Emergency Outpatient Clinic Research Articles

Rates of buprenorphine prescribing and racial disparities among patients with opioid overdose

BackgroundAwareness of the relationship between real-world buprenorphine prescribing and overdose frequency is limited, especially in the Southeastern United States. We described buprenorphine prescribing rates for patients experiencing nonfatal opioid overdoses in the context of overdose frequency. MethodsElectronic medical records review was conducted at an urban, academic hospital in Alabama from January 1 through December 31, 2021. Patients with opioid use disorder (OUD) and nonfatal opioid overdoses, dispositioned from either the emergency department (ED), inpatient, or outpatient affiliated clinics, were identified by International Classification of Diseases-10 codes. ResultsThe study included 358 unique patients. Many patients were white (71.5%), male (59.2%), and uninsured (54.2%), with a mean age of 42.0±12.8 years. The majority (85.5%) experienced one to three overdoses, and 14.5% of patients had more than three overdoses. The buprenorphine prescription rate increased to 55.8% when patients had more than three overdoses, compared to one overdose (34.5%) and two to three overdoses (37.4%) (p=0.025). Compared to females, more males overdosed more than once (p=0.004). Black patients were less likely to receive buprenorphine prescriptions than white patients (27.3% vs. 44.5%, p=0.004). Compared to patients with multiple overdoses, more patients with one overdose had public insurance (p=0.028) and were less likely to present to the ED (p<0.001). ConclusionUnder-prescribing of buprenorphine is high among patients with OUD and opioid overdoses, even in patients with multiple overdoses, and there appear to be racial disparities in prescribing. Our findings indicate clinical opportunities for improving buprenorphine prescribing and reducing the current disparities.

Comparing the Prevalence and Characteristics of Chest Pain in Children and Adolescents Pre- and Post-COVID-19: A Retrospective Study.

Chest pain is a common complaint among pediatric patients, often leading to visits to Emergency Departments or outpatient clinics. While most cases are benign, timely diagnosis is essential to prevent fatalities in those with serious conditions. The COVID-19 pandemic has shifted healthcare dynamics, necessitating an understanding of its impact on pediatric health, including potential complications such as chest pain, fever, cough, shortness of breath, sore throat, and headache. This study aims to explore the prevalence, characteristics, and potential association between COVID-19 and chest pain in children during two time periods: 2019 (before the COVID-19 pandemic) and 2021 (the full year during the pandemic). Data were collected from medical records and telephone interviews with pediatric patients presenting with chest pain at the University of Jordan Hospital. The study included a sample size of 3294 patients with selection criteria based on presenting symptoms and COVID-19 status. Data collection occurred from 2019 and 2021, and demographic information (age, gender, weight), medical history (perinatal and family history), COVID-19 status (vaccination, infection history), and details about chest pain (frequency, onset) were documented. Statistical analyses were performed to evaluate differences between the two time periods using IBMSPSSStatistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States). The results indicate a significant increase in the number of patients presenting with chest pain in 2021 compared to 2019 (P value = .0157). The mean age of patients was 11 years, predominantly male. There was a notable increase in the percentage of patients with comorbidities in 2021. Echocardiography results were normal in approximately 84% of cases across both years, with no significant differences in ECG outcomes. Palpitations remained the most common associated symptom. 4.6 % of patients in 2021 were confirmed to have COVID-19, most of whom were diagnosed with muscular causes of chest pain. Notably, none of the patients had received the COVID-19 vaccine. This study highlights a marked increase in pediatric patients presenting with chest pain during the pandemic, although characteristics and underlying causes remained consistent between years. The rise in cases may be attributed to heightened awareness rather than a direct link to COVID-19. Recommendations for clinical practice include careful evaluation of chest pain in pediatric patients during the pandemic, considering psychosocial factors and the broader impact of COVID-19 on health-seeking behaviors. Future research should investigate the long-term effects of COVID-19 on pediatric populations and explore the psychological implications on health service utilization. This study underscores the need for ongoing assessment of pediatric healthcare practices amid evolving pandemic conditions.

