Higher Incidence Of Hospitalization Research Articles

Efficacy of Intravenous Ferric Carboxymaltose in Heart Failure Patients with Iron Deficiency Anemia: A Meta-analysis of 6271 Patients.

Iron deficiency is prevalent among heart failure patients and is associated with worse clinical outcomes, including decreased quality of life and functional capacity. This condition often results in a higher incidence of hospitalization and mortality. Iron supplementation, particularly with intravenous ferric carboxymaltose (FCM), has shown potential benefits as an adjunct therapy in heart failure management. This study aims to evaluate the efficacy of FCM in the treatment of patients with heart failure and iron deficiency anemia, with a focus on its impact on mortality and hospitalization rates. A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases from their inception until 1st December 2023. Meta-analysis was performed using RevMan 5.4, employing a random-model effect. The results were reported as risk ratios (RRs), standard mean differences (SMDs), and 95 % confidence intervals (CIs). The meta-analysis included 13 studies with a total of 6271 patients. Ferric carboxymaltose administration resulted in a significant improvement in the 6-minute walk distance (SMD: 1.45; 95 % CI: 0.55, 2.36; p = 0.002), quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) (SMD: 1.49; 95 % CI: 0.87, 2.11; p < 0.00001), the rate of first hospitalization for heart failure or cardiovascular death (RR: 0.91; 95 % CI: 0.84, 0.98; p = 0.02). However, FCM did not show a significant impact on the risk of cardiovascular death (RR: 0.90; 95 % CI: 0.77, 1.05; p = 0.17), the need for intervention due to worsening heart failure (RR: 0.41; 95 % CI: 0.04, 4.51; p = 0.47), or all-cause mortality rates (RR: 0.89; 95 % CI: 0.69, 1.16; p = 0.28). While FCM treatment in patients with heart failure and iron deficiency anemia significantly improves functional capacity and quality of life, it has no notable effect on mortality rates or the likelihood of hospitalization. These findings highlight the need for further research to explore comprehensive treatment strategies that address both the symptomatic and survival aspects of heart failure management in this patient population.

Effects of Nasal Solution Incorporating Resveratrol and Carboxymethyl-Β-Glucan in Preschool Non-Atopic Children with Wheezing.

Upper respiratory tract infections (URTI) account for more than 80% of wheezing episodes in children with a high incidence of hospitalization in preschool age. Most children with symptoms of wheezing during an URTI are usually non-atopic. As the majority of wheezing episodes resulting from URTI are attributed to viral triggers, several studies have suggested the potential anti-inflammatory and antiviral properties of resveratrol. This study aims to identify the effect of resveratrol for pediatric non-atopic patients with recurrent wheezing triggered by URTIs. We conducted a prospective single-blind study to assess the effectiveness of a short course of nasal solutions incorporating resveratrol and carboxymethyl-β-glucan, administered for 7 days at the onset of URTIs, compared to standard nasal lavage with 0.9% saline solution. A total of 19 patients entered the active group, 20 patients were assigned to the placebo group. The comparison of overall wheezing days (p < 0.001), mean wheezing days per month (p < 0.01), and wheezing episodes per patient (p < 0.001) in the two groups showed a significant reduction in the group receiving resveratrol compared with the placebo group, with less hospital access (p < 0.001) and oral corticosteroid administration (p < 0.01). Our findings seem to suggest that, in non-atopic children with recurrent wheezing secondary to URTIs, nasal resveratrol could be effective to prevent or reduce the occurrence of wheezing, when started from the onset of upper airway symptoms.

Childhood poisoning: a 10-year experience in a tertiary hospital in Enugu State, Nigeria

Childhood Poisoning is a common cause of emergency room presentation, more so in underdeveloped countries where it contributes to a high incidence of hospitalization with variability in morbidity and mortality. This study retrospectively assessed the sociodemographic profiles, poisoning agents, clinical features and management of cases of childhood poisoning admitted at Enugu State University Teaching Hospital, Enugu. It was a 10-year retrospective study of all the cases of childhood poisoning admitted within the period of study at the Children’s Emergency Room of Enugu State University Teaching Hospital (ESUTH), Enugu. The prevalence of childhood poisoning in the study was 0.3%. Of all the subjects, 78.4% were ≤5 years and more than half were males and from lower socioeconomic classes. Accidental poisoning accounted for 70.3%; the predominant agents were kerosene and organophosphates. Palm oil was used by 67.6% of the participants as an intervention before presentation. Pneumonitis was the most common complication. Patients with peripheral oxygen saturation (SpO2) &lt; 95% were 14 times more likely to have complications than those with SpO2 ≥ 95%. The duration of hospital stay was ≤3 in 59% of the cases and no mortality was recorded in this study.Childhood poisoning remains prevalent in our environment with kerosene being the commonest agent. Palm oil administration as a predominant pre-hospital intervention worsens outcomes. Duration of hospitalization depends on SpO2 at presentation, need for antibiotic therapy, and intention.

