Hospital Database Research Articles

Scleritis and Episcleritis in Patients with Idiopathic Small Fiber Neuropathy

PurposeTo report the prevalence of scleritis and episcleritis in patients with idiopathic small fiber neuropathy (SFN). MethodsThe Mass General Brigham (MGB) hospital database was queried for patients with SFN, scleritis and episcleritis using diagnostic codes and natural language processing. Electronic medical chart review of patients diagnosed with SFN and episcleritis/scleritis who had at least one ophthalmology visit was conducted. The prevalence of scleritis and episcleritis in patients diagnosed with SFN was compared to those without SFN using logistic regression to adjust for covariates. All statistical analyses were performed in RStudio 4.2.1. ResultsFrom the 2100 SFN patients with an eye exam in the MGB database, 23 patients had episcleritis or scleritis (1.1%) confirmed by chart review. Ten patients had episcleritis (0.48%) and thirteen patients had scleritis (0.62%). Of the episcleritis and scleritis patients, 16 (69.6%) were women and 7 (30.4%) were men. Ten (43.5%) had bilateral ocular disease. The mean age of ocular diagnosis was 51.0 years (range, 22-77 years). Out of the 507,128 controls without SFN in the MGB database, 1,481 (0.29%) had scleritis and 1,430 (0.28%) had episcleritis. Episcleritis and scleritis were more prevalent in patients with SFN than in those without SFN: 0.48% vs. 0.28% for episcleritis and 0.62% vs 0.29% for scleritis (P values = 0.32 and 0.02, respectively). Conclusionsand Importance: There were higher rates of scleritis in SFN patients compared to non-SFN patients. This potential systemic disease association had not been previously reported.

Nodular vasculitis – Retrospective study of an uncommon disease in a non-tuberculosis endemic country with focus on treatment modalities and efficacy

Introduction Nodular vasculitis (NV) is a rare form of panniculitis primarily affecting middle-aged females, presenting as painful, sometimes ulcerated nodules on the dorsal lower legs. Erythema induratum Bazin (EIB) is a form of NV and is considered a manifestation of cutaneous tuberculin hypersensitivity. This retrospective study aims to analyze demographics, clinicopathological findings, laboratory results, and treatment outcomes of NV in a non-TB endemic country. Methods: Data of NV patients were extracted from the electronic hospital database of the University Hospital Zurich. Patients were included only if histopathologically confirmed diagnosis of NV and sufficient information on demographics, treatment, and follow-up was available. Results: We conducted a 20-year retrospective study , including 62 patients with NV. The most common site of involvement was the lower extremities. Disease duration varyied from several months to over 20 years. Histopathological examination revealed lobular panniculitis, with or without vasculitis, and granuloma formation. Tuberculosis association was assessed through the QuantiFERON test and Mycobacteria PCR, showing positive results in 22 or 37 (59%) tested cases and in 2 out of 27 cases (7.4%), respectively. . Comorbidities were found in over half of the patients. Treatment modalities included topical corticosteroids, antitubercular therapy, systemic steroids, and potassium iodide. Almost 50% of all patients experienced relapses despite treatment. Conclusion: Topical steroids, antitubercular therapy, systemic steroids, and potassium iodide showed similar response rates. Tuberculostatic therapy upon detecting latent TB is recommended. Considering the high recurrence rate and potential side effects of systemic therapies, we recommend first-line treatment with potent topical steroids and compression stockings.

The epidemiology of road traffic injuries in the republic of Serbia: a study based on hospital data, 2015-2019

IntroductionRoad traffic injuries (RTI) are the leading cause of death and severe disability among individuals under the age of 40, posing a significant public health challenge globally. This manuscript highlights key aspects of the epidemiology of injuries in road traffic crashes (RTC) in Serbia, based on hospitalization report data.ObjectivesThe main aim of this study was to analyze the epidemiological characteristics of road traffic injuries (RTI) based on hospital data over a five-year period in Serbia.MethodsThe data for this study were obtained from the Hospitalization Report, which is part of the hospitalization database maintained by the Institute for Public Health of Serbia “Dr Milan Jovanović Batut,” covering the period from January 2015 to December 2019. The research included data from the Hospitalization Reports of 66 healthcare institutions across Serbia.ResultsDuring the study period, a total of 15,028 patients with road traffic injuries were admitted to healthcare institutions in Serbia. During the five-year period, the crude RTI incidence rate increased every year, from 39.0/100, 000 in 2015 to 43.7/100,000 in 2019. Older adult people aged 65 and over were particularly vulnerable as bicyclists and pedestrians (31.3, 27.7%, respectively). The Vojvodina region experienced a higher incidence of injuries among bicyclists compared and car accidents were most frequent in Central Serbia than in the other regions of Serbia. Craniocerebral injuries were the most common type of road traffic injury, accounting for 37.8% of cases. Significant differences in the types of injuries were observed based on age (χ2 = 649.859; p < 0.001) and gender (χ2 = 31.442; p < 0.001).ConclusionUnderstanding the epidemiological profile of road users involved in accidents is essential for monitoring and controlling specific risk factors. Our results highlight the need for enhanced traffic safety measures at the local level.

