Genitourinary Infections Research Articles

O02 Antibiotic prescribing practices in primary healthcare in sub-Saharan Africa: a systematic review and our experience on the use of telemedicine in Zambia

BackgroundAntimicrobial resistance (AMR) presents a challenge to clinicians globally, particularly in low- and middle-income countries (LMICs) which often have a high prevalence of infectious diseases, coupled with limited diagnostic, treatment and surveillance capabilities.1,2 To date, there is limited information on antimicrobial prescribing in sub-Saharan Africa, particularly in rural clinics,3 where systematic data gathering can be impacted by the resource-poor nature of these settings. The Virtual Doctors charity (VDrs)4 uses a bespoke smartphone app to give remote telemedical advice to clinicians throughout rural Zambia. This approach links primary healthcare workers with volunteer doctors, predominantly based in the UK. We propose that this approach may be a valuable tool to promote antimicrobial stewardship (AMS) in these locations, and consequently that telemedicine can play a key role in preventing a future AMR pandemic.MethodsWe carried out a systematic review to investigate current antibiotic prescribing practices in LMICs within sub-Saharan Africa, specifically the indications for use, choice of antimicrobial, and prescribing rates. Three Africa-specific databases, EMBASE, MEDLINE, Cochrane Library, Web of Science, Scopus, CINAHL, IRIS and Global Health databases were searched. English language studies evaluating antimicrobial use in primary care in LMICs in sub-Saharan Africa published between January 2010 and July 2021 were included. Data on the prevalence of antibiotic prescription, choice of agent and appropriateness was collated. We then reviewed anonymized prescribing data from the VDrs database, investigating antibiotic prescribing in cases over a period between January 2019 and June 2020. We excluded non-adult (<18 years old) patients, and reviewed cases that had been coded as ‘InfectiousDiseases’, ‘RespiratoryMedicine’ or ‘MedicineGeneral’ to identify those in which antibiotics were prescribed acutely and the impact of consultations on antibiotic prescriptions.ResultsSystematic review: 29 eligible studies from nine countries were identified, with 18 (62%) undertaken in urban settings and 7 (24%) encompassing rural settings. The prevalence of antibiotic prescription was 32.7%–84.4% (median 55.2%, IQR 44.5%–67.7%), with respiratory and genitourinary infections the most common indications. The most prescribed antibiotics were β-lactams (primarily amoxicillin), then quinolones and metronidazole. Only two studies assessed the appropriateness of prescriptions, with 13%–36.4% found to be inappropriate. Retrospective cohort analysis of VDrs database: 502 cases were reviewed. 154 (30.7%) were receiving 1–3 antibiotic agents at the time of consultation. The most prescribed agents were metronidazole and amoxicillin. Following consultation, 53 patients (10.5%) were initiated on antibiotics. Of those already receiving antibiotics, 29.2% had these actively continued, and 45.5% had antibiotics rationalized or stopped based on volunteers’ advice.ConclusionsOur systematic review confirms high rates of antimicrobial prescription in LMICs in sub-Saharan Africa, with a significant proportion being inappropriate. However, data are limited, and mainly from urban settings, hindering the generalizability of results. Our analysis of VDrs data reveals that 45.5% of antibiotic prescriptions were rationalized through our telemedicine-based approach. The VDrs model aims not only to deliver case-based guidance to rural healthcare practitioners, but also provide long-term educational gains to enhance local and global health. We suggest that the appropriate use of telemedicine can have short- and long-term benefits for AMS in LMICs.

Antimicrobial Resistance Pattern in E. coli Isolated from Placental Tissues of Pregnant Women in Low-Socioeconomic Setting of Pakistan.

Infections during pregnancy can culminate in adverse pregnancy outcomes, including preterm birth (PTB). Pakistan is among the top ten nations with high PTB-associated neonatal mortality rates, where access to prenatal as well as neonatal care is only afforded by the privileged few. Societal stigma further discourages women seeking healthcare for minor infections. Microbial pathogens associated with genitourinary infections can lead to gestational complications culminating in earlier onset of labor. In this study, association of Escherichia coli (E. coli) with PTB in Pakistani women of low-socioeconomic status is examined. 57 paired vaginal swabs and placenta samples from mothers with full term and preterm deliveries were collected and processed for isolation and molecular characterization of extraintestinal pathogenic E. coli (ExPEC). ExPEC isolated from vaginal swabs and placenta showed phylotype B2 being most prevalent (Vagina n = 3 (9), 33%) (Placenta n = 4 (12), 33%) in preterm cases followed by phylotype B1 (Vagina n = 2 (9), 22%) (Placenta n = 3 (12), 25%) and untypeable strains. Antibiotic susceptibility profiling showed a large percentage of resistant isolates to multiple antibiotics, including carbapenem and included extended-spectrum beta-lactamase (ESBL) producers. Our study is the first to report different phylotypes of E. coli from placental tissues in preterm deliveries which may be a cause for concern for maternal and neonatal health. ExPEC from vaginal swabs and placental of females delivering preterm shows the pathogenic phylotype B2 dominance with a large percentage of isolates resistant to multiple antibiotics, including carbapenem and included ESBL producers. The placental isolates may indicate ascending infection from vagina or urinary tract which may lead to preterm birth.

