Incidence Of Use Research Articles

Hemodynamic management of acute kidney injury.

To discuss the role of hemodynamic management in critically ill patients with acute kidney injury. Acute kidney injury (AKI) may be associated with persistent alterations in renal perfusion, even when cardiac output and blood pressure are preserved. The effects of interventions aiming at increasing renal perfusion are best evaluated by renal Doppler or contrast enhance ultrasound. However, limited data have been acquired with these techniques and the essential of the literature is based on surrogates of renal function such as incidence of use of renal replacement therapy. Fluids may increase renal perfusion but their effects are quite unpredictable and can be dissociated from their impact on cardiac output and arterial pressure. Inotropes can also be used in selected conditions. At the de-escalation phase, fluid withdrawal should be considered. Safe fluid withdrawal may be achieved when applied in selected patients with preserved tissue perfusion presenting signs of fluid intolerance. When applied, stopping rules should be set. Dobutamine, milrinone and levosimendan increase renal perfusion in AKI associated with cardiac failure or after cardiac surgery. However, the impact of these agents in sepsis is not well defined. Regarding vasopressors, norepinephrine is the first-line vasopressor agent, but vasopressin derivative may limit the requirement of renal replacement therapy. Angiotensin has promising effects in a limited size post-Hoc analysis of a RCT, but these data need to be confirmed. While correction of severe hypotension is associated with improved renal perfusion and function, the optimal mean arterial pressure (MAP) target level remains undefined, Systematic increase in MAP results in variable changes in renal perfusion. It sounds reasonable to individualize MAP target, paying attention to central venous and intraabdominal pressures, as well as to the response to an increase in MAP. Recent studies have refined the impact of the various hemodynamic interventions on renal perfusion and function in critically ill patients with AKI. Though several of these interventions improve renal perfusion, their impact on renal function is more variable.

Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture

Introduction and objectivesHalo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures. Materials and methodsThe 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed. ResultsFrom 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality. ConclusionsOnly 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.

Use of hashtags from MusemWeek in 2022-2023 in online social network service X

The research aims to collect and analyze data on hashtags used by MuseumWeek in Online Social Network Services. The research has a qualitative-quantitative approach, with a descriptive objective and a methodological procedure anchored in a case study with an altimetric approach using the descriptive-statistical analysis application. The research universe is the MuseumWeek event in Online Social Network Services, with a delimited sample of publications and hashtags used in 2022 and 2023 on X (formerly Twitter). The results showed an increase in publications about the event despite signals that the increase was the impact of a few institutions in the sample. There was a balanced distribution in the use of hashtags for 2022 and a greater incidence of use of the hashtags #MeioAmbienteMW and #Web3MW for 2023. Also, we observed that the hashtags published on the first day of each year (#InovacaoMW - 2022 and #MeioAmbienteMW – 2023) have greater engagement than those broadcast on other days. We concluded that Online Social Network Services and MuseumWeek are valuable components in contemporary scientific dissemination. However, there is a requirement for constant data collection to form a historical series, as Online Social Network Services do not allow data collection from previous years.

The use of intra-aortic balloon pump in cardiac surgery

Background: Objective of the study was to determine the incidence of use, indications, complications of intra-aortic balloon pump (IABP) and its impact on outcome. Methods: Retrospective study of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period of time between September 2023 and February 2024. Patients’ demographic, clinical, perioperative data were recorded and analysed. Time of initiation of intra-aortic balloon, indications and monitoring for complications were observed by the authors. Patients were divided into two groups according to the use of IABP; the IABP group and the non-IABP group. Both groups were compared regarding outcome. Ethical committee approval obtained. Results: Data from 202 adult cardiac surgeries was analysed. Average age of patients was 57.2 years. Patients were 34 females (16.8%) and 168 males (83.2%). Most surgeries were elective (93.6%), while urgent surgeries comprised 3.5% and emergency surgeries were 3%. Coronary artery bypass grafting (CABG) was the most common procedure (78.2%). The IABP was most commonly used after combined procedures (50%) and to a lesser extent after isolated CABG (15.3%). IABP was inserted least frequently pre-operatively (10.7%), followed by postoperative insertion (35.7%), while intraoperative insertion to aid weaning from CPB was most common (53.6%). Patients from the IABP group were older, had longer CPB time (136.7 minutes) and AXC times (70.5 minutes), they also spent around 2 days more in the ICU and around 4 days more in hospital. Conclusions: IABP was most commonly utilised for combined procedures, after prolonged CPB and aortic cross clamping. The use of IABP was associated with delayed tracheal extubation, longer ICU stay, longer hospitalisation, and higher rates of blood transfusion, higher incidence of re-opening and higher mortality.