The utilization of ophthalmological emergency departments is on the rise : 14-year results from aGerman tertiary university outpatient department

The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time. The aim of this study is to make awell-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived. Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1January 2010 to 31December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, aquestionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022. The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, ashift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without areferral from adoctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic. The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to adouble burden: providing treatment for emergency cases with specialist referrals and at the same time acting as acatchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term.

The hidden link between late-onset seizures and cerebral amyloid angiopathy: A case-control study.

Epileptic seizures occurring in late adulthood often remain of unknown origin. Sporadic cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease characterized by intracerebral hemorrhage, microhemorrhage and superficial siderosis, occurring mostly in elderly. This observational case-control study aimed to assess the occurrence of CAA in patients experiencing their first seizure in late adulthood. We enrolled consecutive patients aged ≥55 years presenting with late-onset seizures (LOS) to the emergency departments or outpatient clinics of two Italian centers, from April 2021 to October 2022. Two age-matched control subjects with neurological symptoms other than epileptic seizure were recruited for each enrolled case. All participants underwent brain MRI (1.5 Tesla) including blood-sensitive sequences and were assessed for probable CAA diagnosis according to Boston criteria 2.0. Chi-squared test was performed to evaluate group differences. Univariate logistic regression analysis tested the association between clinical variables and CAA. We included 65 patients with LOS (27 females; mean age 72.2 ± 8.9 years) and 130 controls (49 females; mean age 70.3 ± 8.9 years). Diagnosis of probable CAA was achieved in 10.8% (7/65) of LOS patients and 2.3% (3/130) controls, with a statistically significant difference (p = 0.011). The OR for CAA in the LOS group was 5.2 as compared to the control group (95% CI = 1.3-20.6, p = 0.02). The frequency of CAA is significatively higher in patients with LOS as compared to other neurological diseases, suggesting that a portion of LOS of unknown or vascular origin are associated with CAA. Late-onset seizures (LOS) are very frequent in the elderly and often have no clear cause. Cerebral amyloid angiopathy (CAA) is a condition where amyloid proteins build up in the blood vessels of the brain, causing them to become weak and prone to bleeding. In this study, we explored the occurrence of CAA in people with LOS. We found that people with LOS were more likely to have a diagnosis of CAA than controls (i.e., people with other neurological diseases).

Comparison of effectiveness indicators before and during the COVID-19 pandemic in a university hospital

Objective: Our aim in this study is to reveal to what extent hospital efficiency indicators changed in a University Hospital between the period before the Covid 19 pandemic (2018-2019) and the period when the pandemic started and continued (2020-2021). Method: The study planned as a retrospective and descriptive type, data belongs to a 4-year period (2018-2021). The number of personnel for the years examined in the study, the number of applications to the outpatient clinic and emergency department calculated monthly and the number of deceased patients. Bed occupancy rate, inpatient rate, average patient stay days, bed turnover rate and bed turnover interval were used as hospital bed utilization efficiency indicators. Result: Among all years, April 2020 had the lowest number of emergency applications (n=1287) and total number of outpatient clinic applications (n=7530). The year with the highest bed occupancy rate was 2020 with 77.2±6.7. The highest inpatient rate was in 2020 with 6.7±2.1, the highest average day of stay was in 2021 with 10.8±2.2, the highest bed turnover rate was in 2018 and 2019 with 4.7±0.3 and the highest bed turnover interval was observed in 2021 with 5.2±2.2. April 2020 was the month with the highest inpatient rate at 11.8% and the highest bed turnover interval at 16.8. Conclusion: The number of patients applying to emergency departments and outpatient clinics decreased, the inpatient rate increased, the bed turnover rate decreased, the bed turnover interval extended and the average day of stay increased during the pandemic period.