Active-comparator restricted disproportionality analysis for pharmacovigilance signal detection studies of chronic disease medications: An example using sodium/glucose cotransporter 2 inhibitors.

Disproportionality analysis is a common pharmacovigilance tool to detect safety signals of type 2 diabetes medications from spontaneous drug reporting databases. The aim was to demonstrate the impact of using active-comparator restricted disproportionality analysis (ACR-DA), wherein the reference group is restricted to reports with a clinically appropriate active comparator. Using reports from the Food and Drug Administration Adverse Event Reporting System, we assessed if sodium/glucose cotransporter 2 (SGLT2) inhibitors are associated with higher reporting of 5 potential adverse events: acute kidney injury, genitourinary tract infections, diabetic ketoacidosis, fractures, and amputations. For each adverse event, we calculated the proportional reporting ratio (PRR) and adjusted reporting odds ratio (aROR [95% confidence interval, CI]) using 3 types of reference groups: no SGLT2 inhibitor (background risk reference), other diabetes drugs (therapeutic class reference), and dipeptidyl peptidase 4 inhibitors (active comparator reference). Based on ACR-DA, we did not detect a safety signal for acute kidney injury (PRR 0.92 [0.81-1.04]; aROR 0.78 [95% CI 0.72-0.85]) or fractures (PRR 0.44[95% CI 0.17-1.15]; aROR 0.74 [95% CI 0.61-0.91]) associated with SGLT2 inhibitors compared to dipeptidyl peptidase 4 inhibitors. However, we detected safety signals for genitourinary tract infections (PRR 2.75[2.02-3.76]; aROR 2.54[2.26-2.86], diabetic ketoacidosis (PRR 63.85[39.37-103.53; aROR 91.49[70.66-118.48]), and amputations (PRR 52.60 [19.66-140.75]; aROR 22.64 [15.32-33.42]. The use of the proposed ACR-DA to detect safety signals of type 2 diabetes medications may reduce false positive safety signals through careful selection of the comparator which is expected to reduce channelling bias.

“A STUDY OF ETIOLOGICAL PREVALENCE OF INFECTIONS IN DIABETES MELLITUS PATIENTS IN A TERTIARY CARE HOSPITAL”

BACKGROUND: Infection is still the most common cause of morbidity and mortality in patients with Diabetes in our country. Many common infections are polymicrobial in Diabetic patients,So heightened sense of awareness about these infections will lead to early diagnosis and subsequent treatment of these potential life threatening infections,for better prognosis and also to avoid high degree of Drug resistance in them. AIM:To study the etiological agent and its responsible for the prevalence of infections in Diabetes mellitus patients. MATERIALS AND METHODS: A Hospital based observational prospective study was conducted in the department of general medicine in santhiram medical college and general hospital for 6 months,50 Diabetic patients attending patient in the department of general medicine and relevant investigations done and assessed the etiological agent responsible for prevalence of infections in diabetes mellitus patients. RESULTS: rd th Out of 50 Patients studied,the majority of the group belonged to the 3 and 4 decade which shows that Diabetes with infections are more prevalent in the middle aged people in this study. Soft tissue infections,being the commonest of the infections contributed,37% of the total patients in the study, followed by respiratory infections 30% , genitourinary infections 20% and a very small group of GI infections 7%. Nervous system infections and infections of blood infections constituted a minority of 3% and 4% respectively. CONCLUSION : rd Infections in diabetes are more in the 3 and 4 th decades. Soft tissue infections, respiratory tract infections, and genitourinary infections are more prevalent in diabetics in that order

Maternal infection during pregnancy and the risk of attention-deficit/hyperactivity disorder in the offspring: A systematic review and meta-analysis.