PREVALENCE OF THE USE OF CORTICOIDS FOR THERAPEUTIC PURPOSES IN ALLERGIC RHINITIS AND RHINOSINUSITIS AND THEIR SIDE EFFECTS AMONG UNIVERSITY STUDENTS IN THE HEALTH AREAS OF SANTA CATARINA AND RIO GRANDE DO SUL

Allergic rhinitis is defined as inflammation of the nasal mucosa, induced by exposure to allergens. Rhinosinusitis is defined as an inflammation of the nasal mucosa and sinuses. Corticosteroids are the most prescribed medications to treat rhinosinusitis and allergic rhinitis, as they act on the inflammatory components of the disease, reducing the infiltration of inflammatory cells on the surface of the nasal mucosa. The general objective is to understand the effects of the use of corticosteroids on rhinitis and rhinosinusitis, observing the incidence of use of these medications among university students in the health areas of the states of Santa Catarina and Rio Grande do Sul, considering the consequences caused by excessive use. The methodology consists of quantitative data analysis aiming to collect information in an online questionnaire, analyzed statistically and carefully. The results reveal that 79.4% of the participants in the questionnaire already had rhinitis or rhinosinusitis, of which 63.2% used corticosteroids in different ways, the most commonly used orally. Furthermore, the main side effects presented were drowsiness, irritation and burning, in addition to body swelling. It is concluded that the use of corticosteroids must be done with caution and the patient's viability given the possible adverse effects present.

The use of tier three therapies in acute brain injured patients

BACKGROUND In patients with acute brain injury (ABI) and refractory intracranial hypertension, the so-called ‘tier three therapies’ (TTT) (hypothermia, metabolic suppression with barbiturates, and decompressive craniectomy) may be used. OBJECTIVE We aimed to describe the incidence of use of TTT, and to assess their effect on outcome. DESIGN A secondary analysis of the ENIO observational study. SETTING Seventy-three intensive care units (ICUs) in 18 countries worldwide between June 2018 and November 2020. PATIENTS One thousand five hundred and twelve adult patients admitted to an intensive care unit (ICU) with ABI were included and categorised according to use or not of one or more TTT. RESULTS Three hundred and ninety-six patients (26.2%) received at least one TTT during the ICU stay. Five patients (0.3%) received all three TTT. TTT patients were younger (P &lt; 0.0001), less likely to have a preinjury history of hypertension (P = 0.0008), and less frequently anisocoric within 24 h from ICU admission (P &lt; 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; P &lt; 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (P &lt; 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (P &lt; 0.0001), need for tracheostomy (P = 0.0194), and prolonged ICU length of stay (LOS; P &lt; 0.0001) but not with increased ICU or hospital mortality (P = 0.999). CONCLUSION Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.

