Hospital Database Research Articles

Effects of COVID-19 pandemic on psychiatric and psychological consultation-liaison contacts in a general hospital in North-East of Italy: a retrospective study

BackgroundThe COVID-19 pandemic has prompted significant changes in healthcare, particularly affecting psychiatric and psychological Consultation-Liaison (CL) services in general hospital settings.AimTo assess the effects of COVID-19-related restrictions on utilization of psychiatric and psychological CL services in Northeast Italy during 2020, and to compare it to the use of services in the previous year (2019).MethodsThe study collected data on psychiatric and psychological consultations in 2019 and 2020 from a hospital database. It categorizes consultations by type of patient (inpatient or outpatient) and referral source (hospital wards, general practitioners, other specialists). Pandemic-related restrictions were classified as “lockdown,” “intermediate restrictions,” and “no or reduced restrictions” based on the Covid Stringency Index (CSI). Poisson regression models were employed to analyze the data.ResultsThe findings reveal a significant 28% increase in the number of psychiatric and psychological consultations in 2020. Consultations for outpatients increased by 51%, while those for inpatients decreased by 11%. However, the lockdown and intermediate restriction phases were deemed responsible of a decrease of 42.9% and 19.5% in consultations respectively.DiscussionThis study highlights the persistent psychological burden during the COVID-19 pandemic, alongside reduced CL services due to lockdown measures. Integrating telemedicine into these types of services becomes imperative for meeting patient needs during restrictions. These findings can inform policies and practices to improve effective mental health care delivery during and beyond pandemics. Future research should explore the impact of pandemic-related restrictions on mental healthcare across settings and clinical factors affecting service accessibility.

Viral rebound on antiretroviral therapy in France according to region of origin, sex, and HIV acquisition group. Results from the French Hospital Database on HIV (ANRS CO4-FHDH).

Assessing the potential increased risk of viral rebound (VR) in migrants requires adequate control for sex and acquisition risk groups. People living with HIV1, enrolled in the ANRS CO4-French Hospital Database on HIV, who achieved virological suppression with antiretroviral therapy (ART) initiated between 2006 and 2016 were included. We first compared the risk of VR, with loss to follow-up and death considered as competing events, across origin among the HIV acquisition groups, then across acquisition groups among the different origins, and finally across modality of a variable combining sex, acquisition group, and origin. Models were adjusted for clinical and biological confounding factors. We included 21 571 French natives (FRA), 10 148 migrants from sub-Saharan Africa (SSA), 1137 migrants from the non-French West Indies (NFWI), and 4205 other migrants (OTHER). The 5-year probability of VR was 19% (95% confidence interval [CI] 19-20) overall, 15% in FRA, 21% in OTHER, 26% in SSA, and 34% in NFWI (p < 0.0001). It was 14% in men who have sex with men (MSM), 23% in heterosexual men, and 23% in women (p < 0.0001). After adjustment, all acquisition groups had a higher risk of VR than MSM from FRA, with men and women from NFWI having the highest risk (adjusted hazard ratio [aHR] 2.46; 95% CI 2.12-2.86 and aHR 2.59; 95% CI 2.20-3.04, respectively). Within each acquisition group, all groups of origin had a higher risk of VR than FRA. Within each region of origin, except the NFWI, heterosexual men had a higher risk of VR than MSM. After accounting for sex and acquisition group, migration, especially from NFWI, remains prognostic of VR.

Infertility treatments and risk of breast benign diseases: a case‒control study

BackgroundTheoretically, endocrine fluctuations occurring during infertility treatments, including ovulation induction (OI) and assisted reproductive techniques (ART), could be associated with an increased risk of benign breast diseases (BBDs). To date, no studies have been conducted on this association. Therefore, the present study investigated the association between different types of infertility treatments and BBDs.MethodsThis case‒control study was conducted in Arash Women’s Hospital, Tehran, Iran. The case group included infertile women diagnosed with BBDs without atypia, and the control group included infertile women without breast disease. Breast imaging studies (mammography/ultrasound) were performed for BBD screening, and the diagnosis was confirmed by histopathological examination. Study variables were collected retrospectively from medical records, hospital databases, and questionnaires.ResultsFinally, 154 infertile women, including 50 cases (BBDs) and 104 controls (no BBDs), were compared. Our data showed that 66% of cases and 61.4% of controls had undergone at least one course of infertility treatment. There was no association between BBD risk and previous infertility treatments (OR = 1.21; 95% CI = 0.59–2.46), ART (OR = 1.14; 95% CI = 0.90–1.44), or OI cycles (OR = 1.13; 95% CI = 0.98–1.32). Stratification by confounding variables did not change these results.ConclusionsIt seems that there is no association between BBDs in infertile women and the type, duration, or number of prior infertility treatments; however, considering the small sample size of the study, the clinical significance of this finding should not be neglected. Therefore, we consider it essential to carry out more extensive, detailed, and prospective studies to distinguish the association of BBDs with different infertility treatments and medications.

