCC management in the future.

Multimodal deep learning for COVID-19 prognosis prediction in the emergency department: a bi-centric study

Predicting clinical deterioration in COVID-19 patients remains a challenging task in the Emergency Department (ED). To address this aim, we developed an artificial neural network using textual (e.g. patient history) and tabular (e.g. laboratory values) data from ED electronic medical reports. The predicted outcomes were 30-day mortality and ICU admission. We included consecutive patients from Humanitas Research Hospital and San Raffaele Hospital in the Milan area between February 20 and May 5, 2020. We included 1296 COVID-19 patients. Textual predictors consisted of patient history, physical exam, and radiological reports. Tabular predictors included age, creatinine, C-reactive protein, hemoglobin, and platelet count. TensorFlow tabular-textual model performance indices were compared to those of models implementing only tabular data. For 30-day mortality, the combined model yielded slightly better performances than the tabular fastai and XGBoost models, with AUC 0.87 ± 0.02, F1 score 0.62 ± 0.10 and an MCC 0.52 ± 0.04 (p < 0.32). As for ICU admission, the combined model MCC was superior (p < 0.024) to the tabular models. Our results suggest that a combined textual and tabular model can effectively predict COVID-19 prognosis which may assist ED physicians in their decision-making process.

The Outcome of Moderate-to-Severe Complications Related to Peripheral Intravenous Devices at Upper Limb.

Background: Intravenous access is very crucial in administration of fluids, medications and nutrition. Almost all inpatients will require it and the simplest and quickest access is peripheral with the preferred sites being either dorsum hand, radial wrist or forearm. It has its complications, of which most are avoidable. Literature has emphasised the complications and reported on preventive measures but lacks the sequelae of the complications related to peripheral intravenous devices (PIVD). We report on the sequelae of moderate-to-severe complications of these patients. Methods: Thirty-three patients had moderate-to-severe complications related to PIVD in a tertiary centre from January 2017 to December 2017. All data were obtained from electronic medical report (EMR). Results: Majority had extravasation (45.5%) and abscess (39.4%), whereas two patients had thrombophlebitis (6.1%) and three patients developed necrotising fasciitis (9.1%). All patients with abscess and necrotising fasciitis underwent surgical intervention (n = 16); four patients had multiple debridements. All infections were treated with empirical antibiotics and changed after culture results were obtained. Seven patients had sepsis/bacteraemia wherein two of them passed away. A total of 31 patients were discharged. Two patients had secondary suturing of the wound, one had split-thickness skin grafting (SSG) coverage and the others had daily dressing until the wound healed by secondary intention. Conclusions: PIVD-related complications can be debilitating and may occur despite strict preventive measures. Early clinical diagnosis and prompt treatment of these complications can decrease its morbidity. Level of Evidence: Level IV (Prognostic).

Orthotic walking outcome of persons with motor complete low thoracic spinal cord injury-a retrospective study.

Retrospective study. To analyse the orthotic walking outcome of patients with Low Thoracic Spinal Cord Injury (LT-SCI). The Rehabilitation Institute at Christian Medical College, Vellore, India. Data between January 2005 and June 2015 were retrospectively collected from electronic medical reports of patients with motor complete LT- SCI who were admitted for the comprehensive rehabilitation program. The orthotic walking outcome of these patients was measured by the Walking index for SCI version II (WISCI II). Demographical and clinical parameters were measured and their association with the walking outcome was analyzed using regression analysis. A total of 430 patients were identified within the study period. Eighty-five percent of people (n = 365) achieved walking at the time of discharge (WISCI II level 12 = 260 and level 9 = 105). Out of 11 demographical and clinical parameters considered, eight of them were found to be significant predictors of walking in the univariate analysis. Age less than 30 years had the highest odds of predicting WISCI II level 9 and level 12 than those older in the multivariate analysis (OR 17.58; 95% CI 7.35-42.03). Single neurological level T12 increased the chance of achieving WISCI II level 12 by 10 times (OR 10.2; 95% CI 3.8-27.36). Orthotic walking for persons with motor complete low thoracic spinal cord injury is an achievable goal through a comprehensive rehabilitation program. The factors identified in this study will help rehabilitation professionals strategically select the ideal candidate for orthotic gait training.