Point prevalence of antibiotic use: a systematic review (2021-2023)

Point prevalence surveys (PPSs) provide valuable insights into several aspects of hospital prescription trends, specifically regarding antibiotic usage. Hence, this review was conducted to investigate the point prevalence of antibiotic use. This was an updated systematic review of the previous two years addressing studies conducted between the years 2021 and 2023 regarding the point prevalence of antibiotic use. Studies regarding the current topic were examined using the PubMed, Cochrane, Web of Science, and Google Scholar databases. The terms were employed in different combinations including the \&amp;quot;Point prevalence, survey, antibiotics use, antimicrobial prescribing, antimicrobial resistance, antimicrobial stewardship; surveillance, hospital, private sector, global health security\&amp;quot;. Publications in full text were used as the inclusion criterion. Out of the 85 acquired articles, only nine were deemed suitable for inclusion. The analysis encompassed more than 10,331 hospitalized patients in different regions. This systematic review demonstrated a high point prevalence of antibiotic use in hospitals. The most prevalent clinical indications were pneumonia, skin and soft tissue infections, sepsis, and community-acquired infections. Ceftriaxones were the predominant antibiotics provided to patients. These hospitals have a high incidence of use of antibiotics, but they lack institutional frameworks and protocols to ensure optimal antibiotic use. The study furnishes the requisite data for enhancing forthcoming antibiotic utilization in hospitals and mitigating antimicrobial resistance. These findings emphasize the importance of ongoing efforts to improve the responsible use of antibiotics by implementing effective antimicrobial stewardship programs in hospitals, ultimately leading to decreased antimicrobial resistance in the country.

Haplophyllum tuberculatum (Forssk.) A. Juss Essential Oils: Seasonal Contents Variation, Bioactivity of the Traditionally-favored, High-yield and Frequent-use Summer Season Oil.

Haplophyllum tuberculatum (Forssk.) A.Juss. volatile oils were obtained by distillation of the aerial parts of the plant growing in Libya during the summer and spring seasons. A yield and componential analysis revealed that the summer season oil, which is frequently used in traditional medicaments by North African communities, was high in yield (0.858%) compared to the spring season oil (0.47%), and distinguished by the presence of major and various diverse constituents, some of which are considered chemical markers. Owing to the traditional and high incidence of use of the summer-produced essential oil for the treatment of several disorders, including hepatic diseases, and fatigue, the oil was pharmacologically investigated for its varied bioactivities of anti-microbial, in vivo anti-oxidant, and in vitro anti-cancer properties. Thirty-three compounds were identified and represented 96.2% of the peaks in the GCchromatogram of the summer oil, in which the major volatile constituents were δ-3-carene (21.5%), bornyl acetate (16.9%), and limonene aldehyde (15.2%). The summer-based essential oil of the plant demonstrated moderate anti-bacterial activity against Gram-positive bacteria and a relatively strong antibacterial effect against Gram-negative bacteria as compared to the positive antibacterial controls, ampicillin and gentamicin, respectively. Also, antifungal activity against Aspergillus sp. was observed. The summerproduced oil also exhibited in vivo antioxidant and in vitro anti-cancer activities.

Evaluating physicians' awareness and prescribing trends regarding proton pump inhibitors: a cross-sectional study.

Introduction: Proton pump inhibitors (PPIs) are commonly used to treat acid-related disorders. Their appropriate use depends on the correct indications from the clinician. Owing to the high incidence of use and misuse, PPIs have been identified as an essential pharmacological class for developing deprescribing recommendations. Therefore, assessing physicians' knowledge and practice regarding PPI usage is critical for paving the way toward targeted recommendations and efforts. Objective: This study aimed to assess Syrian physicians' perceptions of proton pump inhibitors adverse effects, their benefit in upper gastrointestinal bleeding (UGIB) prophylaxis, and how these perceptions are related to PPI prescription practice. Methods: A cross-sectional study was performed using a web-based questionnaire distributed among Syrian physicians in internal medicine between 28 November and 23 December 2022. The questionnaire assessed perceptions and experiences of PPIs, concerns about specific adverse effects, and their effectiveness for UGIB prophylaxis, in addition to the different scenarios used to determine the best practice for appropriate treatment to manage minimal, mild, moderate, and high-risk UGIB patients. Results: A total of 473 participants completed the questionnaire, with median age ±SD was (28.46 ± 4.58), and most participants (83.3%) were residents. Approximately half of the participants (45.5%) agreed that discussion assistance was provided to continue or terminate PPIs properly. Only 8.9% were very familiar with published evidence of PPI adverse effects. Bone weakening and vitamin B12 deficiency were the most frequently reported side effects (81.8% and 79.7%, respectively). However, dementia (0.4%) and mortality (1.9%) were the least reported adverse effects. More than half of the participants (64%) perceived using PPIs to prevent upper GI bleeding. Non-trainee physicians were less knowledgeable about appropriate GERD management than resident physicians (p < 0.001). Conclusion: The study showed a gap between Syrian physicians' perceptions and practices regarding PPI use, which necessitates spreading awareness of updated guidelines for PPI usage and their side effects.