Healthcare, school and daily life experiences of patients with microphthalmia or anophthalmia and their parents.

This qualitative study explored the lived experiences of the patients with microphthalmia and anophthalmia and their parents, focusing on the healthcare, school settings and daily life challenges to improve patient management. In-depth interviews were conducted in Stockholm, Sweden, from October 2022 to June 2023. Participants were recruited through the St Erik Eye Hospital database (2008-2022), and the data was analysed using reflexive thematic analysis. The study included 15 patients (9 female and 6 male), with a median age of 21 years (range 15-31), and 1 parent per patient. Five key themes were identified from the parental interviews and three from the patient interviews. Both groups emphasised the need for improvements in healthcare, including better physician continuity, emotional support, information provision and prosthesis functionality. Families of those with severe bilateral visual impairment highlighted the need for additional school and daily life support. While some parents had future concerns, most patients viewed their condition as a natural part of life. Patients and parents shared insights on the psychosocial impact and suggested improvements in the healthcare and school settings, providing valuable guidance for enhancing care and management for this patient group.

Retrospective Evaluation of Clinical Characteristics of Children with Cat Sensitivity

Aims: Cat allergy has an important place among allergic diseases and it is known that environmental factors as well as genetic factors affect sensitisation. It has been reported that having a cat at home increases the risk of sensitisation, especially in susceptible individuals. The aim of this study was to retrospectively evaluate the clinical features of cat sensitisation in children. Methods: In this descriptive retrospective study, children aged 0-18 years with cat sensitisation who were admitted to the clinic between June 2023 and December 2023 were examined. Clinical characteristics, total IgE, eosinophil count, specific IgE values and skin prick test results were retrospectively evaluated using data obtained from the hospital database. Results: The study included 76 children with cat sensitisation. The mean age was 7 years and 56.6% were male. The most common diagnoses were asthma (63.2%) and allergic rhinitis (31.6%). Cat sensitisation was positive in 100% of the patients, house dust mite sensitisation was found in 78.9% and pollen sensitisation in 14.5%. Total IgE levels of patients with multiple allergies were significantly higher than those without multiple allergies. Conclusion: The study showed that additional allergen sensitisation was common in children with cat sensitisation and the most common diagnoses were allergic rhinitis and asthma. The findings are consistent with the existing literature and emphasise the importance of total IgE in the clinical management of allergic diseases.

Insights from a hospital database: injuries among children under 6 years old due to falls

Abstract Background Pediatric injuries represent a significant public health concern globally, contributing to substantial morbidity and mortality among children. In Georgia, limited data exists regarding pediatric injuries. The aim of the study was to analyze epidemiological characteristics and trends of pediatric injuries among children aged under 6 years who received treatment in hospitals across whole country. Methods NCDC hospitalization database for 2015-2022 was used for the study. Results Over the study period, a total of 5979 children under the age of 6 received treatment in all hospitals across Georgia. The highest number of hospital admissions were registered in 2019. 60% were boys and 40% were girls of the hospitalized patients. Boys were predominant across all age groups, with the highest proportion among children aged 5 years old. There was a significant variation in hospital admissions according to the seasons, with the highest admissions occurrence in summer. As for the cause of admission, 37% resulted from falls on the same level, 10% from falls between different levels, 7% involved falling from a bed, 4% from falling out or through a building, and 4% from falling down stairs. The cause of falls was unspecified in 23%. In 72% of cases, the injured body part was the head, 17% were upper extremity injuries, and 7% were lower extremity injuries. Of the patients, 90% recovered, 2% discontinued treatment, 8% were transferred, and the outcome was fatal for 0.23% of patients. Among the fatal cases, 36% resulted from falls from, out of, or through a building, 29% from falls between different levels, 14% from falling or jumping, 7% from falls involving a bed, and 7% from falls on the same level. Conclusions These findings underscore the importance of preventive measures, especially regarding fall prevention, to reduce the incidence of pediatric injuries in Georgia. Key messages • There was a significant variation in hospital admissions according to the seasons, with the highest admissions occurrence in summer. • These findings underscore the importance of preventive measures, especially regarding fall prevention, to reduce the incidence of pediatric injuries in Georgia.

