High-risk Comorbidities Research Articles

Diabetic ketoacidosis and hypoglycemia management interventions in the emergency department

Among patients with diabetes mellitus, hypoglycemia, and hyperglycemia crises are the most frequent acute consequences. One avoidable cause of death, illness, and decreased quality of life is hypoglycemia. The chance of having hypoglycemia doubles beyond the age of 60 years, making it more prevalent among older persons. With advancing age and a history of severe hypoglycemia, hypoglycemia is linked to death rates that increase two to three times. This study aimed to present evidence on the effectiveness of treatments used in the emergency management of diabetic ketoacidosis (DKA) and hypoglycemia. The PRISMA statement was followed in the conduction of this study. The comparators for either hypoglycemia or DKA were excluded from the search strategy to prevent restricting the search results. Randomized controlled trials and cohort studies were considered, and only English-language articles were selected. The electronic health databases Medline, Cochrane, and Embase were searched for relevant content between the years 2019 and 2024. It was found that hypoglycemia can be effectively treated with both 10% and 50% dextrose. Sodium chloride and playmate-based fluid treatment had a greater impact, shortened hospital stays, and DKA recovery times. Similarly, a potassium content below 10 mmol/l raises mortality, and excessive use of fluids containing chloride was linked to prolonged hospital stays and a higher risk of comorbidities.

Does Approach Matter? Comparison of Early Postoperative Life-threatening Complications in Elderly Patients With Multilevel Cervical Stenosis.

Retrospective cohort study. The optimal surgical approach for multilevel cervical stenosis in elderly patients is controversial because of the risk of life-threatening complication. To compare life-threatening early complication rates between ≥3 levels anterior and posterior cervical surgery in elderly patients. Data from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) were queried for patients 65 years or older who underwent ACDF or PS between 2016 and 2021. Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3-5 levels; ACDF3+), laminoplasty or laminectomy (3-5 levels), and posterior decompression and fusion (3-5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches. We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P=0.275), airway complications (0.9% vs. 0.9%; P=1.000), and VTE (1.1% vs. 0.7%; P=0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P=0.045), UTI (1.1% vs. 3.0%; P=0.035), and LOS (2.5±6.1 vs, 4.3±3.9d; P<0.001). Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.

P118 Palmoplantar psoriasis: association with comorbidities

Abstract Introduction Palmo-plantar psoriasis (PP) is a localized form of psoriasis that can affect only palms and/or soles in the absence of psoriatic lesions in any other parts of the body or may accompany psoriatic lesions elsewhere. Term ‘Psoriatic disease’ refers reveals systemic impact of the disease. Some publications reveal correlation between psoriasis severity and affected area (BSA) with higher risk of comorbidities. The aim of this study was to reveal comorbidities in palmoplantar psoriasis patients with relatively low BSA percentage, but still high disease burden. Materials and Methods Data was collected from October 2022 till January 2024. Forty-five patients with isolated palmoplantar psoriasis were included into study if complete medical documentation was available and histological diagnosis of PP was approved. Paediatric patients were excluded from the study. Results A total of 45 patients with PP were included into research. Thirty patients (66.66%) had at least one comorbidity with the disease duration from 1 to 4 years. From 30 patients with comorbidities 53.3% had primary arterial hypertension (35.5% in total). 20% had gastrointestinal disease [incl. ulcerative colitis, hepatic steatosis, gastroduodenal ulcer, GERD (13.3% in total)]. Dyslipidaemia was present in 16.6% in this group (11.1% in total) ; bronchial asthma in 13.3% (8.8% in total); and diabetes mellitus second type, haemolytic anaemia, psoriatic arthritis, neurologic disorders (incl. insomnia, anxiety, depression: each in 6.66% (4.4% in total). Autoimmune thyroiditis was revealed in 3.3% from PP patients with comorbidities and 2.2% in total. Conclusions The obtained results are consistent with literature data on the association between psoriasis and arterial hypertension. Palmoplantar psoriasis patients with relatively low percentage of affected skin area reveals most concomitant associated diseases—cardiovascular, gastrointestinal, neurological etc. The risk of developing hypertension is elevated in patients not only with severe psoriasis, but also in PP. Further investigation should be performed to determine association with metabolic syndrome and disease duration as well as comprehensive cardiovascular risk assessment in this population.