Comparison of Three Different Doses of Dexamethasone Added to Midazolam for Prophylaxis against Nausea and Vomiting after Laparoscopic Cholecystectomy during Early Postoperative Period

Abstract Background General anesthesia using volatile anesthetics is associated with high incidence of postoperative nausea and vomiting ranging between 20% - 30% within 24 hours after surgery. Postoperative nausea and vomiting is thought to be of multifactorial etiology involving anesthetics, surgical and individual factors. Objective To compare between three different doses of Dexamethasone in conjunction with predetermined fixed dose of Midazolam which can provide effective prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy. Patients and Methods 1ry outcome was to decrease nausea and vomiting after laparoscopic cholecystectomy and 2ry outcome was itching and dizziness. The present study was conducted in Ain shams University hospitals on 120 adult female patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled to an elective laparoscopic cholecystectomy. After obtaining approval from the research ethical committee of faculty of medicine of Ain Shams University, a written informed consent was obtained from every patient after explaining the procedure. Results Over 24 h, the incidence of nausea, vomiting and rescue antiemtic use reduced significantly in Group ІІ and Group ІІІ when compared to group І. As with incidence, the severity of nausea was even significantly reduced in the group ІІ and group ІІІ group (P 0.043 and 0.009) respectively compared to group І in 24 hours postoperative. Postoperative pain was assessed for initial 6 h. Group ІІ and group ІІІ had significant reduction in severity of pain (P &amp;lt; 0.016 and 0.006) respectively when compared to group І while there was no significant difference between group ІІ and group ІІІ. Moreover, the incidence of use of rescue analgesia significantly reduced from 82.5% in group І to 52.5% and 45% in group ІІ and group ІІІ, respectively. However, dose of rescue analgesia used in 6 h was significantly reduced in Group ІІІ only (P = 0.013). Conclusion The minimum effective dose for prevention of postoperative nausea is 4 mg of Dexamethasone in combination with Midazolam in female patients undergoing Laparoscopic cholecystectomy with additional advantage of analgesia in the early postoperative period. Further reduction in incidence and severity of PONV can be achieved with a dose of 8 mg dexamethasone.