Association between left ventricular outflow tract velocity time integral, ejection fraction, clinical characteristics, and mortality in an undifferentiated cohort of hospitalised patients

Abstract Background Left ventricular ejection fraction (LVEF) is commonly used to predict mortality in heart failure patients. However, LVEF is dependent on factors including preload, afterload, contractility, heart rate and measurement accuracy. Recently, left ventricular outflow tract velocity time integral (LVOT VTI) has been shown to confer additional prognostic value in both patients with advanced heart failure and patients hospitalised with heart failure with preserved ejection fraction. Purpose We evaluated the association between LVOT VTI, LVEF, clinical characteristics and mortality in an undifferentiated cohort of hospitalised patients. Methods All hospitalised patients who underwent echocardiogram between January – March 2021 were identified from a single-centre tertiary hospital database. Baseline characteristics, echocardiographic parameters, biomarkers, and mortality at 24 months were collected. Patients were categorised into LVOT VTI tertiles (&amp;gt; 19cm, 13.1 – 18.9cm, &amp;lt; 13cm) and LVEF tertiles (&amp;gt; 50%, 40-50%, &amp;lt; 40%) for analysis; p&amp;lt;0.05 was considered significant. Results Altogether, 653 patients comprising 370 (57%) with LVOT VTI &amp;gt; 19cm, 228 (35%) with 13.1 - 18.9cm, and 55 (8%) with &amp;lt; 13cm were included. There were 183 (28%) deaths. Mortality was associated with increased age (75.6 + 13.5 years vs 64.9 + 16.8 years, p&amp;lt;.0001), high-risk echocardiographic features including increased left atrial size (45.4 + 22.7ml/m² vs 35.8 + 14.9 ml/m², p&amp;lt;.001), E/e’ (14.8 + 8.7 vs 10.4 + 4.3, p&amp;lt;.001), reduced LVEF (51.7 + 15% vs 55.9 + 12%, p=.005) and tricuspid annular plane systolic excursion (TAPSE; 2 + 0.5cm vs 2.1 + 0.7cm, p=.001), and biomarkers including haemoglobin (99 + 45g/L vs 117 + 46g/L, p&amp;lt;.001), albumin 28 + 10g/L vs 32 + 10g/L, p&amp;lt;.001), elevated N-terminal pro brain natriuretic peptide (5126 + 5997ng/L vs 2035 + 3569ng/L, p&amp;lt;.0001), troponin (191 + 1301ng/L vs 102 + 306ng/L, p=.008) and creatinine (152 + 165µmol vs 86 + 99µmol, p&amp;lt;.001) levels on admission. Whilst there was no significant difference between LVOT VTI and mortality (z=-1.73, p=0.083) there was a significant positive relationship between LVOT VTI and LVEF (r [651] =0.49, p&amp;lt;.001). Further, there was a significant association between death and both LVEF tertiles (X2 [2, N=653] = 19.63, p&amp;lt;.0001), and LVOT VTI tertiles (X2 [2, N=653] = 9.05, p=.011). However, small subset analyses revealed similar mortality rates for the lowest LVEF LVOT VTI tertile (46%, n=55), lowest LVEF tertile (46%, n=87), and when combined (50%, n=32). Conclusion In an undifferentiated cohort of hospitalised patients, reduced LVOT VTI and LVEF are both associated with increased mortality. However, LVOT VTI does not appear to outperform LVEF in being associated with mortality.

Relative contribution of imaging techniques for the contemporary diagnosis of infective endocarditis: a single-center experience

Abstract Introduction In developed countries, the incidence of infective endocarditis (IE) is up to 6 cases per 100,000 individuals and in-hospital mortality rates are reported to reach 30%. The diagnostic recommendations for IE have been revised in the new ESC guidelines emphasizing the use of transesophageal echocardiography (TEE) and advanced imaging techniques (computed tomography [CT], magnetic resonance [MR], positron emission tomography [PET] and white blood cell scintigraphy [WBC-SPECT]). Aims This research aims to investigate the practical applicability of established clinical guidelines in a real-world population with suspected IE. Methods We reviewed the hospital database from 06/2021 to 06/2023 using the international classification of disease codification (ICD-10) for IE. Only patients admitted to Cardiology or Cardiac Surgery departments were included. Diagnosis of IE was defined according to the modified Duke criteria. Firstly, we identified individuals in whom diagnosis was performed by clinical presentation, blood cultures and transthoracic echocardiogram (TTE). Subsequently, we identified those who required further imaging diagnostic investigation. Results A total of 63 patients were included [mean age 64 ±14 years; 76% male (n=48)]. Native IE was diagnosed in 53 (84%) patients, prosthetic IE in 7 (11%) and cardiac implantable electronic devices-related IE in 3 (5%). A total of 26 (41%) patients had at least one predisposing risk factor, 48 (76%) presented with fever, 24 (38%) suffered an embolic event and 1 (2%) had an immunological phenomenon. Out of 49 positive blood cultures (78%), typical microorganisms consistent with IE were isolated in 25 (78%) of samples: 13 (34%) staphylococcus aureus, 10 (26%) oral streptococci, 9 (24%) enterococcus faecalis, 5 (13%) streptococcus gallolyticus and 1 (3%) HACEK group. Overall, in 22 (34%) patients, a definitive diagnosis of IE was established by means of clinical presentation, blood cultures and TTE. In the remaining, TEE was performed in 86% (n=36). Of those, a definite diagnosis was established in 52% (n=22). Brain and whole-body imaging upgraded the diagnosis from possible to definite in 3 (5%) patients. In the one patient in which a comprehensive clinical evaluation including TTE and TEE rejected IE, the diagnosis was ultimately established by means of PET. The median time from admission to the definite/possible diagnosis of IE was 6 (IQR 2-17) days. A total of 47 (75%) patients underwent surgery, with the most frequent indications being heart failure 46% (n=21) and uncontrolled infection 28% (n=13). Time from diagnosis to surgery was 10 (2-19) days, hospital length of stay was 45 (35-70) days and in-hospital mortality 21%. Conclusion Clinical presentation, blood cultures and TTE plus TEE established the definite or possible diagnosis of IE in most patients with suspected IE. Advanced imaging techniques allowed the establishment of definite diagnosis in only 6% of patients.