Drug-Resistant Tuberculosis in Rural Eastern Cape, South Africa: A Study of Patients' Characteristics in Selected Healthcare Facilities.

This study investigated the characteristics and outcomes of drug-resistant tuberculosis patients in selected rural healthcare facilities in the Eastern Cape, South Africa. A retrospective review of clinical records from 456 patients, covering the period from January 2018 to December 2020, revealed a statistically significant relationship between DR-TB types and age groups (Chi-square statistic: 30.74, p-value: 0.015). Younger adults (19-35 years) and middle-aged adults (36-50 years) are more frequently affected by RR-TB and MDR-TB, which are the most prevalent forms of DR-TB. Less common types, including Pre-XDR, XDR, and INH TB, were observed in smaller numbers. The study suggests that DR-TB imposes a heavy burden on the working age population. Gender analysis shows that while the frequency of DR-TB differs between males and females, the percentage distribution of DR-TB types is relatively equal. Both genders are predominantly affected by RR-TB and MDR-TB, which together account for nearly 90% of cases. Pre-XDR, XDR, and INH-resistant TB are much less common, comprising only a small percentage of cases in both males and females. High-risk behaviors such as smoking and drinking are linked to a wider diversity of DR-TB types, while occupations like mining and prison work show higher rates of RR-TB and MDR-TB. In HIV-positive individuals, DR-TB is more common, but the distribution of DR-TB types between HIV-positive and negative groups shows no statistically significant difference. However, HIV-positive individuals have a 20% lower survival rate (65%) compared to HIV-negative patients (85%). Financial stability and comorbidities also significantly influence outcomes, with patients having stable income and fewer high-risk comorbidities experiencing better survival and treatment outcomes. The findings underscore the importance of addressing socioeconomic disparities and strengthening healthcare infrastructure to improve DR-TB treatment outcomes in rural Eastern Cape.

Alzheimer’s disease and related dementia as a component of a multiorgan senescence syndrome

Patients with Alzheimer&amp;rsquo;s disease and related dementia (ADRD) have a higher risk for comorbidities than non-cognitively impaired age-matched individuals. Because ADRD is an age-related disorder, it was hypothesized that younger patients with ADRD have a lower prevalence of comorbidities than their older counterparts. To test this hypothesis, the following four patient cohorts were defined in the TriNetX Analytics Network database based on the presence or absence of International Classification of Diseases, Tenth Revision (ICD-10) codes G30 (Alzheimer&amp;rsquo;s disease), and/or F01 (dementia in other diseases classified elsewhere) in their health care records who had health care visits from 2021 to 2023: individuals aged 65 &amp;ndash; 80 years with and without ADRD diagnosis and individuals aged &amp;ge;90 years with and without ADRD diagnosis. Patients with ADRD in both age groups had a higher prevalence of comorbidities in almost all ICD-10 chapters than age-matched non-ADRD individuals. The younger ADRD cohort showed a comorbidity pattern that was significantly different than that of their age-matched cohort (P &lt; 0.0001); however, it was not statistically different than the comorbidity pattern of the older ADRD cohort (P = 0.80). Similarly, the younger non-ADRD cohort showed a comorbidity pattern that was not statistically different than that of the older non-ADRD cohort (P = 0.28). These results indicated that ADRD diagnosis is associated with coincident multiorgan dysfunction in a pattern that is almost identical between the two different age groups. These data also suggested that cognitive impairment associated with ADRD is only a single component of a multiorgan senescence syndrome. Overall, this study revealed that optimizing the health care management of non-cognitive organ dysfunction in patients with ADRD may improve their overall health and, thereby, delay the progression of cognitive impairment.