Hospitalization for SARS-CoV-2 and the risk of self-harm readmission: a French nationwide retrospective cohort study.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the risk of self-harming behaviours warrants further investigation. Here, we hypothesized that people with a history of hospitalization for self-harm may be particularly at risk of readmission in case of SARS-CoV-2 hospitalization. We conducted a retrospective analysis based on the French national hospitalization database. We identified all patients hospitalized for deliberate self-harm (10th edition of the International Classification of Diseases codes X60-X84) between March 2020 and March 2021. To study the effect of SARS-CoV-2 hospitalization on the risk of readmission for self-harm at 1-year of the inclusion, we performed a multivariable Fine and Gray model considering hospital death as a competing event. A total of 61,782 individuals were hospitalized for self-harm. During the 1-year follow-up, 9,403 (15.22%) were readmitted for self-harm. Between inclusion and self-harm readmission or the end of follow-up, 1,214 (1.96% of the study cohort) were hospitalized with SARS-CoV-2 (mean age 60years, 52.9% women) while 60,568 were not (mean age 45years, 57% women). Multivariate models revealed that the factors independently associated with self-harm readmission were: hospitalization with SARS-CoV-2 (adjusted hazard ratio (aHR)=3.04 [2.73-3.37]), psychiatric disorders (aHR=1.61 [1.53-1.69]), self-harm history (aHR=2.00 [1.88-2.04]), intensive care and age above 80. In hospitalized people with a personal history of self-harm, infection with SARS-CoV-2 increased the risk of readmission of self-harm, with an effect that seemed to add to the effect of a history of mental disorders, with an equally significant magnitude. Infection may be a significantly stressful condition that precipitates self-harming acts in vulnerable individuals. Clinicians should pay particular attention to the emergence of suicidal ideation in these patients in the aftermath of SARS-CoV-2 infection.

OGC SO37 - Pyloric drainage interventions for delayed gastric conduit emptying after oesophagectomy: A single centre analysis

Abstract Background Oesophagectomy in combination with perioperative multimodal therapy is the cornerstone of modern curative treatment for resectable oesophageal cancer. Delayed gastric emptying (DGE) is a common postoperative complication that results from the anatomical and physiological changes in the gastric conduit after an oesophageal resection. It is associated with an increased risk of pneumonia, anastomotic leak and prolonged hospital stay. Although several prophylactic pyloric drainage interventions have been postulated to mitigate the risk of DGE, the optimal modality remains debatable. This study aimed to define the incidence, evaluate prognostic factors, and characterise the management of DGE following oesophagectomy. Method Consecutive patients who underwent an oesophagectomy for oesophageal cancer between January 2022 and March 2024 were retrospectively identified from a hospital database. Pyloric drainage procedures consisted of expectant management, endoscopic/open pyloric Botox and pyloroplasty. Univariable and multivariable analyses were performed to define the incidence of DGE after each pyloric drainage modality, evaluate prognostic factors for DGE, and characterise the need for subsequent intervention in the management of DGE. Results The study cohort comprised 137 patients – mean age 66 years, male 78%. The incidence of DGE was 31%. Pyloroplasty had the lowest incidence of DGE (16%) followed by endoscopic botox (21%). Intra-operative pyloric drainage reduced the risk of DGE (p=0.03). The modality of prophylactic pyloric drainage used significantly influenced the risk of developing DGE (p=0.028). No significant differences were identified between patient demographics, operative approach, and oncological variables in the development of DGE. On multivariable analysis, pyloroplasty was associated with a reduced risk of DGE (OR 0.27, 95% CI 0.09 – 0.71). DGE did not influence overall survival. Conclusion DGE is a common postoperative complication which affects up to 39% of patients undergoing oesophagectomy. Patients who did not undergo a prophylactic pyloric drainage procedure during the index oesophagectomy were at an increased risk of developing DGE. Most patients with DGE (71%) require further intervention via endoscopy and botox injection. Pyloroplasty as a prophylactic drainage modality significantly reduced the risk of developing DGE compared to endoscopic botox. Further prospective randomised controlled trials are required to validate these findings.