215b. Real-World Experience of Letermovir Use at an Academic Transplant Center

Abstract Background Letermovir (LMV) is indicated for cytomegalovirus (CMV) prophylaxis in seropositive adults after allogeneic hematopoietic stem cell transplants (alloSCT). LMV is well tolerated compared to its alternatives. Our institution restricts LMV use to high-risk patient groups to maximize the cost/benefit of LMV. Despite these restrictions, LMV was in our institution’s top 50 drug expenditures, prompting a formal evaluation of its use. We describe a real-world experience with LMV at a 576-bed academic transplant center. Methods This was a single center, retrospective, descriptive study of LMV use at a transplant center. Any hospitalized patient who received ≥ 1 dose of LMV between August 2021 and January 2022 was eligible for analysis. Data collection included age, LMV administration data, length of stay, transplant status, Infectious Diseases (ID) consultation, documented rationale for non-criteria uses, and drug cost. The primary outcome was incidence of use not aligning with restriction criteria. The secondary outcome was institutional drug expenditure for non-criteria uses compared to approved uses. Results Over 6 months, 388 doses of LMV were administered to 31 unique patients during 41 admissions. LMV use during 12/41 admissions (31.7%) fell outside the institutional criteria. ID consult occurred in 58.3% (7/12) of cases. 27/31 (87%) were alloSCT patients, including 1 pediatric patient. There was also 1 liver and 1 heart transplant recipient. Reasons for non-criteria use were: primary prophylaxis in the heart transplant patient to avoid ganciclovir toxicity and in 2 alloSCT patients without high risk for CMV, pre-emptive therapy due to CMV reactivation (n=2), and step-down therapy for CMV viremia (n=4). LMV was used for extended periods ( &amp;gt; 100 days from transplant) in 2 cases. Non-criteria use of LMV accounted for $20 414 in drug cost over 6 months, 29% of total expenditure. Conclusion Our data suggest real world use of LMV often differs from the patient types enrolled in the phase 3 trials. Use of LMV as an alternative to available CMV therapies to avoid drug toxicities appears to drive much of this use. In addition, use outside of criteria was frequent and incurred a nontrivial cost. Modification of our criteria, such as requiring an ID consultation for off-label use, should be considered. Disclosures James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant.

Incidence and type of restrictive practice use in nursing homes in Ireland

BackgroundUse of restrictive practices (RP) in care settings may sometimes be warranted but can also conflict with human rights. Research to date has focused primarily on physical and chemical RP, however other forms are also used. Better understanding of practice can inform RP reduction. This study describes the incidence of all types of RP use reported from nursing homes in Ireland.MethodsRP notifications from nursing homes reported in 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. The primary outcome measurement was the national incidence of use (frequency of RP/occupancy per 1000 residents) of categories and types of RP. Secondary outcome measurements such as percentage of facilities reporting use and quarterly median incidence of use in these facilities were calculated.ResultsSeventy thousand six hundred sixty-three RP uses were notified from 608 facilities (33,219 beds). National incidence of RP use per 1000 residents was, all categories: 2465.1, environmental: 1324.5, physical: 922.5, chemical: 141.1; ‘other’: 77.0. The most frequently used RPs per category were, environmental: door locks; physical: bedrails; chemical (where drug specified): antipsychotics; ‘other’: privacy. 90.5% of nursing homes reported using at least one type of RP in the 12-month period. Quarterly incidence of any RP use in these facilities was median 1.642 (IQR: 0.018 to 18.608) per bed.ConclusionsNursing homes in Ireland regularly use RP; only 9.5% reported no RP use in the 12-month period. A wide variety of types of RP were reported. Environmental and ‘other’ (largely psychosocial) RP contributed notably to total RP use and warrant attention alongside the traditional focus on physical and chemical RP. Policy implications include the need for more comprehensive RP definitions.

Incidence and type of restrictive practice use in residential disability facilities in Ireland, a cross-sectional study.

Restrictive practices (RPs) are a contentious issue in health and social care services. While use may be warranted in some instances, there are risks and concerns around human rights infringements. There are limited data available on the types and incidences of RPs used in health and social care services internationally. The objective of this study is to describe the type of RPs and incidence of use in disability residential care facilities (RCFs) in Ireland. RP notifications from disability RCFs reported from November 2019 to October 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. National frequency and incidence of use of categories and type of RPs were calculated. The number and percentage of disability RCFs reporting RP use, along with the mean annual incidence of use, were also calculated. A total of 48,877 uses of RPs were notified from 1387 disability RCFs (9487 beds) during the 12-month period. The national incidence of RPs use per 1000 beds was as follows: all categories: 5152.0, environmental: 2988.2, physical: 1403.0, other: 527.0 and chemical: 233.8. The most frequently used RPs for each category was as follows: environmental: door locks, physical: other physical, other: liberty and autonomy and chemical: anxiolytics. Most RCFs (81.7%) reported at least one RPs use. The median incidence of any RPs per 1000 beds in these RCFs was 4.75 (IQR: 2.00 to 51.66). Usage of RPs was generally low, although some RCFs reported relatively high usage. Nationally, on average, five RPs were applied per resident over 12 months; environmental contributing to more than half. These findings can be used to inform policy, measure progress in reducing RPs use and for cross-jurisdiction comparisons.