The effects of maternal infection during pregnancy on the risk of attention-deficit/hyperactivity disorder (ADHD) in the offspring are unclear, and no overview is available. We searched the PubMed and EMBASE databases for relevant studies and performed a systematic review and meta-analysis of the literature. We found that that maternal infection during pregnancy was associated with a small increase in the risk of ADHD (OR 1.25, 95% CI 1.09, 1.44, P<0.0001; I2 = 92.9%, p<0.0001) in the offspring. In subgroup analyses, the association remained for maternal genitourinary (GU) infection (OR, 1.19, 1.12, 1.27, P<0.001; I2 = 0%; p=0.517). However, there was no significant association when we pooled data from siblings from other pregnancies (OR = 1.06, 95% CI, 0.99-1.13, P=0.084; I2 = 0%; p=0.859), implying that the association was due to confounding. The statistically significant association between maternal infection during pregnancy and ADHD in the offspring can be partially explained by unmeasured confounding.

COVID-19-Associated Mental Health Impact on Menstrual Function Aspects: Dysmenorrhea and Premenstrual Syndrome, and Genitourinary Tract Health: A Cross Sectional Study among Jordanian Medical Students.

The physiology of reproduction is affected by psychological distress through neuroendocrine pathways. Historically, COVID-19 is one of the most stressful events with devastating consequences. This research aims to investigate the relationship between dysmenorrhea, PMS, and reproductive tract health on one hand, and COVID-19-related anxiety, depression, and stress on the other among medical students in Jordan. Medical students were invited through teaching platforms and social media to complete an online survey. SPSS software was used to analyze data. A total of 385 medical students participated in this research. Hence, 49.9% of the study population reported severe dysmenorrhea during COVID-19 compared to 36.9% before COVID-19 (p = 0.000). Dysmenorrhea was significantly associated with disruptions of sport and daily activities during COVID-19 (p = 0.015 and p = 0.002, respectively). The prevalence of PMS components, e.g., mastalgia, fatigue, headache, palpitation, and emotional and sleep disturbances, was raised during COVID-19 compared with before (p < 0.05). Symptoms of genitourinary tract infections, such as lower abdominal pain, vaginal discharge, genitalia rash/ulcers and itching, and urgency, were significantly increased after COVID-19 (p < 0.05). Positive Pearson correlations between COVID-19-associated mental health disorders and dysmenorrhea severity, PMS, and genital tract health abnormalities were observed (p < 0.05). The multiple linear regression model revealed that dysmenorrhea severity, PMS symptoms like palpitation, and genitourinary symptoms like lower abdominal pain and urgency were associated with worsening of depression, while dysuria was associated with a protective effect against depression. Moreover, it was observed that dysmenorrhea severity, PMS symptoms, such as headache and palpitation, and urinary urgency were associated with aggravation of anxiety. However, food craving and dysuria were protective against anxiety. Finally, dysmenorrhea severity, PMS symptoms of headache and palpitation, lower abdominal pain, and urgency were related to worsening of stress, whereas the premenstrual symptom of breast pain was a protective factor against stress. This work showed that COVID-19 pandemic-related psychological distress and menstrual, premenstrual, and genitourinary symptoms are closely related. Further future work is required to evaluate the long lasting-effects of the pandemic on mental health and the physiology of reproduction.

Maternal and neonatal outcomes of vaginal examination frequency during labor

Our aim to conduct the descriptive study was to determine the maternal and neonatal outcomes of frequent vaginal examinations during labor. Data were collected in the first 24 hours, between days 2-5, in week 2 and in week 6 after the birth. No statistically significant correlation was observed between the frequency of vaginal examinations and the development of genitourinary or neonatal infections. On the other hand, it was seen that being a primipara were risk factors for a woman’s developing a genitourinary infection while an increase in the number of personnel performing the vaginal examination was a risk factor for a neonatal infection.