Гинекологические проблемы у подростков: тенденции обращений к гинекологам и жалоб

Adolescence represents a pivotal phase in the transition from childhood to adulthood. Adolescent gynecology is the clinical specialty that focuses on the management of gynecologic problems during this period. This study's primary objective is to emphasize the importance of adolescent gynecology by examining the gynecological causes of adolescent presentations and highlighting the differences that warrant consideration in the clinical approach to adolescent patients. The study was designed as a retrospective cohort study in an academic tertiary hospital and included adolescent individuals presenting to the obstetrics and gynecology emergency department or outpatient clinic. The analysis encompassed a range of factors, including age, presenting symptoms, examination findings, ultrasound results, laboratory data, and the necessity for hospital admission. The study cohort comprised 750 adolescent patients, 71.3% seeking gynecological care. Adolescents most frequently presented for menstrual irregularities (57.6%) and secondly for dysmenorrhea. The results of the gynecological clinical evaluations indicated that 62.9% of the patients had menstrual disorders. Of these, 53.4% had irregular menstrual cycles, 4.5% had prolonged and/or heavy bleeding, and 3% had amenorrhea. Ultrasound imaging revealed the presence of pathological findings in 25.8% of the patients. In conclusion, this study's findings indicate that irregular menstrual cycles are the most common gynecological condition in the adolescent population. The physiological characteristics of adolescents require a distinct approach to diagnosis and treatment compared to adult women, which can significantly impact future fertility and overall reproductive health.

Evaluation of patients presenting with headache to the emergency outpatient clinic

Aims: This study aimed to explore the factors contributing to headache presentation in patients by recognizing headache as a symptom of various potential ailments. It is crucial to understand these factors for appropriate assessment and treatment planning in patients with headaches. Additionally, this study investigated patients' preferences for headache management, which is an understudied aspect in the field. Methods: In 2012, a two-month study was conducted at an emergency department outpatient clinic to assess the general characteristics, severity, frequency, duration, and location of headache episodes among patients presenting with headache complaints. The study analyzed various parameters, including the different types of pain, such as throbbing, stabbing, and burning, as well as the impact of headaches on daily performance, medication use, specific medications taken, and alternative treatment methods via a headache questionnaire. Results: The survey results revealed that 21.7% of the patients described their pain as extremely severe, 52.2% as severe, and 26.1% as distressing. Pain descriptions were predominantly throbbing (79.4%) and pain (62.2%), with sensations of pressure (20%), stabbing (18.3%), pulsating (13.3%), burning (10.6%), and constriction-like a band (2.8%). The localization of pain was bilateral in 15.0% of patients, unilateral in 18.3%, around or behind the eyes in 28.3%, and in the neck or back of the head in 38.3%. Headaches were found to affect the work life of 40.6% of patients, 20% reported no impact, and 39.4% experienced occasional interference. No significant statistical difference was observed regarding the intensity, frequency, and duration of pain, and its impact on work life with respect to sex. The usage of non-prescription medication was high (92.8 %), whereas prescription medication usage was 57.8%. Regarding alternative treatment methods, massage therapy was used by 53.6% of the patients and herbal treatments by 17.8%. Conclusion: This study examined the frequency and handling of headaches among patients visiting an emergency department. The results indicate that headaches affect both sexes equally, with a marginal prevalence in females. To provide better care, addressing patients’ preferences and experiences is important. As patients rely on non-prescription medications and alternative therapies, concerns regarding healthcare accessibility arise. A combination of medication management, patient education, and non-pharmacological therapies is necessary to achieve better outcomes and decrease the burden on healthcare systems.

Prevalence of Medications Errors and Factors of Harmful Errors in Neonates and Paediatrics at Tertiary and Paediatric Hospitals: A Multicenter Study