A comprehensive overview of gastric cancer management from a surgical point of view

Despite advancements in medical care, surgical technologies, and the development of novel treatments over the past decade, the prognosis for patients with gastric cancer (GC) has only modestly improved. This is primarily due to the fact that the majority of patients are diagnosed at advanced stages or present with metastatic disease. Radical resection remains the cornerstone of potentially curative treatment, yet the overall 5-year survival rate remains below 35%. The management of GC varies globally, influenced by factors such as geographical disparities, patient comorbidities and performance status, surgical approaches, and available medical resources. Multidisciplinary collaboration and a multimodal treatment approach are essential for optimizing patient outcomes. Surgeons must stay updated on emerging surgical concepts and make informed decisions regarding patient selection, timing of intervention, and the adoption of appropriate surgical techniques to improve both quality of life and prognosis. This review aims to provide a surgical perspective on the management of GC across all stages, highlighting the importance of a comprehensive treatment approach. Endoscopic resection may be a viable option for early GC in patients with minimal risk of lymph node metastasis, particularly in elderly patients with high surgical risk or severe comorbidities. For advanced GC, neoadjuvant therapy followed by surgery could be a promising strategy to improve patient outcomes. Conversion surgery offers a potential survival benefit for patients who respond to treatment with tumor downstaging. The treatment of peritoneal carcinomatosis remains challenging; however, hyperthermic intraperitoneal chemotherapy combined with complete cytoreductive surgery or pressurized intraperitoneal aerosolized chemotherapy may prolong survival or improve quality of life in highly selected patients.

Lower Urinary Tract Symptoms in Mental Illness: A Topic Modeling Approach to Online Mental Health Communities.

This study aimed to provide foundational data to enhance integrated interventions by gaining an in-depth understanding of the perceptions of patients experiencing both mental illness and lower urinary tract symptoms (LUTS), which carry a high risk of comorbidity and potential mutual exacerbation. Data were collected from a large online mental health community in South Korea, active among individuals with mental illness and their families (as of October 21, 2024: 113,060 members and 368,352 posts). Posts containing the keywords 'pee' or 'urine' (a total of 986 posts) were analyzed including their titles, content, and categories. Analyses included word cloud, latent Dirichlet allocation topic modeling, category frequency analysis, and qualitative analysis. The findings indicate that among individuals with mental illness, LUTS are perceived as side effects of psychiatric medications and regarded as inevitable. Many patients attempted self-regulation or discontinuation of medication instead of seeking urological treatment, but these attempts often led to failure. The study revealed that participants used the community to explore the relationship between LUTS and mental illness. LUTS had negative impacts on family and social life, and urinary incontinence exacerbated emotional distress such as self-blame and despair. Patients with mental illness experiencing LUTS often engage in self-regulation or discontinuation of medication. It underscores the need for accurate information and warnings about risks. As these patients endure discomfort and frustration in daily life, symptom deterioration is likely and necessitates proactive urological intervention to improve their quality of life. This study enhances understanding of the impact of co-occurring mental illness and LUTS and highlights the need for proper information and guidance. However, it has limitations including reliance on self-reported data and limited sample representativeness. Future research can address these issues by linking medical diagnoses with objective data and expanding the sample size.

A case of late presentation of recurrent primary choledocholithiasis 30 years post-cholecystectomy: Presentation and management

Acute cholangitis typically occurs secondary to biliary obstruction and bile stasis. While the most common cause is secondary choledocholithiasis (i.e., stones form in the gallbladder and are expelled into the common bile duct), there is little information on primary choledocholithiasis as the principal source of this obstruction. Furthermore, it is particularly rare to see symptomatic choledocholithiasis years to decades later in patients who previously underwent cholecystectomy. We report a complex case of a 75-year-old woman who presented to the emergency department with a 3 to 4-day history of abdominal pain, nausea, generalized weakness, fever, and shortness of breath. She had septic cholangitis due to primary choledocholithiasis 30 years post-cholecystectomy and numerous other comorbidities that increased the complexity of her case. Endoscopic retrograde cholangiopancreatography (ERCP) was attempted to remove the stone but was unsuccessful due to duodenal diverticula. Eventually, this patient underwent common bile duct exploration using a robot-assisted approach. A 2 cm stone at the distal common bile duct was removed, and her clinical status dramatically improved. The efficiency and increased fine control of a robot-assisted approach introduces our idea that this approach should be an alternative management option for minimally invasive common bile duct exploration in patients who have high-risk comorbidities and failed ERCP. Keywords: Acute cholangitis, primary choledocholithiasis, recurrent choledocholithiasis, post-cholecystectomy, robotic-assisted common bile duct exploration

Broad-Spectrum Engineered Multivalent Nanobodies Against SARS-CoV-1/2.