Association between heat exposure and Kawasaki disease: A time-stratified case-crossover study

Nationwide studies investigating the association between daily mean temperature and Kawasaki disease are lacking. This study aimed to examine the association between ambient temperature and Kawasaki disease by utilizing daily data from nationwide administrative claims databases. The daily number of Kawasaki disease patients younger than 15 years old, who were hospitalized from 2011 to 2022, was extracted from the nationwide administrative claims database of hospitalizations in Japan. Daily mean temperature data and relative humidity data were obtained from the Japan Meteorological Agency. Since the exposure of interest includes heat, hospitalizations during the five warmest months (May through September) were used for analysis. A time-stratified case-crossover study with conditional quasi-Poisson regression analysis was used to estimate the relative risk (RR) of weather exposure for Kawasaki disease hospitalization with a lag of 0–5 days by prefecture. Relative humidity was included in the model simultaneously to control for its potential confounding effect. Random-effects meta-analysis was used to estimate pooled RRs. There was a total of 48,784 cases of Kawasaki disease hospitalization during the study period, of which 87.9% were under 5 years of age. Exposure to high daily mean temperatures was associated with an increased risk of hospitalization for Kawasaki disease. Specifically, exposure to extreme high daily mean temperatures (99th percentile high temperature) was associated with higher risk of hospitalization by 33% (RR 1.33, 95% confidence interval (CI):1.08, 1.65). Similar results were obtained from sensitivity analysis. Future research should elucidate the mechanisms by which high temperature is associated with hospitalization for Kawasaki disease.

Effect of the Covid-19 pandemic on hospitalizations for non-Covid-19-pneumonia and exacerbations of chronic obstructive pulmonary diseases in Switzerland: comparison of national data between 2020/2021 and 2015–2019

BackgroundProtective measures applied during the Covid-19 pandemic had a marked impact on the incidence of pneumonia. However, systematic data are lacking for hospitalizations for pneumonia and acute exacerbations of chronic obstructive lung diseases (AECOPD) not caused by SARS-CoV-2 in Switzerland. We aimed to compare the incidences of hospitalization for these entities between 2020/2021 and prepandemic years.MethodsThis retrospective study examined all nationwide hospitalizations for non-Covid-19-pneumonia and AECOPD listed as primary diagnoses based on ICD-10 codes between 2015 and 2021 in a publicly available hospitalization database of the Swiss Federal Statistical Office. Hospitalizations for acute coronary syndrome (ACS) and stroke were used as controls. Changes of monthly incidences of hospitalizations, length of stay (LOS) and mortality were compared between 2020/2021 and the average of 2015–2019.ResultsThe incidences of hospitalizations for AECOPD and for pneumonia showed seasonal variations from 2015 to 2019 followed by significant and almost identical decreases in 2020/2021 (incidence rate ratio [IRR] 0.59, 95% CI: 0.45–0.77, p < 0.001, and IRR: 0.62, 95% CI: 0.52–0.74, p < 0.001, respectively). Hospital-mortality was slightly higher in 2020/2021 for AECOPD (2015–2019: 3.8%; 2020/2021: 4.2%, odds ratio [OR] 1.24, 95% CI: 1.07–1.44, p = 0.004) and for pneumonia (2015–2019: 4.5%, 2020/2021: 4.6%, odds ratio [OR] 1.17, 95% CI: 1.07–1.28, p < 0.001). Median LOS slightly decreased for AECOPD (2015–2019: 8 [IQR: 5–14] days; 2020/2021: 7 [IQR: 4–13] days, Wilcoxon test: p < 0.001) but slightly increased for pneumonia (2015–2019: 7 [IQR: 4–11] days; 2020/2021: 7 [IQR: 4–13] days, Wilcoxon test: p < 0.001). Throughout 2020/2021, there were no significant fluctuations observed in the incidences of ACS and stroke. (IRR: 0.98, 95% CI: 0.83–1.16, p = 0.810, IRR: 0.96, 95% CI: 0.81–1.14, p = 0.636, respectively).ConclusionThe first two years of the Covid-19 pandemic showed a marked decrease in incidences in AECOPD and non-Covid-19 pneumonia hospitalizations in Switzerland. It is likely that this effect is associated with the society-based, at first vigorous, social distancing measures.