Association between adverse outcomes of hepatitis A and acetaminophen use: A population-based cohort study.

Acetaminophen (APAP) may cause acute liver injury with therapeutic doses in high-risk conditions such as chronic alcohol consumption or malnutrition. In acute hepatitis A (AHA), however, the safety of APAP has not been fully established. This study examined the potential association between APAP use and clinical outcomes of AHA in a nationwide and hospital-based cohort. Adult patients with AHA were identified from claims data of South Korean national healthcare insurance between 2008 and 2016 (n=43,500). Logistic regression models were used to compare the risk of adverse outcomes (renal replacement therapy, hepatic encephalopathy and/or brain edema, mechanical ventilation, and liver transplantation) in patients exposed to APAP against control and patients exposed to NSAIDs. A propensity score (PS)-matched hospital-based AHA cohort (n=146) was assessed for biochemical profiles after exposure to APAP or NSAIDs. AHA patients were exposed to APAP or NSAIDs in 26.4% and 11.5% of cases, respectively. Compared to NSAID treatment, APAP exposure was associated with a higher incidence of hospitalization (98.8% vs. 92.4%; p<0.0001). APAP exposure was independently associated with increased adverse outcomes (odds ratio [OR]=5.66, p<0.0001 against control; OR =1.67, p=0.0015 against NSAIDs). PS-matched hospital cohort showed higher peak serum bilirubin levels (7.0vs. 5.3mg/dL; p=0.03) and a longer time to recovery of jaundice after APAP use than with NSAID use. APAP exposure was associated with increased adverse outcomes in a nationwide AHA cohort.

P.033 COVID-19: neurologic and cardiac complications among Chinese and South Asians in Ontario: waves 1-3

Background: This is a population-based retrospective study of neurologic and cardiac complications of COVID-19 among Chinese and South Asians in Ontario during waves 1-3. Methods: Chinese and South Asians with COVID-19 were identified using a validated surname algorithm and their outcomes of mortality, and cardiac and neurologic complications with those of the general population using multivariable logistic regression models. Results: Compared to the general population (n= 439,977), the Chinese population (n= 15,208) was older (mean age 44.2 vs 40.6 years, P &lt; 0.001) and the South Asian population (n= 46,333) was younger (39.2 years, P &lt; 0.001). The Chinese population had a higher 30-day mortality (odds ratio [OR] 1.44; 1.28-1.61) and more hospitalization or emergency department visits(OR 1.14; 1.09-1.28), with a trend toward a higher incidence of cardiac complications (OR 1.03; 0.87-1.12) and neurologiccomplications (OR 1.23; 0.96-1.58). South Asians had a lower 30-day mortality (OR 0.88; 0.78-0.98) but a higher incidence of hospitalization or emergency department visits (OR 1.17; 1.14-1.20) with a trend toward a lower incidence of cardiac complications(OR 0.76; 0.67-0.87) and neurologic complications (OR 0.89; 0.73-1.09). Conclusions: Ethnicity continues to be an important determinant of mortality, cardiac and neurologic outcomes, and healthcare use among Ontario patients with COVID-19.

Sarcopenia and Multisensory Integration Deficit in Post-COVID Syndrome Patients: The Clinical, Ultrasound and Robotic Evaluation Protocol in a Cross-sectional Study.