SARS-CoV-2 Omicron sublineages escape most preclinical/clinical neutralizing antibodies in development, suggesting that previously employed antibody screening strategies are not well suited to counteract the rapid mutation of SARS-CoV-2. Therefore, there is an urgent need to screen better broad-spectrum neutralizing antibody. In this study, a comprehensive approach to design broad-spectrum inhibitors against both SARS-CoV-1 and SARS-CoV-2 by leveraging the structural diversity of nanobodies is proposed. This includes the de novo design of a fully human nanobody library and the camel immunization-based nanobody library, both targeting conserved epitopes, as well as the development of multivalent nanobodies that bind nonoverlapping epitopes. The results show that trivale B11-E8-F3, three nanobodies joinedtandemly in trivalent form, have the broadest spectrum and efficient neutralization activity, which spans from SARS-CoV-1 to SARS-CoV-2 variants. It is also demonstrated that B11-E8-F3 has a very prominent preventive and some therapeutic effect in animal models of three authentic viruses. Therefore, B11-E8-F3 has an outstanding advantage in preventing SARS-CoV-1/SARS-CoV-2 infections, especially in immunocompromised populations or elderly people with high-risk comorbidities.

Increasing uptake of integrated schistosomiasis treatment and HIV screening services in fishermen at high risk of comorbidities in Malawi

Increasing uptake of integrated schistosomiasis treatment and HIV screening services in fishermen at high risk of comorbidities in Malawi

Declining Trends in Septic Revision Following Total Knee Arthroplasty From 2010 to 2019: A National Cohort Analysis

BackgroundPeriprosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are associated with high patient morbidity, mortality, and health care costs. Methods to reduce the burden of PJI have been shown to be efficacious on a small scale. On a national scale, it is unknown whether these methods have reduced PJI rates. MethodsA retrospective trend analysis was conducted using a national database. The incidence of 2-year septic revision was observed for the entire cohort in patients who had high-risk comorbidities from 2010 to 2019. A multivariable logistic regression was performed to compare the odds ratios of 2-year septic revision rates from 2011 to 2019 to the reference year of 2010. Linear regression was used to compare the change in the overall and high-risk subanalysis groups. ResultsAmong the 860,185 patients, 5,589 underwent septic revision within 2 years. The 2-year septic revision rate decreased from 0.75% in 2010 to 0.69% in 2019 (compounded annual growth rate = −0.94%, P = 0.049). Multivariable logistic regressions demonstrated that the odds of septic revision in 2019 were significantly lower than those in 2010 (odds ratio: 0.83, 95% CI [confidence interval]: [0.70 to 0.96], P = 0.017). In high-risk patients, the septic revision rate decreased from 1.04 to 0.80% (compounded annual growth rate = −2.80%, P = 0.004), specifically in those who had a history of psychoses, Medicaid insurance, anemia, heart failure, obesity, liver disease, tobacco use, and drug abuse (P < 0.05 for all). ConclusionsThis study demonstrated a national reduction in the 2-year septic revision rate in all TKA patients, including patients considered at high risk for PJI. This suggests that current preventative methods may be efficacious on a national scale in TKA. Further research is needed to identify more modalities to reduce the national incidence of this morbid and costly complication.

What is the Optimal Anticoagulation in HGNS Surgery in Patients with High-risk Cardiac Comorbidities?

What is the Optimal Anticoagulation in HGNS Surgery in Patients with High-risk Cardiac Comorbidities?

Implementation and impact of a surgical dashboard on pediatric tonsillectomy outcomes: A quality improvement study.