Vitamin C for\u2009\u2265\u20095\xa0days is associated with decreased hospital mortality in sepsis subgroups: a nationwide cohort study

BackgroundPrevious randomized trials of vitamin C, hydrocortisone, and thiamine on sepsis were limited by short-term vitamin C administration, heterogeneous populations, and the failure to evaluate each component’s effect. The purpose of this study was to determine whether vitamin C alone for ≥ 5 days or in combination with corticosteroids and/or thiamine was associated with decreased mortality across the sepsis population and subpopulation.MethodsNationwide population-based study conducted using the Korean National Health Insurance Service database. A total of 384,282 adult patients with sepsis who were admitted to the intensive care unit were enrolled from January 2017 to December 2019. The primary outcome was hospital mortality, while the key secondary outcome was 90-day mortality.ResultsThe mean [standard deviation] age was 69.0 [15.4] years; 57% were male; and 36,327 (9%) and 347,955 did and did not receive vitamin C, respectively. After propensity score matching, each group involved 36,327 patients. The hospital mortality was lower by − 0.9% in the treatment group (17.1% vs 18.0%; 95% confidence interval, − 1.3 to − 0.5%; p < 0.001), a significant but extremely small difference. However, mortality decreased greater in patients who received vitamin C for ≥ 5 days (vs 1–2 or 3–4 days) (15.8% vs 18.8% vs 18.3%; p < 0.001). Further, vitamin C was associated with a lower hospital mortality in patients with older age, multiple comorbidities, pneumonia, genitourinary infection, septic shock, and mechanical ventilation. Consistent findings were found for 90-day mortality. Moreover, vitamin C alone or in combination with thiamine was significantly associated with decreased hospital mortality.ConclusionsIntravenous vitamin C of ≥ 5 days was significantly associated with decreased hospital and 90-day mortality in sepsis patients. Vitamin C combined with corticosteroids and/or thiamine in specific sepsis subgroups warrants further study.

Identification and Antifungal Resistance among Candida species from the Genitourinary Tract

Background: Candida species are reportedly the most common human fungal pathogens. The incidence of urinary tract infections (UTIs) caused by Candida pathogens has increased in recent decades. However, such infections rarely occur in the absence of any predisposing factors. Aim: The aim of the present study was to identify the Candida species causing UTIs and to determine the antifungal resistance among Candida species from the genitourinary tracts. Methods: Five hundred (500) midstream urine samples were collected between January 2021 to January, 2022 from male and female patients clinically diagnosed of genitourinary tract infection and inoculated onto Sabouraud dextrose agar (SDA). Isolates from SDA were plated on CHROMagar to ensure detection of mixed cultures. Germ tube and carbohydrate assimilation tests performed were necessary for isolate identification. Susceptibility testing was carried on the isolates using broth dilution method. Results: Distribution of Candida species among different age groups showed the highest incidence in age brackets 30-45, followed by 45-60, while the ages of 0-15 had the least. The occurrence rate of Candida species were as follows: Candida albicans 173(65.5%), Candida glabrata 61(23.1%), Candida krusei 19(7.2%) and Candida tropicalis 11(4.2%). High rate of susceptibility was observed for each isolate against fluconazole (92.0%) and ketoconazole (93.9%). The resistance rate was low for fluconazole (8.0%) and ketoconazole (1.2%). Conclusions: These results incriminated C. albicans as the most common Candida species causing genitourinary tract infection in women. This surveillance study has established fluconazole and ketoconazole as very effective antifungal agents for the treatment of genitourinanry tract infections caused by Candida species.

Incidence and Factors Associated With Genitourinary Infections Among Patients With Type 2 Diabetes Mellitus on SGLT2 Inhibitors: A Single Retrospective Cohort Study

Incidence and Factors Associated With Genitourinary Infections Among Patients With Type 2 Diabetes Mellitus on SGLT2 Inhibitors: A Single Retrospective Cohort Study

Prevalência de doenças durante a gravidez em uma grande amostra sul-americana não selecionada

Our aim was to describe the prevalence of diseases during pregnancy and the association between fetal exposure to the most frequent maternal diseases and the risk of preterm (PTB) and/or small for gestational age (SGA) newborns in an unselected sample of women who gave birth in South American countries. We conducted a descriptive, cross-sectional study including 56,232 mothers of non-malformed infants born between 2002 and 2016, using data from the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Diseases with higher- than-expected PTB/SGA frequencies were identified. Odds ratios of confounding variables for diseases and birth outcomes were calculated with a multivariable logistic regression. Of the 14 most reported diseases, hypertension, genitourinary infection, epilepsy, hypothyroidism, diabetes, and HIV/AIDS showed higher PTB and/or SGA frequencies. Advanced and low maternal age, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with PTB, while advanced maternal age, primigravidity, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with SGA. After adjusting for the associated variables, the identified illnesses maintained their association with PTB and all, except epilepsy, with SGA. The description of an unselected population of mothers allowed identifying the most frequent diseases occurring during gestation and their impact on pregnancy outcomes. Six diseases were associated with PTB and two with SGA newborns. To the best of our knowledge, there are no similar reports about women not intentionally selected by specific diseases during pregnancy in South American populations.