HPB SO13 - Comparative analysis of cost and clinical benefit of Robotic Surgery (RS) vs Laparoscopic Surgery (LS) for the treatment of symptomatic liver cysts

Abstract Background The treatment for symptomatic liver cysts involves the removal of a large portion of the cyst wall (deroofing/fenestration). Robotic surgery (RS) is now used more commonly to treat liver cysts. It is unclear whether RS or laparoscopic surgery (LS) results in superior clinical or economic outcomes. The objective of this study is to compare the cost and clinical benefit of RS vs LS in adults with liver cyst(s). Method Patients meeting inclusion criteria were identified from operating notes and a prospectively held hospital database between 2019 to 2024. Eligible candidates were further investigated for post-operative outcome, length of stay (LOS), subsequent in-person clinic follow-ups for review and removal of drain, and further treatment in patients with recurrence of liver cyst. Financial data for all surgical equipment in RS and LS were provided by sales representatives from the relevant industries. Results Forty-four LS and seven RS patients were analysed. Neither approach recorded a return to theatre. There was no mortality in either group. There was a significantly shorter LOS for RS vs LS patients (median LOS=1 vs 2 days, p<0.05). There was no significant difference in bile leak, drain duration or cyst recurrence between LS and RS. The economic analysis revealed that without taking into account reduced LOS, the costs of RS and LS was £1261.70 and £1733.61 per procedure, respectively. The increased cost in LS was primarily due to multiple stapler firings (median staplers used=5) vs zero staplers in RS. Conclusion Robotic liver cyst surgery is cheaper and provides better clinical outcomes in terms of shorter LOS and reduced complications. Further studies are warranted to examine the long-term cost-effectiveness of RS.

Abstract 4133324: Socioeconomic status, race, and ethnicity in management of pediatric SVT

Introduction: Electrophysiology study and ablation (EPS) is often the preferred approach to management of supraventricular tachycardia (SVT) and/or ventricular pre-excitation (WPW) in older children/adolescents. There are inequities in arrhythmia management in adults, and in other areas of pediatric cardiology, but little is known about disparities in management of SVT in children. Research question: Do racial/ethnic and socioeconomic inequities affect referral for EPS in patients with SVT and/or WPW? Methods: This retrospective observational study utilized the Pediatric Health Information System of 49 children’s hospitals’ administrative data from 2016-2022. We included patients with SVT or WPW seen in the emergency department, admitted for observation, or inpatient. We excluded patients with congenital heart disease. The outcome was having a procedure code for EPS. The childhood opportunity index (COI, scale 1-100) based on zip code was used to measure socioeconomic status (SES). Results: Among 37,818 patients with primary diagnosis of SVT (27620, 73%) or WPW (10198, 27%), 9840 (26%) underwent EPS (Table 1). COI was higher in patients who underwent EPS than those who did not (median 59 [IQR 34,82] vs 57 [IQR 30,81]). In addition, time from initial visit with diagnosis of SVT/WPW to EPS was longer in patients with lower COI (beta= -0.026, p=0.007). Black (21.2%), Hispanic (23.8%), and American Indian (19.8%) patients were less likely to undergo EPS than White (26.5%) and Asian (28.31%) patients and those with other (28.4%) or unknown/missing (35.7%) race (p<0.001, Figure 1). In both subgroups of patients with SVT and WPW, EPS differed by race and COI, and higher COI predicted shorter time to EPS. Conclusions: In this hospital database of pediatric patients, we found disparities in use of EPS for the management of SVT and/or WPW. Patients of minoritized race/ethnicity and lower SES were less likely to undergo EPS.

Abstract 4119908: Outcomes for heart failure patients with reduced ejection fraction attending emergency department and discharged within 24 hours versus those admitted patients in heart failure unit.