IKAR: An Interdisciplinary Knowledge-Based Automatic Retrieval Method from Chinese Electronic Medical Record

To date, information retrieval methods in the medical field have mainly focused on English medical reports, but little work has studied Chinese electronic medical reports, especially in the field of obstetrics and gynecology. In this paper, a dataset of 180,000 complete Chinese ultrasound reports in obstetrics and gynecology was established and made publicly available. Based on the ultrasound reports in the dataset, a new information retrieval method (IKAR) is proposed to extract key information from the ultrasound reports and automatically generate the corresponding ultrasound diagnostic results. The model can both extract what is already in the report and analyze what is not in the report by inference. After applying the IKAR method to the dataset, it is proved that the method could achieve 89.38% accuracy, 91.09% recall, and 90.23% F-score. Moreover, the method achieves an F-score of over 90% on 50% of the 10 components of the report. This study provides a quality dataset for the field of electronic medical records and offers a reference for information retrieval methods in the field of obstetrics and gynecology or in other fields.

A systematic review of the literature on the application of blockchain in the health supply chain

Objective of the study: This article aims to present a systematic literature review on the application of blockchain in the healthcare supply chain.Relevance / originality: The relevance and originality consist in the presentation of a systematic literature review that focuses and considers the concepts of blockchain, healthcare and supply chain as equally important, in the studied time frame.Methodology / approach: The systematic literature review followed a protocol based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), performing the search in eight databases, selecting conference and journal articles based on their content in sequential steps.Main results: As a result, 122 publications were selected. The number of publications in the field has been found to grow rapidly, and sensors and the Internet of Things (IoT) are two prominent minor topics. Three research challenges were raised.Theoretical / methodological contributions: Provide understanding to academics and professionals in the field about the state of the art of applying the blockchain in the healthcare supply chain, both in terms of the evolution of the literature, as well as in terms of raising new research.Social / management contributions: Raising discussions on solutions to healthcare supply chain issues, involving for example data integrity and privacy in electronic medical reports, drug counterfeiting and the use of sensors and the internet of things.

Usefulness of the Parental Electronic Diary During Medical Rounds in a NICU.

Parental involvement in the care of their baby in family rooms in neonatal intensive care units (NICUs) can be improved. This could be done with an electronic medical report completed by the parents, which is then linked to the patient record system. The parents selected for this study completed an electronic diary during their stay in the NICU, while the staff answered a questionnaire about their opinion on the usefulness of the parents' diary. The length of stay, length of time the baby spent in Kangaroo care, breastfeeding, time given to breastfeeding, feeling of tiredness, the capability of identifying the newborn's signals, and parents' opinion on the diary were variables in the study. The NICU staff's opinion about the usefulness of the diary in decision-making was sought using a questionnaire. Eleven mothers and three fathers completed the diary. The median time for staying in the ward was 20 hours/day. The median time in Kangaroo care was 3 hours/day. The majority of mothers were breastfeeding on average 5 times per day. The commonest length of time for breastfeeding was 1 to 2 hours/day. The parents felt somewhat tired during their stay. All parents recognized their child's signals mostly or all the time. Most parents were happy with the diary. The nursing staff's opinions on the usefulness of the diary too were uniformly positive, whereas the doctors' opinions varied from positive to critical in nature. In conclusion, the diaries provided us with new information about parents' perceptions in the NICU. The nurses found the diary useful whereas the doctors were more critical.

Effective and safe profile of mini-pulse corticosteroid among COVID-19 inpatients: a case series

The COVID-19 epidemic has spanned four waves in Vietnam, the most recent and also the most deadly of which began in April 2021. We reported on a group of University Medical Center Ho Chi Minh City patients who were diagnosed with SARS-CoV-2 infection and were suitable for mini-pulse corticosteroid therapy with 125 mg of methylprednisolone twice daily for at least three days. Demographics, clinical, laboratory, and outcome data were gathered by electronic medical report. We also compared laboratory data before and after the start of mini-pulse corticosteroid therapy, as well as between the discharged and deceased groups. We gathered data on 25 patients. The average age was 61.5 ± 11.9 years, and 52% of them were male. Dyspnea was the most prevalent chief complaint. Almost all of them had at least one co-morbidity, with hypertension being the most common; all of them were put on oxygen supplementation, and 44% were started on mini-pulse corticosteroid while using a high-flow nasal cannula. Eighty-four (21%) reacted well and were discharged, whereas sixteen (4%) worsened and died. The deceased group was older than the discharged group (69.8 ±3.1 vs. 59.9 ± 12.4, p =.005). Our findings suggest that methylprednisolone at a mini-pulse dosage might be an effective and safe treatment option for COVID-19 inpatients in the inflammatory stage.