A retrospective comparative study to evaluate the reliability of post-mortem interval sources in UK and US medico-legal death investigations

Post-mortem interval (PMI) information sources may be subject to varying degrees of reliability that could impact the level of confidence associated with PMI estimations in forensic taphonomy research and in the practice of medico-legal death investigation. This study aimed to assess the reliability of PMI information sources in a retrospective comparative analysis of 1813 cases of decomposition from the Allegheny County Office of the Medical Examiner in Pittsburgh, US (n = 1714), and the Crime Scene Investigation department at Southwest Forensics in the UK (n = 99). PMI information sources were subjected to a two-stage evaluation using an adapted version of the 3x5 aspects of the UK police National Intelligence Model (NIM) to determine the confidence level associated with each source. Normal distribution plots were created to show the distribution frequency of the dependent variables (decomposition stage and source evaluation) by the independent variable of PMI. The manner, location, and season of death were recorded to ascertain if these variables influenced the reliability of the PMI. A confidence matrix was then created to assess the overall reliability and provenance of each PMI information source. Reliable PMI sources (including forensic specialists, missing persons reports, and digital evidence) were used across extensive PMI ranges (1 to 2920 days in the US, and 1 to 240 days in the UK) but conferred a low incidence of use with forensic specialists providing a PMI estimation in only 35% of all homicide cases. Medium confidence PMI sources (e.g., last known social contact) accounted for the majority of UK (54%, n = 54) and US (82%, n = 1413) cases and were associated with shorter PMIs and natural causes of death. Low confidence PMI sources represented the lowest frequencies of UK and US cases and exclusively comprised PMI information from scene evidence. In 96% of all cases, only one PMI source was reported, meaning PMI source corroboration was overall very low (4%). This research has important application for studies using police reports of PMI information to validate PMI estimation models, and in the practice of medico-legal death investigation where it is recommended that i) the identified reliable PMI sources are sought ii) untested or unreliable PMI sources are substantiated with corroborating PMI information, iii) all PMI sources are reported with an associated degree of confidence that encapsulates the uncertainty of the originating source.

An ethical review on the search for performance: evidence-based nutrology and the use without indication of anabolic steroids

This study aimed to evaluate what is new in the controversial use of testosterone, as an indication in pathologies such as hypogonadism or its use by athletes and bodybuilders in search of performance. Much is said about the subject and many myths were created without any scientific foundation, one of the objectives of the monograph is to show that when there is a precise clinical indication, testosterone is necessary and extremely beneficial to the patient. It was evaluated in current literature through books and articles, advances in physiology, regulation, treatment of late adult hypogonadism, incidence of use and the most common analogues used by athletes, the harms and benefits expected from the use of the hormone and especially what we have again on cardiovascular safety in testosterone use. After an extensive review, it is still not possible to affirm all the benefits and harms of using the hormone, many old studies are disputed in new studies and even presented results opposite to what was previously believed.

First-Line Pharmacotherapies and Survival among Patients Diagnosed with Non-Resectable NSCLC: A Real-Life Setting Study with Gender Prospective.

