Known Cause Of Morbidity Research Articles

Cardiogenic Necrotizing Enterocolitis in Infants with Congenital Heart Disease: A Systematic Review and Meta-analysis.

Necrotizing enterocolitis (NEC) is a known cause of morbidity and mortality in infants with congenital heart disease (CHD), but reports about the burden of cardiogenic NEC frequently conflict. To synthesize the extant literature on the incidence, risk factors, and prognosis of NEC in patients with CHD. Medline, Cochrane, and EMBASE were searched from 1946 through 2023 for studies of NEC in infants 0-12months of age with CHD. Risk of bias was assessed with validated tools for incidence and risk factors. Pooled estimates were meta-analyzed by risk of bias or synthesized without meta-analysis. Eighty-six studies with a total of 67,924 participants were included. The incidence of cardiogenic NEC was 7.1% (95% CI 4.7-10.5%) in term infants and 13.0% (10.2-16.5%) in low birthweight preterm infants. NEC required surgery in 0.8% (0.5-1.1%) of term and 2.7% (2.0-3.7%) of premature infants, respectively. Only gestational age and birth weight were consistently associated with risk of NEC. Restricting pooled estimates to studies of moderate or low risk of bias significantly reduced the number of studies included. Necrotizing enterocolitis is a common cause of morbidity in infants with CHD, but additional research is needed to determine which infants are at highest risk of developing NEC and would benefit most from a change in management. This systematic review and meta-analysis was conducted according to a prespecified protocol registered at the Prospective Register of Systematic Reviews (CRD42021282114).

Trends in the thrombotic complications of myeloproliferative neoplasms: A nationwide analysis.

6581 Background: Thrombotic complications are a well known cause of morbidity and mortality in Philadelphia-negative Myeloproliferative Neoplasms[Polycythemia Vera, Essential thrombocythemia, Primary Myelofibrosis]. Current study evaluated thrombotic events incidence and outcome trends in Myeloproliferative Neoplasms[MPN] from 2012 to 2020. Methods: This is a longitudinal study of thrombotic events in MPN using the Nationwide Inpatient Sample. All patients with a diagnosis of MPN admitted with any thrombotic event including arterial or venous thrombosis were included in the study. Arterial thrombotic events included Myocardial infarction[MI], Ischemic stroke[IS], Transient Ischemic Attack[TIA] while venous thrombotic events included Deep Vein Thrombosis[DVT], Pulmonary Embolism[PE], Budd-Chiari Syndrome[BCS], Portal Vein Thrombosis[PVT]. Thrombosis related inpatient mortality rate, incidence, length of hospital stay, and total hospital charges were calculated. Results: Mortality rate from any thrombotic event overall[arterial plus venous] increased from 2.3% to 2.6% from 2012 to 2020. There was an increase in mortality rates from 2.8% to 3.8% among arterial thrombosis while there was a decrease in venous thrombosis related mortality from 1.7 to 0.4%. Specifically MI and IS related mortality increased from 3.7% to 4.3% and 3% to 4% respectively over the same period. The incidence of any thrombotic event declined from 2 to 1.3 cases/100,000 persons from 2012 to 2020. A similar decline in incidence of arterial, venous events, MI, IS were observed. The mean length of stay decreased from 5.8 days in 2012 to 5.2 days in 2020 among MPN patients with venous thrombosis which was statistically significant. Similar decline was noted in MI patients as well. Though the mean length of stay increased from 7.9 to 9.5 days among MPN patients with IS, this increase was not statistically significant. The mean hospitalization charges for thrombotic events increased from $53,421 in 2012 to $101,598 in 2020 after adjusting for inflation. Similar trends were noted in all types of thrombotic admissions which were all statistically significant. Upon age based stratification of MPN, mortality for those less than 60 years reduced from 2% to 0.3%, while it increased from 4.1 to 5.6% in those more than 60 years from 2012 to 2020. Conclusions: Inpatient mortality from thrombotic events in MPN has shown an increasing trend from 2012 to 2020 though there was a decline in overall incidence of thrombosis during the same period. Despite the decreasing trend in length of stay, the total economic burden of thrombotic complications in MPN is increasing in the US. Specifically the effects were more pronounced in those greater than 60 years. This points to the need for revisiting guidelines regarding thromboprophylaxis in MPN.

Injection Medialization in Infants with Vocal Fold Immobility Improves Dysphagia.