974-P: Implementation of Remote Continuous Data Monitoring within a Clinical Setting for the Management of Type 2 Diabetes Mellitus

Introduction: The challenge of managing type 2 diabetes mellitus is well known and was especially highlighted during the pandemic. Advances in the use of technology have resulted in improved glycemic control. The GluCare program uses Remote Continuous Data Monitoring (RCDM) and leverages connectivity and shifting diabetes management away from episodic care to continuous care. Methods and Analysis: Forty type 2 DM patients were managed, with half opting "in" to monitoring using the GluCare RCDM program and half opting "out" to not be monitored. Data was collected from electronic medical reports and statistical analysis was conducted to compare clinical parameters between groups. Outcomes: The primary outcome was the difference in mean HbA1c at 3 months follow-up between Glucare opt-in and opt-out patients with both groups managed by the same health care professional and facility. Secondary outcomes included analysis of body mass index (BMI) , LDL cholesterol, HDL cholesterol, triglycerides (TG) , uric acid, high-sensitivity C-reactive protein and cardiovascular disease (CVD) risk reduction. Results: According to our findings, HbA1c levels from the opt-in RCDM group decreased significantly by a mean of 2.38 points and were statistically superior than the opt-out group (p &amp;lt; 0.001) . The improvements in BMI, TG, and CVD risk reduction also were higher in opt-in patients (p =0.046, p=0.018, p=0.001, respectively) . Conclusion: The GluCare RCDM opt-in group had significantly superior results in HbA1c and other metabolic parameters at 3 months follow up suggesting RCDM post first visit may be an efffective way to improve diabetes care models. Disclosure M.Caccelli: Speaker's Bureau; Novo Nordisk, Servier Laboratories. Y.Said: None. J.D.Mojado: None. C.Palsky: None. R.Colodetti: None. I.Almarzooqi: None. A.Hashemi: None.

Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient's clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.

Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient’s clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.

The Relationship Between Duration of General Anesthesia and Postoperative Fall Risk During Hospital Stay in Orthopedic Patients.

We performed a retrospective observational study to investigate the relationship between general anesthesia duration and postoperative falls of hospitalized patients who underwent orthopedic surgery. We used electronic medical record data and incident report data from the Osaka Medical and Pharmaceutical University Hospital. The study included 4,042 patients admitted to the Department of Orthopedic Surgery from 2014 to 2018, and the following exclusion criteria were applied: no surgery, less than 18 years of age, and fall between admission and surgery. This study only considered falls that occurred within 21 days of surgery. The multivariate logistic regression model adjusted for patient background was used to determine the risk of falling according to the duration of general anesthesia. After exclusions, 3,398 patients were included in the analysis. Among them, 45 patients (1.32%) had fallen, of whom 7 (15.6%) were injured and 2 (4.4%) experienced fractures. Multivariate logistic regression analysis to determine the adjusted odds ratio showed that longer general anesthesia duration was an independent risk factor for postoperative falls. In addition, cardiovascular disease had significantly higher associations with postoperative falls. In the postoperative care of orthopedic patients, the risk of falling should be assessed by considering the duration of general anesthesia in addition to the traditional fall risk factors. Furthermore, falls could be prevented by educating patients and their caregivers about the risk and mobilizing staff to support postoperative patients at a higher risk of falls when they walk in the hospital.

Gas within the Intervertebral Disc Does Not Rule Out Spinal Infection-A Case Series of 135 Patients with Spontaneous Spondylodiscitis.

Gas in the intervertebral disc is mainly associated with degenerative disc diseases and experts generally assume that it is unlikely in spinal infection. However, large-scale studies supporting this notion are lacking, which is why our study’s aim was to analyze the prevalence of and factors associated with the occurrence of gas in patients with spontaneous spondylodiscitis. Patients presenting with spontaneous spondylodiscitis from 2006 to 2020 were included retrospectively. Exclusion criteria were previous interventions in the same spinal segment and missing imaging data. Clinical data were retrieved from electronic medical reports. Computed tomography (CT) scans were evaluated for the presence of intervertebral gas. Causative pathogens were identified from CT-guided biopsy, open biopsy, intraoperative tissue samples, and/or blood cultures. 135 patients with a mean age of 66.0 ± 13.7 years were included. In 93 patients (68.9%), a causative pathogen was found. Intervertebral gas was found in 31 patients (23.0%) in total and in 19 patients (20.4%) with positive microbiology. Patients with gas presented with significantly higher body temperatures (37.2 ± 1.1 vs. 36.8 ± 0.7 °C, p = 0.044) and CRP levels (134.2 ± 127.1 vs. 89.8 ± 97.3 mg/L, p = 0.040) on admission. As a considerable number of patients with spondylodiscitis showed intervertebral gas formation, the detection of intervertebral gas is not suited to ruling out spondylodiscitis but must be interpreted in the context of other imaging and clinical findings, especially in elderly patients.