Surgical Management of large Basal Ganglia Hemorrhage: A Bi-institutional Experience

Background and Aim: Numerous prognostic factors for spontaneous intracerebral hemorrhage have been advocated; however, only a few studies have specifically addressed basal ganglia bleed prognosis and management. Regarding basal ganglia bleeding, this study determines the predictors of functional outcomes and predictors of severe disability or death in surgically treated cases. Methods and Materials/Patients: This was a one-time follow-up study of 271 spontaneous basal ganglia bleed patients undergoing surgical intervention over 3 years. An electronic hospital database was used to collect data regarding clinical and radiological parameters and functional outcomes according to the glasgow outcome scale (GOS) three months after the hemorrhage. Results: We analyzed 271 cases, with a mean age of 50.8±13.57 years. At the end of 3 months, 53.87% of patients had favorable outcomes (GOS=4, 5), 9.59% had poor outcomes (GOS=2, 3) and mortality was 37.75% (GOS=1) at the end of 3 months. Independent predictors of poor outcome were age (odd ratio [OR]=1.81, 95% CI, 1.09%, 3.02%, GCS OR=6.93, 95% CI, 1.52%, 31.51%), hematoma volume more than 60 mL (OR=12.73, 95% CI, 3.29%, 49.23%, midline shift (OR=2.78, 95% CI, 1.64%, 4.73%), the left side of bleed (OR=1.81, 95% CI, 1.11%, 2.94%), intraventricular hemorrhage (OR=2.94, 95% CI, 1.72%, 5.02%) and intraventricular hemorrhage associated with hydrocephalus (OR=22.30, 95% CI, 6.35%, 78.27%). There was a significant association between these factors and poor outcomes (P&lt;0.05). Conclusion: Almost half of the patients with large basal ganglia hemorrhage survivors were severely disabled or died within three months after the event. Basal ganglia hemorrhage was associated with severe disability or death among patients aged over 60 years with left-side bleeding, low GCS on admission, preoperative computed tomography scan showing midline shift of more than 5mm with the presence of intraventricular hemorrhage or associated hydrocephalus and a large hematoma volume.

Maternal and neonatal outcomes of congenital syphilis at a tertiary care center in Turkey; a retrospective observational study

Background Maternal syphilis (MS) can lead to significant maternal morbidity and neonatal morbidity and mortality if inadequately treated. This study is aimed to retrospectively analyse the maternal and neonatal outcomes of pregnant women diagnosed with MS at our clinic. Materials and Methods We accessed the medical records of 64 cases diagnosed with MS between 2020 and 2022 from our hospital database and the perinatology clinic archives in this retrospective observational study. Case distributions by years, sociodemographic characteristics, and maternal and neonatal outcomes were recorded. Results The distribution of MS cases was 16 (25.0%) in 2020, 20 (31.25%) in 2021, and 28 (43.75%) in 2022. The mean age of the patients was 26.4 ± 6.3 years, mean BMI was 23.36 ± 3.14, the smoking rate was 31.25%, and the majority of patients were educated to primary level (37.5%). Most were housewives (43.75%), lived in urban areas (43.75%), and had lower-level incomes (68.75%). In addition, 43.75% received adequate maternal treatment, the caesarean delivery rate was 43.25%, 31.25% had preterm births, and the mean birth weight was 2956.36 + 514.46 g. CS was largely diagnosed during delivery or the postpartum period (43.75%). Fifty percent of patients were in the latent stage, gestational hypertension and preeclampsia were present in four case each (6.25%), and gestational diabetes mellitus in eight (12.5%). Twenty babies (31.25%) were admitted to the neonatal intensive care unit, eight (12.5%) had congenital anomalies, 12 had foetal growth restriction (18.25%), stillbirth was present in four (6.25%) case, and early neonatal death in four (6.25%). Conclusions Delayed diagnosis and inadequate treatment of MS can lead to significant maternal and neonatal morbidity and mortality. Well-planned antenatal care services should be provided for all expectant mothers in order to reduce these adverse outcomes.

Pregnancy outcomes following second-trimester abortions: A comparison between medical and surgical management. A historic cohort study.