Medication errors (ME) are human mistakes that may occur during drug use, prescribing administration or monitoring. This study aimed to determine the Prevalence of MEs among pediatric patients receiving tertiary treatment in pediatric speciality hospitals and describe their patterns and causes. Three institutions participated in a multicenter retrospective analysis. Reports of all MEs involving paediatrics aged ≤13 years who were hospitalised or visited the Emergency Department or outpatient clinics were reviewed 1 January 2019 - 31 December 2019. The National Coordinating Council for Medication Error Reporting and Prevention classification was used to categorise MEs and to define PRME (category CI) and patient–harming MEs (category EI). A retrospective study was conducted with a total of 318 MEs reported, with an overall prevalence of 0.9 per 1,000 patients. The Prevalence was markedly lower in the CHT (0.35 / 1,000 patients) than in KAMC and KFSH&amp;RC (1.73 and 3.5). The highest rate of MEs was observed in admitted wards (14.69 / 1,000 patients). Most commonly, MEs occurred at the prescribing stage (81.1%), were caused by a physician (83.3%), and were discovered by the pharmacist (85.5%). Improper medication dosage (34.0%), frequency (14.2%), and duration (10.4%) were the three most common forms of MEs. Paediatric inpatient treatment has a significant frequency of MEs, accounting for 24% of hospitalisations. The ME may not get to the patient if independent double-check prescriptions, accurate medication reconciliation of new prescriptions against the previously prescribed, and improved medicine labelling and packaging techniques are used.

The Relationship Between Immune Inflammation Index and Major Cardiovascular Adverse Events in Patients with Heart Failure with Reduced Ejection Fraction.

Aim: We aimed to investigate whether systemic immune inflammation index (SII) has a predictive value in predicting prognosis and major adverse cardiovascular events such as exitus, stroke and hospitalization in heart failure patients with reduced ejection fraction (HFrEF). Methods: Patients over the age of 18 who applied to the cardiology and emergency outpatient clinics between January 2019 and January 2022 and diagnosed with HFrEF (Ejection Fraction

Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses.

This study compared nurses' self-competency assessments and their managers' nurse competence assessments. Nurse competence is important for nursing care quality and patient safety. Executive (charge) nurses play a main role in the nurse competency assessment. In this study conducted at a university hospital between January and December 2020, the self-efficacy evaluations of nurses (n=162) working in services other than the emergency department, operating room, and outpatient clinics of the university hospital were compared with the evaluations of nurse executives (charges) on these nurses (n=21). Data were collected using the personal information form and the Nurse Competence Scale. A cross-sectional study design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guideline was used for reporting. Service nurses' self-assessments and nurses treating charge's assessment of clinical nurses evaluated the competence levels as excellent in both groups. The self-competency assessments of the nurses were higher than the charge nurses' competency assessments. In this study, the lower competence assessment of nurses by the charge nurses was may be due to their ability to observe nurses in their teams in general and that they have more experience in evaluation. It is suggested that professional development and competence programs be created to further develop the competencies of nurses. Nurse competency assessments support planning to ensure patient safety. Patient care burden and planning of risky patients according to the nurse competency level will provide safe patient care.

Systemized approach to equipping medical students with naloxone: a student-driven initiative to combat the opioid crisis

BackgroundNaloxone is an effective and safe opioid reversal medication now approved by the U.S. Food and Drug Administration (FDA) for use with or without a prescription. Despite this, naloxone dissemination lags at a time when U.S. opioid-related mortality expands. The authors proposed distributing naloxone to all U.S. medical students using established statewide standing prescription orders for naloxone, eliminating the financial burden of over-the-counter costs on students and streamlining workflow for the pharmacy. By focusing naloxone distribution on medical students, we are able to capitalize on a group that is already primed on healthcare intervention, while also working to combat stigma in the emerging physician workforce.MethodsBeginning August 2022, the authors established a partnership between Harvard Medical School (HMS) and the outpatient pharmacy at Brigham and Women’s Hospital (BWH) to facilitate access to naloxone for HMS medical students. BWH developed a HIPAA-secure electronic form to collect individual prescription information. BWH pharmacists processed submissions daily, integrating the naloxone prescription requests into their workflow for in-person pick-up or mail-order delivery. The electronic form was disseminated to medical students through a required longitudinal addiction medicine curriculum, listserv messaging, and an extracurricular harm reduction workshop.ResultsOver the 2022–2023 academic year, 63 medical students obtained naloxone kits (two doses per kit) through this collaboration.ConclusionsWe propose that medical schools advocate for a hospital pharmacy-initiated workflow focused on convenience and accessibility to expand naloxone access to medical students as a strategy to strengthen the U.S. emergency response and prevention efforts aimed at reducing opioid-related morbidity and mortality. Expansion of our program to BWH internal medicine residents increased our distribution to over 110 healthcare workers, and efforts to expand the program to other BWH training programs and clinical sites such as the emergency department and outpatient infectious disease clinics are underway. With more than 90,000 medical students in the U.S., we believe that widespread implementation of targeted naloxone training and distribution to this population is an accessible approach to combating the public health crisis of opioid-related overdoses.