Post-COVID syndrome affects relatively young outpatients with fatigue as the mostly reported symptom. We wondered whether sarcopenia could play a role. Seventy-four outpatients (median age: 53.8 yrs, 45 females), reporting fatigue and persistent mild neurological/motor deficits, completed the Clinical, Ultrasound and Robotic Evaluation protocol 4.8 mos after the infection. The incidence of sarcopenia was 41%. Sarcopenic patients were older (62.7 vs. 46.4 yrs, P < 0.001), they experienced longer infection (33 vs. 24 days, P = 0.006) and higher incidence of hospitalization (86.6 vs. 29.5%, P < 0.001), they did not report more fatigue (44.5 vs. 48, P = 0.424), but they walked slower (1.27 vs. 1.5 m/sec, P = 0.027).After multivariable adjustment using multiple logistic regression, sarcopenia was dependent on age (odds ratio = 1.09) and on the duration of the disease (odds ratio = 1.04).When expressed as z score, in 79% of patients, the sway path during elastic balance shifted significantly toward negative values with closed eye, indicating multisensory integration deficit. Post-COVID syndrome in relatively young outpatients complaining mild motor deficit is associated with high incidence of sarcopenia. In addition, they have multisensory integration deficit that further contributes to symptoms. The Clinical, Ultrasound and Robotic Evaluation protocol is able to objectivize symptoms that common diagnostic tool cannot reveal. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Determine the best diagnostic algorithm for the diagnosis of sarcopenia; (2) Identify and treat two additional factors that help to explain and understand the symptoms reported by relatively young post-COVID syndrome patients; and (3) Extend their diagnostic capability through the use of technology. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Association between clinical measures of unhealthy alcohol use and subsequent year hospital admissions in a primary care population

BackgroundScreening for unhealthy alcohol use in primary care may help identify patients at risk for negative health outcomes. AimsThis study examined the associations between 1) screening with the AUDIT-C (alcohol consumption) and 2) an Alcohol Symptom Checklist (symptoms of alcohol use disorder) and subsequent-year hospitalizations. MethodsThis retrospective cohort study was conducted in 29 primary care clinics in Washington State. Patients were screened in routine care (10/1/2016–2/1/2019) with the AUDIT-C (0−12) and administered the Alcohol Symptom Checklist (0−11) if they had AUDIT-C score ≥ 7. All-cause hospitalizations were measured within 1 year of the AUDIT-C and Alcohol Symptom Checklist. AUDIT-C and Alcohol Symptom Checklist scores were categorized based on previously used cut-points. FindingsOf 305,376 patients with AUDIT-Cs, 5.3% of patients were hospitalized in the following year. AUDIT-C scores had a J-shaped relationship with hospitalizations, with risk for all-cause hospitalizations higher for patients with the AUDIT-C scores 9–12 (12.1%; 95% CI: 10.6–13.7%, relative to a comparison group of those with AUDIT-C scores 1–2 (female)/1–3 (male) (3.7%; 95% CI: 3.6–3.8%), adjusted for socio-demographics. Patients with AUDIT-C ≥ 7 and Alcohol Symptom Checklist scores reflecting severe AUD were at increased risk of hospitalization (14.6%, 95% CI: 11.9–17.9%) relative to those with lower scores. ConclusionsHigher AUDIT-C scores were associated with higher incidence of hospitalizations except among people with low-level drinking. Among patients with AUDIT-C ≥ 7, the Alcohol Symptom Checklist identified patients at increased risk of hospitalization. This study helps demonstrate the potential clinical utility of the AUDIT-C and Alcohol Symptom Checklist.

Temporal-spatial analysis of hospitalizations for bronchiolitis in Brazil: prediction of epidemic regions and periods for immunization against the Respiratory Syncytial Virus.

Due to the high cost and short term of passive immunization against the respiratory syncytial virus, the main virus causing acute viral bronchiolitis, predicting epidemic regions and epidemic months is extremely important. The objective of this study is to identify both the month when the seasonal peak begins and Brazilian regions and states with the highest incidence of monthly hospitalizations due acute viral bronchiolitis. Based on data obtained from DATASUS, monthly hospitalization rates due acute viral bronchiolitis were calculated for every 10,000 live births to children under 12 months of age in all Brazilian states and the Federal District between 2000 and 2019. Seasonal autoregressive integrated moving average models were estimated to forecast monthly hospitalization rates in 2020. A higher incidence of hospitalizations was found for male children, especially under six months of age. As for Brazilian regions, between 2000 and 2019, the South region registered the highest incidence of hospitalizations, followed by the Southeast, Midwest, North and Northeast regions, in this order. Considering the seasonal peak, the period between March and July 2020 comprised the highest expected hospitalization rates. Palivizumab is suggested to be started between February/March and June/July for most Brazilian states, with the exception of Rio Grande do Sul, which, in addition to presenting the highest rates of hospitalizations for acute viral bronchiolitis per 10,000 live births, has the longest seasonal peak between May and September.