To compare perinatal outcomes in subsequent pregnancies following second-trimester abortions, stratified by the method of abortion. A historic cohort study was conducted in a single tertiary hospital, including women who had second-trimester abortions between 12+0 and 24+0 weeks and subsequent documented pregnancies within 3-60 months. Data were collected from hospitalization and perinatal databases. Composite outcome variables were constructed, and multivariable logistic regression was used to analyze associations, adjusting for confounders. Among 771 women meeting the inclusion criteria, 83% had surgical abortions and 17% had medical abortions. Medical abortion was associated with a higher incidence of placenta-associated pregnancy complications compared with surgical abortion. No significant differences were found in other perinatal outcomes. The study highlights the potential influence of the abortion method on subsequent pregnancy outcomes, particularly regarding placenta-associated complications. This underscores the importance of considering the method of second-trimester abortion in counseling women regarding potential risks to subsequent pregnancies. Adverse outcomes in subsequent pregnancies following second-trimester abortion were associated with the medical method of abortion, warranting further research and careful counseling in clinical practice.

Exploring characteristics and severity of road traffic injuries in Lebanon using emergency department hospital-based data

In Lebanon, the lack of quality data on road traffic injuries (RTIs) led to the implementation of a hospital-based RTI surveillance system by the Ministry of Health in in private and public-run hospitals in the Bekaa governorate. This paper aims to describe the characteristics and severity of RTIs recorded over two years during the pilot phase. It also assesses the strengths and challenges of the surveillance system, highlighting areas for enhancement. The data collected from the Emergency department (ED) was used to conduct a retrospective analysis of population-based injuries hospitalized for road traffic crashes (RTC). Designated focal persons reported injuries weekly using a standardized form, which included demographic and crash-related variables, body lesions, and vital signs. Data were coded per the International Classification of Diseases (ICD-10), entered into Epidata, and analyzed using SPSS. The RTI surveillance system was assessed using Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. Over two years, a total of 1576 cases of RTIs were reported. The male-to-female ratio was 2.16 and the majority of RTIs (44.4%) were recorded among those aged between 15 and 29 years old. From 2013 to 2015, a decrease of 0.7% in the revised trauma score (RTS < 4) was recorded. On the contrary, an increase of 3.9% in injury severity score (ISS) that ranged between 15 and 75 was reported. The probability of survival of an injured individual at one month was improved. The hospital-based surveillance system demonstrated strengths in structured data collection and ethical considerations but faced challenges like underreporting, limited coverage, and resource constraints. Recommendations for improvement include enhancing data quality and timely reporting, ultimately supporting evidence-based road safety interventions.

Correlations among quality of life, spinal mobility, and disease activity in early-treated axial spondyloarthritis: a single-center cross-sectional study

BackgroundAxial spondyloarthritis (axSpA) significantly impacts patients’ lives. The ASAS-OMERACT guideline was formulated for the multidimensional evaluation of axSpA patients, employing a specific set of tools. Given the pivotal role of patient perception, comprehensive correlation among these tools, especially concerning quality of life, may provide a clinically relevant perspective and enhance treatment efficacy in the early stages of the disease. This study aims to investigate the correlation among disease activity, functional ability, and quality of life in early-treated axSpA patients. In addition, the association between high disease activity and clinical characteristics was explored.MethodsThis cross-sectional study was conducted in a tertiary hospital in Thailand. Patients diagnosed with axSpA according to ASAS classification criteria and receiving treatment from rheumatologists within three years of onset of symptoms were included. Clinical and laboratory data were retrieved from a hospital database. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score with ESR or CRP (ASDAS-ESR/CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Spinal mobility was measured using the Bath Ankylosing Spondylitis Metrology Index (BASMI), while quality of life and function were evaluated using the ASAS Health Index (ASAS-HI) and Bath Ankylosing Spondylitis Functional Index (BASFI), respectively. The correlation between these measurements was analyzed using the Pearson correlation coefficient (r). Additionally, factors associated with high disease activity (ASDAS/CRP > 2.1) were explored using multivariate regression analysis.ResultsSixty-six patients (41 males; mean age 49.3 ± 13.3 years) were enrolled between April to December 2022. Disease activity (ASDAS-CRP) was significantly inversely correlated with spinal mobility (BASMI), function (BASFI), and quality of life (ASAS-HI). High disease activity was associated with obesity (BMI ≥ 30 kg/m^2) and a longer duration of symptoms before treatment (≥ 2 years).ConclusionIn early-treated axSpA patients, ASDAS-CRP showed significant correlations with functional ability, quality of life, and spinal mobility. High disease activity was associated with obesity and a longer pre-treatment symptom duration in our study. Early treatment may enhance patients’ function, mobility, and quality of life, with weight reduction being possibly beneficial for obese axSpA patients.Clinical trial numberNot applicable.