Introduction: Heart failure (HF) is a clinical syndrome with increasing prevalence. Currently, there are extensive evidence-based therapies targeted at managing patients with heart failure and reduced ejection fraction (HFrEF) to improve outcomes. The National Heart Failure Audit shows the quality of inpatient care (specialist review, discharge medication etc) is related to outcome. This study aimed to evaluate the current practice at a London tertiary centre hospital in managing patients with heart failure and compared outcomes in patients who had a short course of admission (less than 1 day) with those who had a more prolonged course of admission. Method: Retrospective data was collected from a London tertiary centre hospital database for consecutive patients from Sep/2022 till Sep/2023. Statistical analysis was performed using Chi-Square test. The eligibility criteria included a new or previous diagnosis of HF with left ventricular ejection fraction (LVEF) < 40%. Patients were divided into two groups: Group A included 40 eligible patients who were admitted and discharged from the emergency department (ED) within 24 hours. Group B included 37 eligible patients who were admitted and discharged from the dedicated heart failure unit after 10-15 days of hospital admission. Results: In Group A, prescribing guideline-directed medical therapy (GDMT) was lower compared to Group B; Renin-Angiotensin-Aldosterone Inhibitors (47.50% vs. 94.59%), beta blockers (55% vs. 91.89%), mineralocorticoid receptor antagonists (12.50 %vs. 94.59%), and sodium-glucose co-transporter 2 inhibitors (15% vs. 89.19%). More patients in Group B received all four pillars of GDMT (86.49%) compared to Group A (5%). At 6-month follow-up,18.75% were on 4 GDMT in Group A versus 92% in group Group B. Re-admission within 6 months was higher in Group A (30%) compared to Group B (16.22%); however, the difference was not statistically significant (P value: 0.153). Higher mortality rates were observed in Group A (mortality rate: 20%) compared to Group B (mortality rate: 2.70%), with statistical significance (P value: 0.018). Conclusion: This study showed that HFrEF patients admitted to a specialist heart failure unit achieve higher rates of GDMT and have significantly improved outcomes compared to those who had a shorter inpatient stay and discharged from the emergency department. These findings underscore the high risks associated with rapid discharge from hospital on incomplete medical therapy.

The interplay of body mass index, gestational weight gain, and birthweight over 3800 g in vaginal breech birth: A retrospective study.

Optimal counseling of women for vaginal breech birth requires consideration of both established and emerging risk factors for adverse perinatal outcomes. Currently, rising prevalences of maternal obesity and impaired glucose tolerance challenge obstetric care. We aimed to investigate the effects of these parameters on the outcome of vaginal breech birth to improve counseling practices. A total of 361 women (without previous vaginal births) attending vaginal birth of a singleton fetus in breech presesntation between 01/2015 and 11/2021 were included in this retrospective single-center study. Data were derived from the hospital data base. We analyzed the effect of the maternal body mass index (BMI) at birth (compared to pre-pregnancy BMI), excessive weight gain, gestational diabetes, and neonatal birthweight on obstetrical and neonatal short-term outcomes (intrapartum cesarean delivery, performance of obstetric maneuvers (Løvset-, Bracht-, Veit-Smellie maneuver and Bickenbach's arm delivery), admission to the neonatal unit, Apgar score after 5 minutes<7, and arterial cord pH-value <7.10). Multivariable logistic regression was used for analysis and adjustment of variables. Overall, 246 women (68.1%) had a successful vaginal birth. Intrapartum cesarean delivery (n = 115/361; 31.9%) was independently associated with maternal BMI at birth (p = 0.0283, aOR = 1.87 (1.19-3.97)) if birthweight was ≥3800 g. The rate of intrapartum cesarean delivery was also higher in women with gestational diabetes (p = 0.0030, aOR = 10.83 (2.41-60.84)). A significantly higher risk of neonatal acidosis (arterial pH-value <7.10) was observed in women with BMI at birth ≥30 kg/m2 (p = 0.0345, aOR = 1.84 (1.04-3.22)) without affecting other outcomes. Pre-pregnancy BMI, gestational weight gain and BMI-gain did not significantly affect the obstetrical and neonatal birth outcomes. When neonatal birthweight is ≥3800 g, maternal BMI at birth (p = 0.0283; aOR = 1.87 (1.19-3.97)) is independently associated with the rate of intrapartum cesarean delivery. However, pre-pregnancy BMI and BMI-gain during pregnancy were not associated with the need for intrapartum cesarean delivery or other adverse outcomes. Consequently, BMI at the time of birth could be more informative than pre-pregnancy BMI and may improve counseling of women attempting vaginal breech birth.

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary

BackgroundSevere acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.MethodsWe collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.ResultsOur results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4–7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43–7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14–6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29–8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35–4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.ConclusionsOur research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.

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.