Hospitalization, death, and probable reinfection in Peruvian healthcare workers infected with SARS-CoV-2: a national retrospective cohort study

BackgroundPeru has some of the worst outcomes worldwide as a result of the SARS-CoV-2 pandemic; it is presumed that this has also affected healthcare workers. This study aimed to establish whether occupation and other non-occupational variables were risk factors for possible reinfection, hospitalization, and mortality from COVID-19 in cohorts of Peruvian healthcare workers infected with SARS-CoV-2.MethodsRetrospective cohort study. Healthcare workers who presented SARS-CoV-2 infection between March 1, 2020, and August 6, 2021, were included. Occupational cohorts were reconstructed from the following sources of information: National Epidemiological Surveillance System, molecular tests (NETLAB), results of serology and antigen tests (SICOVID-19), National Registry of Health Personnel (INFORHUS), and National Information System of Deaths (SINADEF). The incidence of probable reinfection, hospitalization, and death from COVID-19 was obtained in the cohorts of technicians and health assistants, nursing staff, midwives, dentists, doctors, and other healthcare workers. We evaluated whether the occupation and other non-occupational variables were risk factors for probable reinfection, hospitalization, and death from COVID-19 using log-binomial and probit binomial models, obtaining the adjusted relative risk (RRAJ).Results90,398 healthcare workers were included in the study. Most cases were seen in technicians and health assistants (38.6%), and nursing staff (25.6%). 8.1% required hospitalization, 1.7% died from COVID-19, and 1.8% had probable reinfection. A similar incidence of probable reinfection was found in the six cohorts (1.7–1.9%). Doctors had a higher incidence of hospitalization (13.2%) and death (2.6%); however, they were also those who presented greater susceptibility linked to non-occupational variables (age and comorbidities). The multivariate analysis found that doctors (RRAJ = 1.720; CI 95: 1.569–1.886) had a higher risk of hospitalization and that the occupation of technician and health assistant was the only one that constituted a risk factor for mortality from COVID-19 (RRAJ = 1.256; 95% CI: 1.043–1.512).ConclusionsPeruvian technicians and health assistants would have a higher risk of death from COVID-19 than other healthcare workers, while doctors have a higher incidence of death probably linked to the high frequency of non-occupational risk factors. Doctors present a higher risk of hospitalization independent of comorbidities and age; likewise, all occupations show a similar risk of probable reinfection.

Hereditary spherocytosis before and after splenectomy and risk of hospitalization for infection.

The infectious burden in hereditary spherocytosis (HS) children before splenectomy has rarely been reported and the risk of severe postsplenectomy infection is controversial. We conducted a retrospective study of pediatric patients with HS to evaluate the risk of infection presplenectomy and postsplenectomy. The primary outcome was any bacterial, Mycoplasma, or fungal infection that required hospitalization. The secondary outcomes were sepsis and septic shock. Appendectomized children were matched on age at surgery and enrolled as controls. In all, 232 patients were included. Before splenectomy, the primary outcome was identified in 51 (22.0%) patients, and the secondary outcome was identified in 1 (0.4%) patient. After splenectomy, the primary and secondary outcomes were detected in 8 (4.1%) and 1 (0.5%) patients, respectively. The risk of infection was higher presplenectomy than postsplenectomy (OR, 6.6; 95% CI, 3.0-14.2). HS patients had a higher risk of infection than the controls before surgery (OR, 3.7; 95% CI, 2.3-5.9) but not after surgery (OR, 1.4; 95% CI, 0.6-3.6). HS patients who require splenectomy later in life had a high incidence of hospitalization for infections. In contrast, postsplenectomy risk of hospitalization involving infection or severe infection was low. Patients with hereditary spherocytosis who require splenectomy later in life have a high risk of hospital admission for infections, especially those with severe hereditary spherocytosis. With vaccines or postoperative antibiotics, splenectomy does not increase the risk of infection or severe infections. Splenectomy may reduce the risk of hospitalization for infections by alleviating the complications of hereditary spherocytosis. With vaccines, prophylaxis, or advanced antibiotics, the benefits of splenectomy in children with hereditary spherocytosis and a heavy disease burden may outweigh the risks.

Incidence and characteristics of stroke in Zanzibar-a hospital-based prospective study in a low-income island population.