Copy Number Analysis of Whole Exome Sequencing Data

Abstract Background Genetic alterations implicated in constitutional disorders range in size from single nucleotide substitutions to losses and gains of millions of bases. Whole exome sequencing (WES) captures many clinically relevant variants, but an analytic pipeline optimized for detection of small substitutions, insertions, and deletions may miss pathogenic copy number variants (CNVs). Historically, our laboratory performed separate cytogenetic tests to evaluate for larger genomic imbalances. Addition of copy number analysis to our WES pipeline could improve the assay’s diagnostic yield. This study describes part of our strategy to validate copy number analysis of our constitutional whole exome sequencing data. Methods We identified 18 CNV specimens that underwent both chromosomal microarray analysis (CMA) and WES between 2017 and 2023. Variants included 13 deletions (size range 14Kb-2Mb) and 5 duplications (size range 325Kb-10Mb). The standard method of constitutional copy number analysis in our clinical laboratory is CMA using the Affymetrix Cytoscan HD Array and analysis software. CNVs identified on CMA were reviewed with reference to the Database of Genomic Variants and multiple academic hospital databases. WES was performed on an Illumina sequencing system following capture-based library enrichment with the Integrated DNA Technologies xGen Exome Research, CNV Backbone, Human mtDNA Research, and Human ID Research Panel probes. CNVs identified on WES were called using the Broad Institute’s Genomic Analysis Toolkit (GATK) with a quality score cutoff of 120. Whole exome sequencing data was visualized on the Integrative Genomics Viewer. Results 14 out of 18 CNVs reported on CMA were also detected on WES with a quality score at or above 120 (78%). This includes 10 out of 13 deletions (77%) and 3 out of 5 duplications (60%). For both deletions and duplications, the size ranges of detected variants at or above the cutoff score and undetected variants overlapped. One duplication reported on CMA was detected on WES with a quality score below 120. Visualization of whole exome sequencing data showed variation in probe density that may have affected CNV calling. Conclusions The majority of CNVs reported after CMA (14/18, 78%) were also detected on WES data using a GATK quality score cutoff of 120. The data does not suggest an association between CNV size and detection by WES, although interpretation is limited by the small number of cases. Data visualization may be required to identify some CNVs. Future steps to characterize the limitations of copy number analysis of WES data include assessments of variance in probe density and read depth across the exome. Copy number analysis of WES data from cases with normal CMA results will also be performed for assay validation.

Comparison of traditional and next-generation oral anticoagulants in the etiology of epistaxis

Background/Aim: There is a dearth of studies addressing the effects of next-generation anticoagulants on epistaxis. The aim of this investigation was to determine whether there are any differences between traditional and next-generation anticoagulants in the etiology of epistaxis. Methods: This retrospective cohort study focused on a total of 7,110 individuals (3,278 females (46.1%) and 3,832 males (53.9%)) diagnosed with epistaxis between 2018 and 2022; the mean age of the patients was 37.7 years. Patient data (age, gender, outpatient and inpatient treatments, relevant laboratory parameters, and treatment evidence) were retrospectively reviewed from a hospital database. The severity of epistaxis was assessed based on treatment notes. Patients with hypertension and those undergoing antiaggregant therapy were excluded from the study. International Classification of Diseases (ICD) codes from the automated system were examined retrospectively. The data were used to establish three patient groups: the first group consisted of individuals taking next-generation oral anticoagulants, the second group consisted of individuals taking traditional oral anticoagulants, and the third group consisted of healthy controls. Results: We found statistically significant differences among the groups in terms of age, the severity of epistaxis, the treatment modality, and laboratory findings (P&lt;0.001); no statistically significant difference was found in terms of gender (P=0.954). Group 2 contained the largest number of hospitalized patients and patients with severe active nosebleeds. Conclusion: Next-generation anticoagulants are more reliable than traditional anticoagulants in terms of the severity of epistaxis, the need for hospitalization, and laboratory results.

Impact of the COVID-19 pandemic on lung cancer diagnoses and mortality: A nationwide study in France

BackgroundDuring the first wave of the COVID-19 pandemic, a reduction in the number of newly diagnosed cases of lung cancer has been reported worldwide, often associated with a higher proportion of cases diagnosed at an advanced stage compared with previous years. MethodsUsing the French National Hospital Database, we investigated incident lung cancer cases and their mortality during pandemic years 2020 and 2021, compared to predictions based on pre-pandemic years 2013–2019. Mortality was assessed up to 24 months following incidence date. Expected numbers of incident cases and all-cause deaths during the pandemic were estimated using Poisson regression models and survival was analyzed using Cox regressions. ResultsThe database included 397,092 incident lung cancer cases in total, 20 % of whom underwent thoracic surgery. During the first pandemic wave (March–June 2020), there were 12 % i.e., 1940 fewer incident lung cancer cases than the expected figure (16,325), while no significant difference was found thereafter. Survival at 6 and 24 months improved steadily from 2013 to 2019 and continued to improve during pandemic years 2020–2021. However, during the first wave, a slight excess mortality was observed compared with predictions based on pre-pandemic trends. ConclusionsThe lower incidence observed during the first wave with no catch-up in the following periods could be explained by deaths among yet undiagnosed patients, either from COVID-19 or as a result of barriers to accessing healthcare. The excess mortality observed for both operated and non-operated patients may be attributable to delayed diagnosis, as well as to COVID-19-related deaths.