Quality of life and healthcare utilization during the COVID-19 pandemic are more restricted in chronically ill than in healthy children: a tertiary care children’s hospital experience

The global COVID-19 pandemic forced changes in everyday life of children and adolescents due to government containment measures, an altered healthcare accessibility and utilization, and public concern about SARS-CoV-2 transmission. Data on the challenges and impact on children and their families with chronic diseases are limited. The primary objectives of this study were to assess (i) concerns for SARS-CoV-2 infection, (ii) perceived effects on health-related and overall quality of life (HRQoL and QoL), and (iii) accessibility and utilization of healthcare, comparing families with chronically ill children to families with healthy children during the second SARS-CoV-2 infection wave in Germany. A caregiver questionnaire was designed and participation offered in the emergency department and outpatient clinic of a German tertiary care children’s hospital. 45.9% of the 205 participants were majorly concerned about their children contracting a SARS-CoV-2 infection. Caregivers of chronically ill children (128/205, 62.4%) stated significantly more often a negative impact on their child’s QoL (w = 0.17; p = 0.014), while caregivers of chronically ill adolescents over the age of 13 expressed significantly more frequent a negative impact on their child’s HRQoL (w = 0.21; p = 0.016). Outpatient appointments for chronically ill children were significantly more often canceled (w = 0.17; p = 0.025). Caregivers of chronically ill children were significantly more likely to report that they would actively delay hospital visits for emerging health issues due to the pandemic (w = 0.12; p = 0.049). Conclusion: Our findings underscore the importance of identifying families with chronically ill children as a vulnerable patient group with higher burdens during the COVID-19 pandemic and potential future pandemics. Healthcare providers may mitigate such burdens by ensuring reliable appointment allocation, offering contactless healthcare options, and providing tailored advice regarding vulnerabilities and preventive measures specific to their chronically ill children.What is Known:• The SARS-CoV-2 pandemic has led to significant restrictions in everyday life and both accessibility and utilization of healthcare for children and adolescents.• Chronically ill children faced exceptional challenges as they depend on regular and functioning medical care, but data comparing the pandemic’s impact between chronically ill and healthy children are lacking.What is New:• The perceived impact of the SARS-CoV-2 pandemic on quality of life is more negative for chronically ill children and their health-related quality of life is more often affected compared to healthy children.• Caregivers of chronically ill children would more often delay a visit to their child’s doctor during the SARS-CoV-2 pandemic and their medical appointments are more often postponed which both could increase health burdens for such vulnerable patients.

Differences in Troponin I and Troponin T Release in High-Performance Athletes Outside of Competition.

Troponin I and troponin T are critical biomarkers for myocardial infarction and damage and are pivotal in cardiological and laboratory diagnostics, including emergency settings. Rapid testing protocols have been developed for urgent care, particularly in emergency outpatient clinics. Studies indicate that strenuous physical activity can cause transient increases in these troponin levels, which are typically considered benign. This research focused on 219 elite athletes from national teams, evaluating their troponin I and T levels as part of routine sports medical exams, independent of competition-related physical stress. The results showed that 9.2% (18 athletes) had elevated troponin I levels above the reporting threshold, while their troponin T levels remained within the normal range. Conversely, only 0.9% (two athletes) had normal troponin I but raised troponin T levels, and 2.3% (five athletes) exhibited increases in both markers. No significant cardiovascular differences were noted between those with elevated troponin levels and those without. This study concludes that elevated troponin I is a common response to the intense physical training endured by high-performance endurance athletes, whereas troponin T elevation does not seem to be directly linked to physical exertion in this group. For cardiac assessments, particularly when ruling out cardiac damage in these athletes, troponin T might be a more reliable indicator than troponin I.

Identified Factors in COVID-19 Patients in Predicting Mortality.