BackgroundStroke in adults is a critical clinical condition and a leading cause of death and disability globally. Epidemiological data on stroke in sub-Saharan Africa are limited. This study describes incidence rates, stroke types and antecedent factors among patients hospitalized with stroke in Zanzibar.MethodsThis was a prospective, observational study of stroke patients at hospitals in Unguja, Zanzibar. Socioeconomic and demographic data were recorded alongside relevant past medical history, medicine use and risk factors. The modified National Institute of Health Stroke Scale (mNIHSS) was used to assess admission stroke severity and, when possible, stroke was confirmed by neuroimaging.ResultsA total of 869 stroke admissions were observed from 1st October 2019 through 30th September 2020. Age-standardized to the World Health Organization global population, the yearly incidence was 286.8 per 100,000 adult population (95%CI: 272.4–301.9). Among these patients, 720 (82.9%) gave consent to participate in the study. Median age of participants was 62 years (53–70), 377 (52.2%) were women, and 463 (64.3%) had a first-ever stroke. Known stroke risk factors included hypertension in 503 (72.3%) patients, of whom 279 (55.5%) reported regularly using antihypertensive medication, of whom 161 (57.7%) had used this medication within the last week before stroke onset. A total of 460 (63.9%) participants had neuroimaging performed; among these there was evidence of intracerebral hemorrhage (ICH) in 140 (30.4%). Median stroke severity score using mNIHSS was 19 (10–27).ConclusionZanzibar has high incidence of hospitalization for stroke, indicating a very high population incidence of stroke. The proportion of strokes due to ICH is substantially higher than in high-income countries. Most stroke patients had been in contact with health care providers prior to stroke onset and been diagnosed with hypertension. However, few were using antihypertensive medication at the time of stroke onset.www.ClinicalTrial.gov registration NCT04095806.

Epidemiology of COVID-19 and Its Cardiac and Neurologic Complications Among Chinese and South Asians in Ontario: Waves 1, 2, and 3

BackgroundAlthough we had previously reported the cardiac and neurologic outcomes of Chinese and South Asian Ontarians in wave 1 of COVID-19, data on subsequent waves of COVID-19 remain unexamined. This is an extension study of this cohort in waves 2 and 3. MethodsWe identified adult Ontarians with a positive COVID-19 polymerase chain reaction test from January 1, 2020 to June 30, 2021, and they were classified as being Chinese or South Asian using a validated surname algorithm; we compared their outcomes of mortality, and cardiac and neurologic complications with those of the general population using multivariable logistic regression models. ResultsCompared to the general population (n = 439,977), the Chinese population (n = 15,208) was older (mean age 44.2 vs 40.6 years, P < 0.001) and the South Asian population (n = 46,333) was younger (39.2 years, P < 0.001). The Chinese population had a higher 30-day mortality (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.28-1.61) and more hospitalization or emergency department visits (OR, 1.14; 95% CI, 1.09-1.28), with a trend toward a higher incidence of cardiac complications (OR, 1.03; 95% CI, 0.87-1.12) and neurologic complications (OR, 1.23; 95% CI, 0.96-1.58). South Asians had a lower 30-day mortality (OR, 0.88; 95% CI, 0.78-0.98) but a higher incidence of hospitalization or emergency department visits (OR, 1.17; 95% CI, 1.14-1.20) with a trend toward a lower incidence of cardiac complications (OR, 0.76; 95% CI, 0.67-0.87) and neurologic complications (OR, 0.89; 95% CI, 0.73-1.09). There was also a significant difference in these outcomes between wave 1, 2 and 3, with a greater mortality in all groups in waves 2 and 3. ConclusionsEthnicity continues to be an important determinant of mortality, cardiac and neurologic outcomes, and healthcare use among patients with COVID-19, requiring further studies to understand factors driving these differences.

Outcomes of Minority COVID-19 patients managed with ECMO: A single-center experience.

BackgroundThe coronavirus disease 2019 (COVID‐19) pandemic has significantly burdened the global healthcare system since December 2019. Minority populations are found to have a higher incidence of hospitalization and higher mortality when compared to Caucasians. Extracorporeal membrane oxygenation (ECMO) is reserved for COVID‐19 patients who develop respiratory failure refractory to conventional management. To our knowledge, no data has been reported on outcome differences between Minority COVID‐19 patients and Caucasian COVID‐19 patients managed with ECMO. We aimed to investigate the outcome differences between these two groups.MethodsOur retrospective cohort study had 23 adults (aged 18 and older) diagnosed with COVID‐19 by polymerase chain reaction. All patients developed acute respiratory distress syndrome (ARDS), refractory to conventional treatment, and were managed on ECMO support. The primary outcome of interest was mortality; the secondary outcome was the rate of ECMO‐related complications.ResultsThe overall mortality rate of our study was higher (70%) than other reports of the COVID‐19 population on ECMO. Caucasians in our study had more severe respiratory acidosis with carbon dioxide retention and appeared to have a higher mortality rate of 85.7% compared to Minorities (62.5%). No differences in complication rates between these two groups were identified.ConclusionsOur cohort revealed a high overall mortality rate of COVID‐19 patients on ECMO support. The Caucasian group was observed to have higher mortality than the Minority group. The high overall mortality was likely attributed to the Caucasian group, which had more severe respiratory acidosis before ECMO initiation, a known predictor of poor prognosis in ARDS patients. Our cohort's ethnic composition may also partially explain the high mortality rate since COVID‐19 Minorities are reported to have worse outcomes than Caucasians. Larger and randomized studies are needed to investigate further the mortality and complication differences between Minority and Caucasian patients diagnosed with COVID‐19 and managed by ECMO.