Multisite community-scale monitoring of respiratory and enteric viruses in the effluent of a nursing home and in the inlet of the local wastewater treatment plant.

The aim of this study was to evaluate whether community-level monitoring of respiratory and enteric viruses in wastewater can provide a comprehensive picture of local virus circulation. Wastewater samples were collected weekly at the wastewater treatment plant (WWTP) inlet and at the outlet of a nearby nursing home (NH) in Burgundy, France, during the winter period of 2022/2023. We searched for the pepper mild mottle virus as an indicator of fecal content as well as for the main respiratory viruses [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, and respiratory syncytial virus] and enteric viruses (rotavirus, sapovirus, norovirus, astrovirus, and adenovirus). Samples were analyzed using real-time reverse transcription PCR-based methods. SARS-CoV-2 was the most frequently detected respiratory virus, with 66.7% of positive samples from the WWTP and 28.6% from the NH. Peaks of SARS-CoV-2 were consistent with the chronological incidence of infections recorded in the sentinel surveillance and the nearby hospital databases. The number of positive samples was lower in the NH than in WWTP for the three respiratory viruses. Enteric viruses were frequently detected, most often sapovirus and norovirus genogroup II, accounting both for 77.8% of positive samples in the WWTP and 57.1% and 37%, respectively, in the NH. The large circulation of sapovirus was unexpected in particular in the NH. Combined wastewater surveillance using simple optimized methods can be a valuable tool for monitoring viral circulation and may serve as a suitable early warning system for identifying both local outbreaks and the onset of epidemics. These results encourage the application of wastewater-based surveillance (WBS) to SARS-CoV2, norovirus, and sapovirus.IMPORTANCEWBS provides valuable information on the spread of epidemic viruses in the environment using appropriate and sensitive detection methods. By monitoring the circulation of viruses using reverse transcription PCR methods in wastewater from the inlet of a wastewater treatment plant and the outlet of a nearby retirement home (connected to the same collective sewer network), we aimed to demonstrate that implementing combined WBS at key community sites allows effective detection of the occurrence of respiratory (influenza, respiratory syncytial virus, and SARS-CoV-2) and enteric (norovirus, rotavirus, and sapovirus) virus infections within a given population. This analysis on a localized scale provided new information on the viral circulation in the two different sites. Implementing WBS to monitor the circulation or the emergence of infectious diseases is an important means of alerting the authorities and improving public health management. WBS could participate actively to the health of humans, animals, and the environment.

6939 Do an empty sella and a partial empty sella affect the modeling and displacement of the optic chiasm?

Abstract Disclosure: B. Kaluza: None. M. Furmanek: None. J. Domanski: None. A. Zuk-Lapan: None. E. Babula: None. P. Iga: None. M. Landowska: None. K. Jarzabek: None. J. Popczynska: None. P. Filipowicz: None. M. Wielgolewska: None. J. Walecki: None. E.M. Franek: None. An empty sella and a partial empty sella are a result of the bulging of the subarachnoid space into the sella turcica. Primary empty sella has no tangible cause, while secondary empty sella is due to a pathology in the central nervous system, which may be manifested as visual disorders occurring via optic chiasm modeling or displacement. The aim of the study was to determine whether an empty sella and a partial empty sella, both primary and secondary, were the risk factors for modeling the optic chiasm. In order to conduct the study, the hospital database was analyzed and 891 patients who had undergone pituitary and CNS MRI were selected. An empty sella and a partial empty sella were confirmed in 212 patients, of which 157 patients had a primary and 55 had a secondary form. Compression and modeling of the optic chiasm were found in 29 patients. Univariate logistic regression showed that the predictors of compression and modeling of the optic chiasm included: the presence of a pituitary adenoma (OR 2.275, 95% Cl 1.083-4.779, p=0.03) - especially macroadenoma (OR 29.472, [10.751-80.789], p=0.0001) and a status post CNS surgery (OR 10.226, [1.031-101.418], p=0.047). Conversely, an empty and partial empty sella (OR 1.02, [0.429-2.422], p=0.965) - both primary (0.741, [0.254-2.161], p= 0.584) and secondary (1.193, [0.353-4.034], p=0.776), as well as Rathke cleft cyst (OR 0.517,[0.121-2.206], p=0.373) and a pituitary cyst (OR 0.789, [0.184-3.383], p=0.749) were not found to play such a role. An empty and partial empty sella do not affect the modeling and displacement of the optic chiasm, so they may not contribute to visual symptoms such as the narrowing the visual field and diplopia. Presentation: 6/3/2024