Prediction model for gonorrhea, chlamydia, and trichomoniasis in the emergency department.

History and physical examination findings can be unreliable for prediction of genitourinary tract infections and differentiation of urinary tract infections from sexually transmitted infections (STIs). The study objective was to develop a prediction tool to more accurately identify patients with STIs. A retrospective review of 64,490 emergency department (ED) encounters between April 18, 2014, and March 7, 2017, where patients age 18 years or older had urinalysis and urine culture or testing for gonorrhea, chlamydia, or trichomonas, was used to develop a prediction model for men and women with Neisseria gonorrhoeae or Chlamydia trachomatis, or both, and for women with Trichomonas vaginalis. The data set was randomly divided into two-thirds discovery and one-third validation. Groups were assigned through a random number generator. Backward step regression modeling was used to identify the best model for each outcome. With use of age, race, marital status, and findings from vaginal wet preparation (white blood cells [WBCs], clue cells, and yeast) and urinalysis (squamous epithelial cells, protein, leukocyte esterase, and WBCs), the models had areas under the receiver operating characteristic curve of 0.80 for men with N gonorrhoeae or C trachomatis, or both; 0.75 for women with N gonorrhoeae or C trachomatis, or both; and 0.73 for women with T vaginalis. The model estimated likelihood of ED patients having STIs was reasonably accurate with a limited number of demographic and laboratory variables. In the absence of point-of-care STI testing, use of a prediction tool for STIs may improve antimicrobial stewardship.

A case of obstructive azoospermia secondary to genitourinary tract infection caused by a prostatic utricle cyst

A case of obstructive azoospermia secondary to genitourinary tract infection caused by a prostatic utricle cyst

Terrible trio of Mycobacterium abscessus, Candida parapsilosis and Carbapenem resistant Klebsiella pneumoniae in a patient with cirrhosis

Background: Cirrhosis is an immunocompromised state which makes the host susceptible to infections of varied etiology. Mycobacterium abscessus has been implicated to cause respiratory infections in patients with underlying pulmonary diseases and also extrapulmonary infections like endocarditis, bacteremia, genitourinary, skin and soft tissue infections. There is only one report of M abscessus infection in cirrhosis in literature.

POSA331 Patient Preferences for Diabetes Management in Spain - A Discrete Choice Experiment

To describe the preferences of individuals with diabetes mellitus (DM) for the attributes of DM medications in Spain. The project was conducted in four phases (A-D). Firstly, in phase A, a Steering Committee reviewed, selected, and validated a total of 18 attributes and its corresponding levels for treating DM. The attributes were classified into four categories: health outcomes, adverse events, treatment characteristics and cost of treatment. Secondly, in phase B, a questionnaire based on Discrete Choice Experiment (DCE) methodology was developed. Subsequently, in phase C, adult people with DM members of associations of DM, were asked to complete an online DCE survey between May and September 2020. Finally, in phase D, the results obtained were analysed and contextualized in a deliberative process. Of the 238 participants who completed the questionnaire, 231 were analysed (mean age, 58 years; males, 62%; mean HbA1c level, 7.00%). The DCE results showed that the best-valued category was health outcomes (39.67%), followed by adverse events (26.85%), treatment characteristics (21.70%) and treatment costs (11.77%). The 10 attributes with the highest relative importance value had a significant effect on participants’ choice (p<0.05): blood pressure reduction (12.82%), hypoglycaemia (12.77%), HbA1c level reduction (8.54%), cost of the medication (8.13%), needle/tablet size (7.20%), weight change (6.72%), risk of genitourinary infections (6.36%), gastrointestinal problems (5.82%), improved kidney function (5.53%) and administration route (5.41%). People with DM prefer a treatment that generates benefits in measurable health effects (reducing blood pressure and HbA1c level, while not risking hypoglycaemia) and an administration route. To consider patients’ preference, above all in people with chronic pathologies could generate better clinical results and therapeutic adherence, reducing morbidity, mortality, and disease burden and improving their quality of life.