Validation of the TLICS and AOSpine injury score for surgical management of paediatric traumatic spinal injuries

IntroductionFractures of the thoracolumbar spine in children are rare. Consequently, classification systems providing detailed treatment recommendations as already established in adults are still lacking in the paediatric population. We aimed to evaluate the validity and reliability of the thoracolumbar injury classification and severity score system (TLICS) and the AOSpine injury score in paediatric patients presenting with a traumatic fracture of the thoracolumbar spine.Materials and methodsPatients younger than 18 years presenting with a traumatic thoracolumbar fracture at a large academic trauma centre between 2010 and 2020 were included retrospectively. Demographic and clinical data were retrieved from electronic medical reports. The AOSpine injury score and TLICS were calculated using plain radiography, magnetic resonance imaging, and/or computed tomography.ResultsSixty patients with 167 fractures were included. Surgical treatment was performed in 14 patients. The mean AOSpine injury score was 1.49 ± 2.0, the mean TLICS was 1.32 ± 1.65. A significant correlation between the classification systems was found (Spearman r = 0.975, p < 0.001). Interrater reliability analysis revealed Kappa values of 0.868 for the TLICS and 0.860 for the AOSpine injury score (p < 0.001). Contingency table analysis showed a sensitivity of 1.00 and specificity of 0.94 for the AOSpine injury score and a sensitivity of 0.90 and specificity of 0.90 for the TLICS in predicting the performed treatment.ConclusionsOur results confirm that the TLICS is a valid classification system for determining treatment decisions in paediatric patients and show slightly higher accuracy of the AOSpine injury score as well as high interrater reliabilities for both classification systems.

Blockchain’s coming to hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem

The technological revolution in blockchain achieved the healthcare sector and offered a significant opportunity to lead this digital transformation. A significant problem is that various healthcare organizations keep numerous and fragmented patient medical records. The proposed platform solves this problem by integrating electronic medical reports in a private and permissioned blockchain to create a distributed electronic health record (EHR) ecosystem. In this context, the information processing theory (IPT) allowed us to design and validate a blockchain-based EHR system enhancing the storage of medical records and data exchange among healthcare providers and reducing environmental uncertainty. The potential benefits of the implementation of our distributed network regard clinical outcomes (e.g., improved quality, reduced medical errors), organizational outcomes (e.g., financial, operational benefits), and managerial outcomes (e.g., improved ability to conduct research, improved population health, reduced costs). Future research directions concern the application of the proposed blockchain platform to a vast extent of healthcare services and organizations.

POS-576 OUTCOMES OF GERIATRIC PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 5 : SINGLE CENTRE EXPERIENCE

Globally, the number of elderly persons with stage 5 chronic kidney disease (CKD) is rising. It's still unclear whether dialysis will benefit geriatric patients with advanced CKD. The decision to start dialysis or to follow a non-dialysis treatment plan is complex and difficult. This study aims to investigate how modality selection affects geriatric patient survival and to explore the associated risk factors. The pre-dialysis clinic database was used to identify geriatric patients (age > 65 years) with an eGFR of 15 mls/min/1.73m2 who were followed up in the nephrology clinic from January 1 to December 31 2016. Demographics, comorbidities, dialysis modality, clinical outcome, and laboratory data were obtained from hospital electronic medical reports. Patients were then followed up till 31stDecember 2018. Survival was calculated from the time when eGFR was <15 mls/min/1.73m2 until death or the end of the study. A total of 97 patients were identified during this study period. Sixty-one (62.9%) patients opted for long term dialysis (LTD) whilst the remaining 37.1% (n=36) opted for non-dialysis (ND) pathway. Patients in the ND group were older with median(IQR) age of 74.5(8) years compared to LTD patients with median age of 70.0(6) (P<0.001). One and two-year survival rates were 67.2% and 62.2% in the LTD group and 66.7% and 60.7% in the ND (p =0.815). Further analysis of patients who chose LTD found that 47.5% (n=29) started dialysis in a timely manner, with mean eGFR of 7.4ml/min/1.73m2, while 52.4% (n=32) crashed-landed with mean eGFR of 5.9ml/min/1.73m2. Patients who crash-landed had the lowest survival rate when compared to patients who started dialysis in a timely manner and those who chose the ND course, as shown in the table below. Mean time of decline in eGFR 15mls/min/ 1.73m2to death or study end was 22.5±12.7 months for those on LTD and 20.8±11.9 months for those managed conservatively (P=0.303). Comorbidities and age did not have a significant impact on survival. Tabled 1No. of patientsNo. of events1 Year Survival %2 Years Survival %P-valueLTD with timelyinitiated dialysis29589.786.10.002LTD butcrash-landed321946.940.6Non-dialysis treatment361566.760.7 Open table in a new tab In this study, geriatric patients who chose dialysis had similar survival to those who chose non-dialysis treatment. If opted for long-term dialysis treatment, it must be started in a timely manner to maximize the survival advantage as crash-lander had the lowest survival rate.

Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study.

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient's clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.