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in global mortality rates. Numerous studies have been conducted to identify the factors associated with mortality in COVID-19 cases. In these studies, overall mortality was evaluated in patients, and no distinction was made as ward or intensive care mortality. This study aims to determine mortality-related factors in patients who died while in the ward. This could enable us to review the indications for intensive care hospitalization in possible pandemics. This retrospective study was conducted on a cohort of 237 patients who applied to our institution between January 2020 and December 2021 with the diagnosis of COVID-19. Demographic characteristics, length of stay, type of admission (emergency ward or outpatient clinic), presence of comorbidities, thoracic computerized tomography (CT) findings, and laboratory findings were extracted from the hospital database. The demographic and laboratory results of both deceased and recovered patients were compared. While many demographic and laboratory findings were statistically significant in the initial analysis, multiple logistic regression analysis showed that decreased albumin levels (adjusted OR = 0.23, 95% CI = 0.09 - 0.57), increased troponin (adjusted OR = 1.03, 95% CI = 1.02 - 1.05), and procalcitonin (adjusted OR = 3.46, 95% CI = 1.04 - 11.47) levels and higher partial thromboplastin time (PTT) (adjusted OR = 1.18, 95% CI = 1.09 - 1.28) values, presence of diabetes mellitus (DM) in patients (adjusted OR = 2.18, 95% CI = 1.01 - 4.69, P = 0.047), and admission to hospital from the emergency department (adjusted OR = 5.15, 95% CI = 1.45 - 18.27, P = 0.011) were significantly associated with mortality when adjusted for age. When a predictive model is constructed with these variables, this model predicted mortality statistically significant (AUC = 0.904, 95% CI = 0.856 - 0.938, P < 0.001), with a sensitivity of 77.2% (95% CI, 67.8 - 85), a specificity of 91.2% (95% CI, 85.1 - 95.4), a positive predictive value (PPV) of 86.7% (95% CI, 72 - 85.3), and an negative predictive value (NPV) of 84.4% (95% CI, 79.4 - 89.6). In this study, we may predict mortality among COVID-19-diagnosed patients admitted to the ward via this model which has the potential to provide guidance for reconsidering the indications for intensive care unit (ICU) admission.

Discharge from the emergency department and outpatient clinic in cancer patients with acute symptomatic and incidental pulmonary embolism: A multicenter retrospective cohort study

BackgroundIt is unclear how often cancer patients with acute pulmonary embolism (PE) are discharged from the emergency department (ED) or outpatient clinic and whether direct discharge is safe. We assessed treatment setting and early safety outcomes in cancer patients with acute symptomatic and incidental PE. MethodsCancer patients diagnosed with PE at the ED or outpatient clinic between August 2017 and May 2021 were included in Four Cities VTE Cancer, a Dutch multicenter retrospective cohort study. The main outcome was direct discharge versus hospitalization. Safety outcomes were cumulative 14-day mortality and PE-related readmission incidences. ResultsWe included 602 patients (median age 71 years; 49.5 % female) of whom 285 (47.3 %) were discharged directly and 317 (52.7 %) were hospitalized. The cumulative 14-day mortality incidence was 0.7 % (95 % CI, 0.1–2.4 %) in patients discharged directly and 9.0 % (95 % CI, 6.2–12.5 %) in those hospitalized. The cumulative 14-day PE-related readmission incidence was 1.8 % (95 % CI, 0.7–3.9 %) and 1.4 % (95 % CI, 0.5–3.3 %) in directly discharged and hospitalized patients, respectively. Of the 220 patients with incidental PE, 180 (81.8 %) were discharged directly compared to 105 of 382 (27.5 %) patients with symptomatic PE (P < 0.001). Mortality and readmission incidences in symptomatic and incidental PE were consistent with the main analysis. ConclusionsAbout 28 % and 82 % of cancer patients with symptomatic or incidental PE, respectively, were discharged directly, with low 14-day mortality and PE-related readmission incidences. These data underline the need for PE risk stratification in oncological populations and suggest that clinicians successfully identify a proportion of patients in whom direct discharge is safe.