Предикторы формирования хронической диареи у детей раннего возраста

Chronic diarrhea in young children requires long multi-stage diagnosis, which often results in delayed therapy and, as a consequence, poorer quality of life. Objective. To identify risk factors for chronic diarrhea in young children. Patients and methods. This study included 70 children with chronic diarrhea and 70 healthy children matched for main characteristics. Results. We identified the following predictors of chronic diarrhea in young children: chronic genitourinary infections during pregnancy, Cesarian section, late initiation of breastfeeding, early initiation of formula feeding, and antibacterial therapy in the neonatal period. Family history of food intolerance and allergic diseases were also found to be significant risk factors for chronic diarrhea in young children (food-dependent forms of diarrhea). Key words: chronic diarrhea, young children, risk factors

Association of chronic spontaneous urticaria and Chlamydia trachomatis genitourinary infection in men: A case control observational study

Association of chronic spontaneous urticaria and Chlamydia trachomatis genitourinary infection in men: A case control observational study

Assessment of the Urinary Microbiota of MSM Using Urine Culturomics Reveals a Diverse Microbial Environment.

The urinary tract is not sterile and is populated by microbial communities that influence urinary health. Men who have sex with men (MSM) are understudied yet have increased risk factors for genitourinary infections. Our objective was to interrogate the composition of MSM urinary microbiota. Midstream urine specimens (n = 129) were collected from MSM (n = 63) and men seen for routine care (clinical cohort, n = 30). Demographics and sexual/medical history were documented. Specimens underwent culture using standard-of-care and enhanced methods designed to isolate fastidious and anaerobic microorganisms. Isolates were identified by MALDI-TOF mass spectrometry or 16S rRNA gene sequencing. The MSM cohort was younger (mean (SD), 35.4 (11.26) years) compared to the clinical cohort (62.7 (15.95) years). Organism recovery was significantly increased using enhanced vs standard culture for the MSM (mean of 9.1 vs 0.6 species/sample [P < 0.001]) and clinical (7.8 vs 0.9 species/sample [P < 0.001]) cohorts. The microbial composition of MSM urine specimens was dominated by Gram-positive and anaerobic microbes and clustered distinctly from that of clinical urine specimens. Composition of microbial species recovered within the same subject was dynamic between urine specimens but more similar relative to inter-individual comparisons. Principal coordinate analysis showed no correlation between urinary microbiota composition and age, recent antibiotic use, sexually transmitted infection/HIV status, or sexual practices. Enhanced culture recovered a large diversity of microbial species from MSM urine specimens, especially taxa typically associated with mucosal surfaces. These findings may increase understanding of urologic disease in MSM and improve diagnostic methods for detection of genitourinary infections.

Home-hospital care for children with acute illnesses: A 2-year follow-up study.

Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3-9.5). Seventy-five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty-six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per-day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. Paediatric HAH programmes are a feasible, cost-effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.

Effects of Low-Load Blood-Flow Restricted Resistance Training on Functional Capacity and Patient-Reported Outcome in a Young Male Suffering From Reactive Arthritis.

Introduction: Reactive arthritis (ReA) is a chronic inflammatory disease usually caused by a preceding gastrointestinal or genitourinary bacterial infection. ReA usually occurs in the lower limbs causing joint pain and joint swelling. Physiotherapy-led exercise is recommended to prevent muscle atrophy. The purpose of this case report is to describe the outcome after 12 weeks of low-load blood flow restricted resistance training (BFR-RT) as a rehabilitation method for a young male suffering from ReA.Methods and materials: A 17-year-old male suffered from ReA in the both knee joints and the left hip joint. 36 months after the incident, he suffered from another ReA incident in his right knee. Non-steroid anti-inflammatory drugs and a new arthrocentesis added with corticosteroid injection was unsuccessful in treating the ReA. The patient performed 12 weeks of BFR-RT on the right lower limb with a low amount of supervision after the first week of training. Assessment of unilateral 30-sec chair stand test (u30-sec CST), low-thigh circumference above apex patella, The Knee Injury and Osteoarthritis Outcome Score (KOOS), The Forgotten Knee Joint Score (FJS), and Numeric Ranking Scale for pain (NRS) was performed at baseline and after 3,6,9, and 12 weeks of BFR-RT.Results: The patient completed all planned exercise sessions. u30-sec CST improved with 7 repetitions (reps) on the right limb and 5 reps on the left leg. Low-thigh circumference decreased 1.1 cm on the right leg and 1.0 on the left leg. KOOS symptoms, ADL, quality of life and FJS demonstrated a clinically relevant change on 10, 14 and 23 points.Conclusion: The present case study indicates that even with low amounts of supervision BFR-RT could increase functional performance, reduce knee joint swelling and improve key patient-reported outcome.