In pediatric tonsillectomy management, the consistent tracking of surgical outcomes and adherence to guidelines are vital. This study explores how a surgical dashboard can serve as a tool in research analysis, translating AAO-HNSF guidelines into measurable performance improvements. Using a prospective registry from three pediatric hospitals, a Tableau dashboard was constructed to graphically visualize key demographic and postoperative outcomes (including intensive care unit [ICU] utilization, 30-day emergency department (ED) visits, and postoperative bleed rates) in children undergoing tonsillectomy from 2020 to 2024. From the dashboard data, a retrospective cohort study analyzing 6767 tonsillectomies was conducted from January 2, 2020, to June 20, 2023. Patients were categorized into low-risk, OSA-only (by ICD-10 codes), and high-risk groups based on comorbidities. Logistic regression identified factors influencing ED revisits and unplanned nursing calls. Three quality initiatives were assessed: preoperative school absence notes, perioperative dexamethasone recording, and post-tonsillectomy parental education. A total of 2122 (31%) were low-risk, 2648 (39%) were OSA-only, and 1997 (30%) high risk. Risk factors that increased the likelihood of ED visits were high-risk comorbidities (OR = 1.46; 95% CI = 1.24-1.74; p < 0.001) and older age (OR = 1.05; 95% CI = 1.03-1.08; p < 0.001). Risk factors that increased the likelihood of an unplanned nursing communication were high-risk comorbidities (OR = 1.53; 95% CI = 1.34-1.75; p < 0.001), older age (OR = 1.03, 95% CI = 1.01-1.04; p = 0.001), and Medicaid insurance (OR = 1.25; 95% CI = 1.09-1.43; p = 0.002). Postoperative bleed control was generally comparable between the groups, at 2.8% (low risk), 2.7% (OSA), 3.2 (high risk) (p = 0.651). The dashboard aided in data collection, data visualization, and data analysis of quality improvement initiatives, effectively translating guidelines into tangible measures to enhance care. NA.

Contrasting presentations of children with ADHD and subthreshold ADHD.

We aimed to explore the differences and relationships in body composition, social function, and comorbidities between children with attention-deficit/hyperactivity disorder (ADHD) and subthreshold ADHD. A case-control study was conducted to analyze the differences between children with ADHD and subthreshold ADHD. Logistic regression models were used to analyze the factors influencing social functional impairments and comorbidities. Children with ADHD and subthreshold ADHD had a higher fat mass index than healthy children (p < 0.05). The scores of all six social functional domains were higher in the subthreshold ADHD and ADHD groups than in the control group (p < 0.05). The prevalence of comorbidity was higher in children with subthreshold ADHD and ADHD compared to the control group (p < 0.05). Inattention and comorbid anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), whereas a higher fat-free mass index reduced the risk. The severity of hyperactivity was associated with a higher risk of comorbidity in children with ADHD (full syndrome/subthreshold). Children with subthreshold ADHD and ADHD had more fat mass and higher rates of social functional impairments and comorbidities than healthy children. There were clinical correlations between body composition, social functional impairments, and comorbidities in ADHD. 1. Children with subthreshold ADHD and ADHD had higher fat mass levels than normal children. 2. The social function impairments and comorbidities of children with subthreshold ADHD were similar to those with ADHD. 3. Inattentiveness and anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), while a higher fat-free mass index and skeletal muscle-to-body fat ratio reduced the risk.

Bariatric Metabolic Surgery Might be More of a Benefit than a Risk During a Pandemic Outbreak.

Introduction: This report aimed to analyze the outcomes of patients with obesity who were on a bariatric program during the SARS-Cov-2 pandemic outbreak and compare those who received surgery with the ones who were not operated on. Methods: This was a retrospective study between 2020 and 2021. Patients were divided into two groups: those who underwent surgery (O) and those who were not operated (NO). The evolution of the risk factors identified for severe COVID infection and death was studied (ASMBS criteria). For this study, a follow-up period of 12 months was initiated. Results: In the O group, 83 patients were included and 99 were in the NO group. In the O group, patients with body mass index (BMI) > 35 Kg/m2 before surgery resolved the condition in 73.5% (61) cases, and this was done in the first 30 days by 38 (45.7%). Type 2 diabetes mellitus remission was documented in 18 patients (85.7%) of the O group, and the mean time elapsed for remission was 102.2 days (P < .01). Hypertension remitted in 66.7% (20) of the patients in group O in 82.4 days (P < .01). The subgroup of patients with obesity and one high-risk associated condition (30.2%, 25) resolved both in 44% (11) cases and one in 48% (12) cases. In the group of patients with obesity and two high-risk associated conditions (15.6%, 13), 47% (6) patients resolved the three conditions, 38% (5) resolved two conditions, and 15% (2) resolved one condition. Among the NO group, no comorbidity resolutions were recorded (P < .01). Admission because of COVID infection was necessary for 7.1% of NO and 1.2% of O (P = .04). Conclusion: Bariatric metabolic surgery would not increase the risk of COVID infection or of suffering serious complications resulting from it. Patients undergoing bariatric metabolic surgery rapidly resolved high-risk comorbidities and had less need for hospitalization because of SARS-CoV-2 infection.