From Epidemiology of Community-Onset Bloodstream Infections to the Development of Empirical Antimicrobial Treatment-Decision Algorithm in a Region with High Burden of Antimicrobial Resistance.

Antimicrobial-resistant (AMR) infections have increased in community settings. Our objectives were to study the epidemiology of community-onset bloodstream infections (BSIs), identify risk factors for AMR-BSI and mortality-related factors, and develop the empirical antimicrobial treatment-decision algorithm. All adult, positive blood cultures at the emergency room and outpatient clinics were evaluated from 08/2021 to 04/2022. AMR was defined as the resistance of organisms to an antimicrobial to which they were previously sensitive. A total of 1151 positive blood cultures were identified. There were 450 initial episodes of bacterial BSI, and 114 BSIs (25%) were AMR-BSI. Non-susceptibility to ceftriaxone was detected in 40.9% of 195 E. coli isolates and 16.4% among 67 K. pneumoniae isolates. A treatment-decision algorithm was developed using the independent risk factors for AMR-BSI: presence of multidrug-resistant organisms (MDROs) within 90 days (aOR 3.63), prior antimicrobial exposure within 90 days (aOR 1.94), and urinary source (aOR 1.79). The positive and negative predictive values were 53.3% and 83.2%, respectively. The C-statistic was 0.73. Factors significantly associated with 30-day all-cause mortality were Pitt bacteremia score (aHR 1.39), solid malignancy (aHR 2.61), and urinary source (aHR 0.30). In conclusion, one-fourth of community-onset BSI were antimicrobial-resistant, and one-third of Enterobacteriaceae were non-susceptible to ceftriaxone. Treatment-decision algorithms may reduce overly broad antimicrobial treatment.

Ultrasonographic evaluation of common findings in acute abdomen amongst paediatric age group in Kano Metropolis, Nigeria

Acute abdomen is very common complaint for paediatric patients presenting to the paediatric emergency departments and outpatient clinics and its management is time consuming. Ultrasound is reliable for the diagnosis of acute abdomen. This study was aimed at evaluating the commonest ultrasonographic findings in paediatric age group presented with acute abdomen in Kano metropolis, Nigeria. This was rospective, cross sectional study conducted from September, 2020 to December, 2022. A convenience sampling method was employed and a sample size of 170 paediatric patients with ages ranging between 0 and 18 years. Paediatrics presenting with non-traumatic acute abdomen were included in the study, while those with traumatic acute abdomen were excluded. GE LOGIQ F6 US machine with transducer frequency of 3.5 MHz-8 MHz was used as an instrument for data collection. The selected patients were scanned in supine position. Data generated was analyzed using SPSS version 22.0. Results generated indicate that the commonest symptoms of acute abdomen among paediatric in Kano metropolis besides abdominal pain were vomiting (63.5%) and running fever (55.8%). The commonest ultrasonographic findings of acute abdomen were gastroenteritis (17.1%), acute appendicitis (12.9%), nonspecific abdominal pain (10.0%) mesenteric adenitis (7.6%) and acute cholecystitis (7.1%). Intussusception, intestinal obstruction and intestinal perforation accounted for 5.9% each. Pyelonephritis, and cystitis accounted for 4.1% and 4.7% respectively. There was 2.9% for each acute hepatitis, renal calculus and pelvic inflammatory disease (PID). Midgut malrotation and volvulus and acute peritonitis accounted for 1.8% each. The common findings in acute abdomen among paediatrics in Kano metropolis, Nigeria were gastroenteritis, acute appendicitis, nonspecific abdominal pain and mesenteric adenitis.

Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target.