The importance of prenatal dental care: a concise systematic review

Introduction: Prenatal dental care is extremely important, as it requires a series of specific care for pregnant patients. There is a need for specific care with the health of the mouth and informing the patient of essential care for her and her baby's health. Also, the microorganisms that cause these diseases can migrate to the uterus and cause premature births. Several studies show that dental care was considered safe for the mother and fetus throughout the entire period of pregnancy. Objective: To carry out a brief systematic review of the literature to elucidate the main considerations for success during the treatment of oral health in pregnant women. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 244 articles were found. A total of 76 articles were evaluated in full and 19 were included and evaluated in the present study. A total of 3 Studies with a High Risk of Bias and 1 Study with Uncertain Risk. Studies have suggested a protective effect of prenatal oral health care against the onset of caries in infancy and up to before 4 years of age. The transport of S. mutans in children was also significantly reduced in the intervention group. Children exposed to the use of maternal substances had a higher incidence of hospitalization for dental caries than unexposed children. Thus, inadequate prenatal education in oral health can negatively impact the quality of oral hygiene in children. It is imperative to develop strategies to improve oral health and develop a health system strengthening by interprofessional collaboration in the prenatal phase of pregnant women. Furthermore, an inverse relationship was observed between 25(OH)D levels and the number of decayed primary teeth. Conclusion: Taking care of oral health is part of the daily rhythm of personal hygiene. The monitoring of a dental surgeon during pregnancy is considered to prevent and treat the pregnant woman's oral diseases and clarify the doubts of future mothers since the baby's oral health begins to establish itself during the gestational period.

COVID-19s Impact on the Hispanic Community: How Understanding Culture Can Improve Outcomes

Background &#x0D; A disproportionate burden of SARS-Cov-2 infection, or coronavirus disease 2019 (Covid-19), and death are highest among racial and ethnic minority groups. Based on data available on June 12, 2020, Hispanic people are more likely to acquire COVID-19 and have higher incidence of hospitalization and death compared to their white, non-Hispanic counterparts. While this issue is complex, many have hypothesized that the difference is due to societal factors and communication methods. The aim of this project was to evaluate information related to how the Hispanic population is affected by COVID-19 and how communications about the disease should be designed based on past research, physician input, and cultural sensitivities. &#x0D; &#x0D; Methods &#x0D; We conducted a thorough literature search on COVID-19 articles, both peer reviewed and grey literature, evaluating race and ethnic differences in disease prevalence and severity. Additionally, we conducted interviews with a small number of Indiana doctors who treat Hispanic patients to obtain a doctor’s perspective on the Hispanic community’s needs during the pandemic and ways to help reduce prevalence. &#x0D; &#x0D; Results &#x0D; Physicians in Indiana believe the main approach to help the Hispanic community is by utilizing trusted community resources to communicate information and build relationships with patients over time. It is recommended to develop new methods to deliver essential information about COVID-19 through multiple mediums, in a clear way, and in Spanish with focus on the collective good of the family. In addition, it is important not to just translate resources from English to Spanish but to design materials addressing barriers specific to the Hispanic community. &#x0D; &#x0D; Conclusion &#x0D; More culturally tailored information should be released to educate the Hispanic community about COVID-19. This information will assist in the design of materials and initiatives for the Hispanic community that we hope will improve methods of communication and care delivery related to COVID-19.

Obesity aggravates COVID-19: An updated systematic review and meta-analysis.