Association between Regular Use of Analgesics before Cancer Diagnosis and Occurrence of Mood Disorders.

We aimed to determine the relationship between the use of analgesics prescribed for pain management and the onset and progression of mood disorders using a large-scale cohort database. We calculated hazard ratios (HR) with 95% confidence intervals (CI) for patient risk of developing mood disorders based on age, income, health-related variables, disease history, Charlson comorbidity index, and analgesics prescription behavior (Models 1-3). Additionally, we determined the risk of mood disorder occurrence by age group (Model 4) using a proportional hazards regression model. The age- and income-adjusted HR (Model 1) was 1.8275. The age-, income-, BMI-, and physical-activity-adjusted HR (Model 2) was 1.882. The fully adjusted HR (Model 3) was 1.698. Compared with no analgesic use, nonregular use (HR = 1.386) and regular use (HR = 1.698) was associated with a higher risk of mood disorders. Among patients older than 50 years, those who participated in physical activity (less than five days) had a lower risk of mood disorders than those who did not. This suggests that it may be useful for preventing mood disorders in older cancer survivors. A high risk of comorbidities and regular use of analgesics are risk factors for developing mood disorders. Therefore, our results suggest that cancer survivors with a high risk of comorbidities and a history of regular analgesic use should undergo careful psychiatric consultation.

Why do children not survive extracorporeal membrane oxygenation?

Extracorporeal membrane oxygenation (ECMO) is used in critically ill children with cardiac and/or respiratory failure. Use is increasing in children with high-risk comorbidities. Reasons children do not survive ECMO are poorly described. Describe characteristics and cause of death, compare mortality in children with high-risk comorbidities, evaluate mortality trends over a decade. All children <18 years old who received ECMO at this institution from 1 January 2011 to 31 December 2020 were described and categorised by outcome: died on or <48 h post-ECMO, died ≥48 h post-ECMO, survived to hospital discharge. Children who did not survive ECMO (DNSE) were categorised to: ECMO withdrawal for irrecoverable original condition, withdrawal for poor prognosis neurological condition, brain death, withdrawal for poor prognosis with multiple complex conditions, and unsupportable. Poison regression was used to analyse survival trends. Four hundred twenty-eight children received ECMO, 19% DNSE, 14% died ≥48 h post-ECMO and 67% survived. ECMO was electively withdrawn for irrecoverable original condition (39%), poor prognosis for neurological condition (32%) or multiple complex conditions (18%). One hundred twenty-two children had ≥1 high-risk comorbidity. Children with genetic syndromes (58%), risk-adjusted congenital heart surgery score-1 ≥4 (53%), primary immunodeficiency (50%) had lower hospital survival. No children with malignancy/bone marrow transplant survived to hospital discharge. Overall hospital survival was 67%, with no significant change during the study period (P-trend = 0.99). Children who DNSE have therapy electively withdrawn for irrecoverable disease or poor prognosis. Children with high-risk comorbidities have a reasonable chance of survival. This study informs clinicians ECMO may be a therapeutic option.