This study aimed to identify factors associated with late diagnosis and clinically monitor newly diagnosed HIV/AIDS patients. Retrospective study, based on secondary data from a specialized unit at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the University of Sao Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data of newly diagnosed HIV patients between 2015 and 2019. Data analysis was undertaken using inferential statistical tests. A total of 314 individuals were newly diagnosed with HIV/AIDS, 86.6% (272) had a late diagnosis and 53.8% (169) were diagnosed very late. Using the adjusted odds ratio, we observed that bisexual and MSM patients were less likely to have a late diagnosis compared to straight patients. Individuals who entered through the emergency department and Outpatient Clinic had a lower chance of having a very late diagnosis compared to those diagnosed in the ward/inpatient unit. Having a higher education and university education were protective factors against having a very late diagnosis of HIV infection compared to elementary school education only. In addition, male patients were more likely to have a very late diagnosis compared to female patients. This study evidenced a high prevalence of late and very late diagnoses. Therefore, attention should be directed towards factors related to late and very late presentation.

ADHERENCE OF PHYSICIANS PRACTICE TONATIONAL MINISTRY OF HEALTH (MOH) URGENT CARE GUIDELINE IN EASTERN REGION,SAUDI ARABIA

Introduction: In the new era of the Ministry of health transformation, urgent care units (UCCs) were established in primary care. This research evaluated the current practice at the urgent care unit in comparison to the MOH Guideline of Extended Hour Services. Materials and Methods: This is an analytical cross-sectional study that included 293 physicians who worked in UCCs at Primary health care (PHC), Saudi Arabia (SA). The data were collected via a validated online questionnaire distributed to the physicians. Furthermore, UCCs were visited to assess the availability of suitable settings. Univariate and multivariate data analyses were done using the SPSS program. Results: Less than a quarter (23.6%) of UCC physicians were aware of the presence of the National MOH Guideline of extended-hour services. Overall adherence as per physicians perception of the guideline was 48 (24.7%). Increased adherence to Ministry of Health policy as per guidelines by UCC physicians was associated with attending all training courses (OR = 33.72, 95% CI: 2.116-4.920) and awareness of the MOH manual of extended hours services (OR = 2.45, 95% CI: 0.345-1.435). Participants agree on the absence of a clear referral policy to an emergency department and outpatient clinics, 32.3% and 52.3% respectively. Conclusion: UCC physicians training and practices at PHCs did not adequately adhere to the Ministry of Health guidelines. More effort is needed to achieve better outcomes.

Demographic characteristics of patients with anosmia consulting to the COVID-19 outpatient clinic

Background/Aim: Coronavirus disease 2019 (COVID-19) cases first emerged in Turkey in March 2020, spreading rapidly and peaking in April and May. This study aimed to assess individuals with loss of taste and smell who were admitted to our hospital with a COVID-19 diagnosis. Methods: Between March and June 2020, we retrospectively assessed 6966 patients who visited Kartal Dr. Lütfi Krdar City Hospital’s Infectious Diseases and Clinical Microbiology COVID-19 outpatient clinics; 137 patients with loss of taste and smell were included in the study. We enrolled 18-year-old patients who were admitted to the infection emergency outpatient clinics. Results: Out of the 6966 patients hospitalized with a pre-diagnosis of COVID-19 infection, 137 (0.19%) complained of poor taste and smell. Among these, 69 (50.4%) were female, and 68 (49.6%) were male. Of the 137 patients, 100 (73%) reported a loss of smell, while 94 (68.6%) reported a loss of taste. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR (reverse transcriptase-polymerase chain reaction) was positive in approximately one-third (n=2672, 38.4%) of the 6966 patients and roughly half (n=62, 48.4%) of the patients with loss of taste and smell. The most common symptoms observed in patients with anosmia were fever (n=123, 91%), cough (n=102, 75%), shortness of breath (n=411, 30%), sore throat (n=12, 9%), malaise (n=12, 9%), myalgia (n=11, 8%), nausea/vomiting (n=6, 5%), diarrhea (n=4, 3%), loss of smell (n=2, 2%), and loss of taste (n=2, 2%). Comorbidities included hypertension (n=4, 3%), diabetes mellitus (n=4, 2%), chronic obstructive pulmonary disease (n=2, 2%), and coronary artery disease (n=1, 1%). Conclusion: Patients admitted to our hospital during the initial wave of the pandemic experienced typical and prevalent symptoms such as fever, cough, shortness of breath, sore throat, and loss of taste and smell. Further large cohort studies are required to address the “tasteless” COVID-19 more fully.