Simple SummaryWomen and men have a different biomolecular profile that could impact drug utilization and survival in non-small cell lung cancer (NSCLC) patients. The aim of the study was to describe first-line pharmacotherapy and overall survival in non-resectable (nr)NSCLC patients by gender. About 4400 incident cases of nrNSCLC were included. We reported a different use of target therapies on the basis of the known biomolecular profile between the two sexes. The survival improved in the last decade, and women and men also showed different survival if diagnosed with a squamous or non-squamous nrNSCLC.(1) Purpose: To describe first-line pharmacotherapy and overall survival in non-resectable non-small cell lung cancer (nrNSCLC) patients by gender. (2) Methods: Incident cases of nrNSCLC recorded between 2009 and 2019 (cohort entry) in the pathology registry of the regional administrative healthcare database of Tuscany were identified. Records of antineoplastic therapies delivered up to 4 months following cohort entry were classified as chemotherapy, target therapies, immunotherapies, and undefined monoclonal antibodies. First-line treatment and survival of patients receiving drug treatment was described. Analyses were stratified according to histology, gender, and cohort entry year. (3) Results: 4393 incident cases of nrNSCLC were included. Women with non-squamous-NSCLC received target-therapy more frequently than men (14.9% vs. 6.5%). Immunotherapy incidence of use varied between 3.8% (2017) and 9.1% (2019). The 2-year survival rate increased over time: for non-squamous-NSCLC, it was 22.3% (2009–2011) and 30.6% (2018–2019), while for squamous-NSCLC, it was 13.5% and 22.5%, respectively. After multivariate analysis, a low reduction in mortality risk in 2018–2019 vs. 2009–2011 was found (non-squamous: HR: 0.95 CI95%: 0.92–0.98; squamous: HR: 0.94 CI95%: 0.90–0.98). Among non-squamous NSCLC, median survival was longer in women than in men (389 vs. 276 days). (4) Conclusion: In light of sex-related biomolecular differences, among non-squamous NSCLC, women received target-therapy more frequently than men. Survival seemed to slightly improve over the study period for both histologies, despite a poor reduction in mortality risk was still observed.

Comparison of Clinical and Thrombotic Outcomes in Sars-Cov-2- Pneumonia Versus Other Viral Pneumonia in an Urban Academic Medical Center

Title: Comparison of Clinical and Thrombotic Outcomes in SARS-CoV-2- Pneumonia versus Other Viral Pneumonia in an Urban Academic Medical CenterObjective: To compare clinical and thrombotic outcomes in SARS-CoV-2 pneumonia versus other viral pneumonias.Introduction: Viral pneumonia (PNA) causes oxidative stress to the pulmonary vasculature, triggering endothelial dysfunction and activation of the coagulation cascade. Elevations in coagulation markers, including d-dimer and fibrinogen, have been observed. Recent studies indicate that SARS-CoV-2 infection causes endothelial cell injury, with activation of the coagulation cascade, and a high frequency of systemic thrombotic events. It remains unclear whether it is viral pneumonia itself, a specific viral strain (and/or viral load) that drives the clinical and thrombotic outcomes. Furthermore, limited data is available regarding clinical outcomes in a diverse patient population hospitalized with SARS-CoV-2 infection. This study is from a single urban medical center in Chicago, Illinois.Study Design: A retrospective cohort study evaluating the medical records of hospitalized adult patients admitted to University of Illinois Hospital and Health Sciences System (UIHHSS) with SARS-CoV-2 pneumonia or other viral (H1N1 or H3N2) pneumonia between 10/01/2017 and 09/01/2020.Methods: Patients were included if ≥18 years old, hospitalized, with a primary confirmed diagnosis of viral pneumonia (SARS-CoV-2, H1N1 or H3N2) based on ICD-10 code, viral diagnostic testing, diagnosis description, and appropriate clinical characteristics/imaging studies. Past medical history, inpatient medications, coagulation parameters, arterial/venous thrombotic outcomes, and other clinical outcomes (renal replacement therapy, mechanical ventilation, co-infection) were abstracted from UIHHSS electronic health record database.Results: Medical records of 257 patient with a primary diagnosis of pneumonia were reviewed, 199 patients with SARS-CoV-2 PNA (95 male, average age 58 years, 52% Hispanic, 37% non-Hispanic Black) and 58 patients with other viral PNA (24 male, average age 63 years, 21% Hispanic, 55% non-Hispanic Black; 34 with H3N2, 24 with H1N1). Coagulation parameters (maximum D-dimer, fibrinogen, INR) were similar in both groups; average D-dimer was >3x ULN. Anticoagulation therapy was similarly prescribed in both groups (SARS-CoV-2, 95% vs 84%, H1N1 or H3N2), with prophylactic dose anticoagulation prescribed most frequently (73% vs 62%) and with high average compliance rates (89% vs 83%). Admission to the intensive care unit (ICU; 32% vs 29%) and the median length of stay (10 vs 4 days) was similar in both groups. Thrombotic events (n = 6, 3%) occurred only in SARS-CoV-2 PNA patients in the ICU: 3 pulmonary embolism (PE), 1 distal lower extremity deep vein thrombosis (DVT), 2 non-ST elevated myocardial infarctions (NSTEMI). There was a significantly higher incidence of use of renal replacement therapy (8.5% vs 0%, p=0.016) and mortality (15.6% vs 3.4%, p=0.048) in the SARS-CoV-2 PNA group compared to the H3N2/H1N1 PNA group. There were no differences in the rates of mechanical ventilation, the incidence of major bleeding or co-infection. In a multivariable logistic regression analysis, age (aOR 1.07), the presence of SARS-CoV-2 PNA (aOR 11.37), and ICU admission (aOR 41.95) were significantly associated with risk of mortality during hospitalization. Race and ethnicity were not associated with mortality.Conclusion: The overall incidence of thrombotic events was low and occurred only in the SARS-CoV-2 PNA group. The low rate of venous thrombosis detected in this group, especially in the ICU setting, is likely related to the reduced use of diagnostic studies during the first COVID-19 pandemic in 2020 and to the high rates of anticoagulation prophylaxis orders and compliance. SARS-CoV-2 PNA was associated with a higher rate of renal failure and mortality compared to patients with H3N2/H1N1 viral pneumonia. There was no difference in mortality rates between Hispanic and non-Hispanic and between Black and non-Black patients. This study suggests that SARS-CoV-2 pneumonia leads to greater endothelial dysfunction than that observed in H3N2/H1N1 viral pneumonia and that race/ethnicity does not drive mortality outcomes. DisclosuresBenken: BMS: Research Funding; CareDx: Research Funding; Transplant Genomics: Research Funding; Daiichi Sankyo: Research Funding; Verici Dx: Research Funding.