Surgical outcomes of external double needle puncture epiglottopexy in severe laryngomalacia patients with high-risk comorbidities

ObjectivesPatients with severe laryngomalacia (LM) and high-risk comorbidities require surgical interventions such as supraglottoplasty. However, evidence supporting epiglottopexy for these patients is scarce. This study aims to report the surgical outcomes of external double needle puncture using a single thread for epiglottopexy in severe LM patients with high-risk comorbidities. MethodsThis retrospective study was conducted at a single tertiary hospital. We enrolled 32 patients under 12 months with severe LM who underwent external double needle puncture epiglottopexy. We compared clinical factors between the successful and failed groups and identified risk factors for the failure of epiglottopexy. ResultsOf the airway surgical outcomes, 22 (68.7 %) patients were in the successful group. In the failed group (n = 10, 32.3 %), patients received tracheostomies due to uncontrolled saliva (n = 3), the need for mechanical ventilation (n = 3), and uncontrolled LM (n = 4). There was a statistically significant difference in body weight at the time of surgery and the proportion of associated comorbidities between the two groups. Gestational age was the only factor significantly associated with successful surgical outcomes in both univariate and multivariate logistic regression analyses (odds ratio = 2.263; 95 % confidence interval, 1.042–4.918; P = 0.039). ConclusionExternal double needle puncture epiglottopexy is an effective surgical method for patients with LM who present with a retroflexed floppy epiglottis and high-risk comorbidities. Low gestational age is a major risk factor for surgical failure. Consideration of factors such as the need for mechanical ventilation and uncontrolled saliva should be prioritized before and after surgery to enhance surgical success.

Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals or no treatment in England: a retrospective cohort study

Objective To describe characteristics and acute clinical outcomes for patients with COVID-19 treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated patients at highest risk per National Health Service (NHS) criteria. Methods Retrospective study of non-hospitalized patients between 1 December 2021 and 31 May 2022, using data from the Discover-NOW dataset (North-West London). Included patients were aged ≥12 years and treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated but expected to be eligible for early treatment per NHS highest-risk criteria. COVID-19-related and all-cause hospitalizations were reported for 28 days from COVID-19 diagnosis (index). Subgroup analyses were conducted in patients with advanced renal disease, those aged 18–64 and ≥65 years, and by period of Omicron BA.1, BA.2 and BA.5 (post-hoc exploratory) predominance. Results Overall, 1503 treated and 4044 eligible high-risk untreated patients were included. A high proportion of patients on sotrovimab had advanced renal disease (29.3%), ≥3 high-risk comorbidities (47.6%) and were aged ≥65 years (36.9%). Five of 696 (0.7%) patients on sotrovimab, <5/337 (0.3–1.2%) on nirmatrelvir/ritonavir, 10/470 (2.1%) on molnupiravir and 114/4044 (2.8%) untreated patients were hospitalized with COVID-19. Similar results were observed across all subgroups. The proportion of patients dying within 28 days of the index period was similarly low across all cohorts (<2%). Conclusion Patients receiving sotrovimab appeared to show evidence of multiple high-risk comorbidities. Low hospitalization rates were observed for all treated cohorts across subgroups and periods of predominant variants of concern. These results require confirmation with comparative effectiveness analyses adjusting for differences in underlying patient characteristics.

Transcatheter Aortic Valve Implantation (TAVI) In Small Island Nation- Maldives, Leading Cardiac Care to A Higher Standard

Background: Surgical aortic valve replacement is still considered the preferred treatment option for patients with severe aortic valve stenosis, and it is known to improve the survival of the patients. However, about 30-50% of patients are not operated on due to several reasons including old age, high risk and other comorbidities. Transcatheter Aortic Valve Implantation (TAVI) is emerging as an alternative treatment option for elderly patients with high surgical risk. Methods: In our study, four patients have undergone TAVI from February 2022 till May 2023 using Medtronic Transcatheter Aortic Valve, Core valve Evolut R (Medtronic Inc., Minneapolis, MN, USA) bioprosthesis. Results: All the patients were discharged early. Follow-up Echocardiography showed decreased transaortic gradient with improved quality of life. Conclusion: We conclude, implementation and use of this emerging technology in small Island Nations like Maldives would help to treat many patients, mostly elderly and high-risk as well as patients with intermediate risk requiring aortic valve surgery with less morbidity and comparable mortality in comparison to SAVR.