This review aimed to evaluate the impact of obesity on the onset, exacerbation, and mortality of coronavirus disease 2019 (COVID‐19); and compare the effects of different degrees of obesity. PubMed, EMBASE, and Web of Science were searched to find articles published between December 1, 2019, and July 27, 2020. Only observational studies with specific obesity definition were included. Literature screening and data extraction were conducted simultaneously by two researchers. A random‐effects model was used to merge the effect quantity. Sensitivity analysis, subgroup analysis, and meta‐regression analysis were used to deal with the heterogeneity among studies. Forty‐one studies with 219,543 subjects and 115,635 COVID‐19 patients were included. Subjects with obesity were more likely to have positive SARS‐CoV‐2 test results (OR = 1.50; 95% CI: 1.37–1.63, I 2 = 69.2%); COVID‐19 patients with obesity had a higher incidence of hospitalization (OR = 1.54, 95% CI: 1.33–1.78, I 2 = 60.9%); hospitalized COVID‐19 patients with obesity had a higher incidence of intensive care unit admission (OR = 1.48, 95% CI: 1.24–1.77, I 2 = 67.5%), invasive mechanical ventilation (OR = 1.47, 95% CI: 1.31–1.65, I 2 = 18.8%), and in‐hospital mortality (OR = 1.14, 95% CI: 1.04–1.26, I 2 = 74.4%). A higher degree of obesity also indicated a higher risk of almost all of the above events. The region may be one of the causes of heterogeneity. Obesity could promote the occurrence of the whole course of COVID‐19. A higher degree of obesity may predict a higher risk. Further basic and clinical therapeutic research needs to be strengthened.

Abstract 15459: Impact of Progression From Paroxysmal to Sustained Atrial Fibrillation on Clinical Outcomes in Patients With Obesity: The Fushimi Af Registry

Background: Obesity, which leads to left arterial remodeling, increases the risk for the development of atrial fibrillation (AF). We previously demonstrated the progression from paroxysmal to sustained AF was associated with an increased risk of ischemic stroke or hospitalization for heart failure (HF). However, the risk of progression from paroxysmal to sustained AF in obese patients has not been fully evaluated. Methods: Based on the initial type of AF and whether paroxysmal AF progressed to sustained AF during follow-up (FU), patients enrolled in the Fushimi AF registry were categorized into 3 groups; i) paroxysmal AF without progression, ii) paroxysmal AF with progression, iii) sustained AF. Obesity was defined as BMI at baseline &gt;30. Results: Obese patients (172/3834) had a higher prevalence of sustained AF at baseline as compared with those without obesity (58.7% vs 51.0%, p=0.047), and they had a higher rate of progression from paroxysmal to sustained AF during a median FU of 4.3 years (2.4% vs 1.5% [per person-year], p&lt;0.01). Both obese and non-obese patients had the highest rate of ischemic stroke in the category of paroxysmal AF with progression as compared with other two categories (obese patients: 0.2% [paroxysmal AF without progression] vs 2.6% [paroxysmal AF with progression] vs 0.7% [sustained AF] [per person-year], non-obese patients: 1.2% vs 2.2% vs 1.8%). In contrast, obese patients had the lowest percentage of hospitalization for HF in the category of paroxysmal AF with progression (2.5% vs 1.8% vs 3.8%), but AF progression was associated with a higher incidence of hospitalization for HF in patients without obesity (2.2% vs 3.9% vs 4.2%). Conclusions: Obesity may be the risk of the progression of paroxysmal to sustained AF. The progression may be associated with increased risk of ischemic stroke in both obese and non-obese patients, but the risk of hospitalization for HF might be lower in patients with obesity as compared with those without obesity.

Hospitalization in South African Adolescents With Perinatally Acquired HIV on Antiretroviral Therapy.