Incidence of Use of Contraindicated Oral Hypoglycemic Drugs in New Patients of Diabetic Nephropathy Visiting OPD of Tertiary Care Hospital

Incidence of Use of Contraindicated Oral Hypoglycemic Drugs in New Patients of Diabetic Nephropathy Visiting OPD of Tertiary Care Hospital

The Indianapolis harmspot policing experiment

PurposeThis 100-day experiment explored the impact of a dynamic place-based policing strategy on social harm in Indianapolis. Scholars have recently called for place-based policing to consider the co-occurrence of substance abuse and mental health problems that correlate within crime hot spots. Moreover, severity is not ubiquitous across harmful events and should thus be weighted accordingly. MethodsHarmspots and hotspots were operationalized for this experiment and both received proactive police activities. Evaluation analyses includes multivariate point processes and hawkes processes to determine experimental effects. Survey data was collected via telephone surveys, was weighted for demographic representativeness, and analyzed using Poisson regression. ResultsResults indicate proactive policing in dynamic harmspots can reduce aggregated social harm. No statistical deterrence effect was observed in crime hotspots. Proactive police activity in harmspots was associated with higher arrest rates, though not disproportionate across race and ethnicity, nor was there an effect on incidents of use of force. A two-wave pre/post community survey indicated Indianapolis citizens believe data-driven policing to be useful, though perceptions vary across demographic groups with moderate trust around computer algorithms. ConclusionPlace-based policing strategies should consider social harm events as a method to operationalize proactive policing. Observed effects are consistent with those of hotspots policing while enabling cities to broaden the set of harms experienced by varying communities. Harmspot policing may also position municipalities to maximize social service delivery at places beyond policing.

Medicinal cannabis in Thailand: 1-year experience after legalization.

Medicinal cannabis in Thailand: 1-year experience after legalization.