Unilateral vocal fold immobility (VFI) is a known cause of morbidity amongst children following congenital heart surgery. Injection medialization (IM) provides medial distraction and improves glottic closure. Limited objective data is available for the effect of IM in young children (<2 years-old) with VFI. Retrospective case series of infants <2 who underwent IM for VFI after congenital cardiac surgery. Primary outcome was objective reduced risk of aspiration based on Dysphagia and Outcome Severity Scores (DOSS) on Video swallow study (VFSS) performed prior to and within 4 weeks following IM. Secondary analysis included perioperative complications and number of children who were able to avoid NG or G tube placement. 17 children <2 years of age had unilateral VFI after congenital cardiac surgery and underwent IM. The median age at time of initial cardiac surgery was 6 days (IQR 3-7). There was no intraoperative or postoperative stridor or associated complications. All 17 patients had preoperative aspiration noted on VFSS. Average swallowing outcomes on VFSS improved after IM with an increase in DOSS score (preop score 3 (IQR 2-4) to postop score 6.5 (IQR 5-7) [P = 0.001]). At 2 months following IM, of the patients who had improvement in swallowing function, 50% (n = 6) were able to feed completely orally, 25% (n = 3) were fed orally with an NG wean, and 3 (25%) had a G tube placed. Initial results suggest that IM is safe and improves early objective swallowing outcomes in children <2 years old with VFI after congenital cardiac surgery. 4 Laryngoscope, 134:4396-4401, 2024.

High frame rate speckle tracking echocardiography to visualize the mechanical activation sequence of the left ventricle

Abstract Background Cardiac arrhythmias are a known cause of morbidity and mortality, with catheter ablation being an effective treatment. In order to detect the focal source or the re-entrant circuit of the arrhythmia, i.e. the ablation target, current practice includes performing an electrophysiological study. This technique is invasive, with increased patient related risk and variable success rate. Conversely, echocardiography could be used to determine the correct ablation target. High frame rate (HFR) ultrasound has a temporal resolution adequately high to detect the onset of myocardial deformation and could assist the accurate localisation of the arrhythmia source. Purpose To test whether HFR speckle tracking echocardiography (STE) can be used to create cardiac mechanical activation maps. Methods 18 healthy volunteers (HV) (age 30±6y; 69 %males) and 12 heart failure patients treated with cardiac resynchronisation therapy (CRT) (age 69±10y; 75 %males) were included. All participants were scanned with a research HFR ultrasound scanner (∼849fps) and the 3 standard apical views were acquired. Patients were scanned with CRT on and after turning CRT off, in order to allow intrinsic ventricular conduction. Data from one CRT patient were acquired by temporarily altering the pacing pole of the CRT LV lead. All patients had a left bundle branch block (LBBB) pattern of native activation on the surface ECG. For each view, a manually placed contour was tracked during the cardiac cycle by a custom-made 2D HFR STE algorithm; the contours were divided in a standard 16 segment model and segmental strain rate (SR) curves were computed and used to measure the temporal distance between electrical and mechanical activation (i.e. distance between the beginning of QRS and the first positive to negative zero crossing in the SR curve). Finally, an activation map for each subject was created by placing the extracted timings in the middle of the corresponding segment of a bull’s-eye plot and interpolating values between them. Results Tracking was feasible in 94% of the segments; SR curves showed a physiological pattern (Fig. 1A). For the HV, mechanical activation started from mid anteroseptal (72%) or mid inferoseptal (28%) segment at 23±5ms, spreading to basal posterolateral segment at 49±8ms from the start of QRS, in all but one case, where activation ended at basal inferoseptal segment (Fig. 1B). During CRT off, septal wall was activated 31±9ms and lateral wall 74±20ms after the beginning of QRS (p&amp;lt;0.01) (Fig. 1C), whereas during CRT on, septal wall was activated 41±11ms and lateral wall 38±7ms after the beginning of QRS (p=0.3) (Fig. 1D). Changing the pacing pole of the LV lead in one CRT patient also changed the start of mechanical activation in the lateral wall (Fig. 2). Conclusion Our findings comply with left ventricular activation as described in the literature and show that HFR STE could be a useful tool in defining the ablation target for arrhythmia treatment.

Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis.

Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI). To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS. We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity. Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, P = 0.025, I 2 = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, P = 0.929), I 2 = 0.0%). Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.