Little is known about hospitalization in African adolescents with perinatally acquired HIV (PHIV+ adolescents). We described the incidence and causes of hospitalization in participants enrolled in the Cape Town Adolescent Antiretroviral Cohort in South Africa. Data collected from July 2013 to October 2018 from PHIV+ and HIV- adolescents were analyzed. Participants were assessed every 6 months and data on intercurrent hospitalization were abstracted. Causes of hospitalizations were classified according to ICD-10 codes. Descriptive statistics, time-to-event analysis and Poisson regression were used to describe causes and incidence and to determine incidence rate ratios for factors associated with hospitalization. Five hundred fifteen PHIV+ and 109 HIV- participants had a median follow-up of 4.1 years [interquartile range (IQR): 3.7-4.6]. At enrollment HIV+ participants had a median duration of ART of 7.6 years (IQR: 4.6-9.2), median CD4 count of 713 cells/mm (IQR: 561.0-957.5) and 387 (75%) had a viral load <50 copies/mL. There were 149 hospital admissions over 64 months. Crude incidence rates for hospitalization were 6.6 [95% confidence interval (CI): 5.7-7.8] and 2.2 (95% CI: 1.2-4.3) per 100-person-years (P = <0.01) in HIV + and HIV-, respectively. Ninety of 149 (60%) admissions in HIV+ participants were classified as non-infectious, 36/149 (24%) were infectious and 23/149 (16%) were "other HIV-related" or "unknown." Older age (15-19 years) and maintaining a CD4 >500 cells/cm were associated with decreased risk of hospitalization: adjusted incidence rate ratios of 0.61 (CI: 0.44-0.86, P = <0.01) and 0.68 (CI: 0.49-0.94, P = 0.02), respectively. PHIV+ adolescents had a high incidence of hospitalization despite ART. Strategies addressing infectious and non-infectious morbidity must be strengthened.

Alzheimer's disease and related syndromes and hospitalization: a nationwide 5-year longitudinal study.

To study the association between Alzheimer's disease and related syndromes (ADRS) and the incidence of short-stay hospitalizations from the year before (Y-1 ) to 4years after (Y1 -Y4 ) ADRS identification in the healthcare system. Among all beneficiaries of the French health insurance general scheme aged 40years or more, those with an incident ADRS in 2011, identified through long-term disease registry, hospitalization diagnoses or ADRS-specific drug delivery, were matched with beneficiaries without ADRS of the same age, gender and residence area. The annual incidence rates of all-cause hospitalizations (excluding those with a diagnosis code of ADRS) were compared between individuals with or without ADRS using incidence ratios (IRs) globally and by age, gender, deprivation index and modified Charlson score. We also studied cause-specific hospitalizations using patients' diagnoses and procedure codes. A total of 90871 subjects with and 90871 subjects without ADRS were included (mean age 79.6years, 66% females). From Y-1 to Y4 , incidence rates were significantly higher in subjects with ADRS than in those without for all-cause hospitalization [IR(Y-1 )=1.73; 95% confidence intervals, 1.71-1.75; IR(Y4 )=1.37; 95% confidence intervals, 1.35-1.39], hospitalizations forsocial reasons [IR(Y-1 )=4.28; IR(Y4 )=2.70], fall [IR(Y-1 )=5.36; IR(Y4 )=2.59], injury [IR(Y-1 )=2.71; IR(Y4 )=2.09] and infection [IR(Y-1 )=2.04; IR(Y4 )=2.07]. The inverse was observed for hospitalizations for cataract surgery [IR(Y-1 )=0.73; IR(Y4 )=0.51] or total hip prosthesis after 2years [IR(Y4 )=0.72]. Incident ADRS cases were associated with a higher incidence of hospitalization, but these subjects underwent some common non-emergency surgeries less frequently. Future studies need to assess the clinical impact of these differences.

Hospitalizations in Patients With Nonmalignant Short-Bowel Syndrome Receiving Home Parenteral Support.

The objective of this retrospective cohort study was to assess the frequency, duration, and causes of hospitalizations in patients receiving home parenteral support (HPS) due to short-bowel syndrome (SBS) of nonmalignant causes. Furthermore, we aimed to investigate potential risk factors and hypothesized that patients with the shortest remnant, functional, small bowel-hence, the highest need for HPS-would have the highest incidence of hospitalizations. Patients with nonmalignant SBS who initiated HPS in the period from 1970 to 2016 from the Department of Gastroenterology, Rigshospitalet, Copenhagen, Denmark, were included. Information about demography, hospitalizations at the department, and duration of HPS was obtained from the Copenhagen intestinal failure database. Patients (n=331) received HPS for a total of 1409.9 years in the period. Hospitalizations accounted for 6.6% of the time registered as HPS-dependent. The average patient was hospitalized for 5.7% (range 0%-82%) of the registered HPS days. The incidence of admissions was 2.5 per HPS year. The median length of stay was 7 days (range; 0-387). Catheter-related complications were the most frequently registered causes of admissions (35.2%), subsequently accounting for 31.3% of the total admission time. A Cox regression of admissions showed no significant influence of the remnant-bowel anatomy but identified the ability to administer HPS unaided as associated with a significantly reduced hazard. This retrospective study illustrated that 6.6% of the provided HPS days were, in fact, spent hospitalized. Since admissions elsewhere were not accounted for, this may be an underestimation.