S2315 Epiglottic Calcification, a Rare a Cause of Dysphagia

Introduction: In consideration of dysphagia, most cases predominate in the oropharyngeal region with the remainder caused primarily by esophageal causes. Lesser known and studied is the development of dysphagia and globus sensation from epiglottic pathology, namely epiglottic calcification. With less than a dozen published cases in literature, very little data exists on identification, diagnosis, and treatment of this known cause of morbidity. Here we present a case of oropharyngeal dysphagia arising from a rare cause, epiglottic calcification. Case Description/Methods: An 81-year-old male with history of aortic stenosis and carotid artery stenosis presented with worsening dysphagia over the course of one month. The patient reported significant dysphagia initially to solids and subsequently to liquids causing a weight loss of over 50 pounds. Physical exam of oropharynx and neck was unremarkable. Bedside swallow evaluation suggested mildly decreased hyolaryngeal movement, but no other significant abnormalities were identified. A Barium swallow study revealed incomplete epiglottic excursion during the pharyngeal phase of swallowing. With gastroenterology consultation, patient underwent evaluation with contrast-enhanced esophagogram that showed severe esophageal dysmotility and reflux. CT of neck demonstrated calcification of epiglottis without epiglottal enlargement, which was ultimately found to be the source of his concern. Via ENT, the patient underwent flexible fiberoptic laryngoscopy, and via gastroenterology, patient underwent EGD with biopsy. Yet, no esophageal or gastric pathology other than epiglottic calcification were identified. As no definitive treatment modality was outlined despite evaluation, patient was changed to a modified diet with ongoing speech and swallow therapy with outpatient follow up (Figure). Discussion: Epiglottic calcification is a rare cause of dysphagia that is poorly understood in its etiology, clinical course and outcomes. With our case, we hope to add to literature a unique presentation and imaging. Furthermore, with our case it is demonstrated that despite consultant recommendations, no clear evaluation process or treatment modality currently exists, lending to further study of this pathology. Currently, diagnosis can be accomplished with radiologic evaluation along with exclusion of other causes; however, no definitive treatments are available for this condition. Although the condition itself is rare, it adds to the differential diagnosis as a cause of significant dysphagia.Figure 1.: Calcification of epiglottis (red arrow) visualized on CT scan.

September 2022 Medical Image of the Month: Epiglottic Calcification

No abstract available. Manuscript truncated after 150 words. In consideration of dysphagia, most cases predominate in the oropharyngeal region with the remainder caused primary by esophageal causes. Lesser known and studied is the development of dysphagia and globus sensation from epiglottic pathology, namely epiglottic calcification. With less than a dozen published cases in literature, very little data exists on identification, diagnosis, and treatment of this known cause of morbidity. Here we present a case of oropharyngeal dysphagia arising from a rare cause, epiglottic calcification. An 81-year-old man with a history of aortic stenosis and carotid artery stenosis presented with worsening dysphagia over the course of one month. The patient reported significant dysphagia, initially to solids and subsequently to liquids causing a weight loss of over 50 pounds. Physical exam of the oropharynx and neck were unremarkable. A bedside swallow evaluation suggested mildly decreased hyolaryngeal movement, but no other significant abnormalities. A barium swallow study revealed incomplete epiglottic excursion …

Clinical Findings on Chromosome 1 Copy Number Variations.

Copy number variants (CNVs) are a major contribution to genome variability, and the presence of CNVs on chromosome 1 is a known cause of morbidity. The main objective of this study was to contribute to chromosome 1 disease map, through the analysis of patients with chromosome 1 CNVs.A cross-sectional study was performed using the array comparative genomic hybridization database of the Genetic Department of the Faculty of Medicine. Patients with pathogenic (P) or likely pathogenic (LP) CNVs on chromosome 1 were selected for the study. Clinical information was collected for all patients. Databases and related literature were used for genotype-phenotype correlation.From a total of 2,516 patients included in the database we identified 24 patients (0.95%) with P (9 patients) or LP (15 patients) CNVs on chromosome 1. These CNVs account for 6.1% (24/392 CNVs) of the total P/LP CNVs in the database. Most common CNVs found were in the 1q21.1-1q21.2 region.This study reinforces the association between chromosome 1 CNV and neurodevelopmental disorders and craniofacial dysmorphisms. Additionally, it also strengthened the idea that CNVs interpretation is not always a linear task due to the broad spectrum of variants that can be identified between benign and clearly pathogenic CNVs.

CMV-Responsive CD4 T Cells Have a Stable Cytotoxic Phenotype Over the First Year Post-Transplant in Patients Without Evidence of CMV Viremia.

Cytomegalovirus (CMV) infection is a known cause of morbidity and mortality in solid organ transplant recipients. While primary infection is controlled by a healthy immune system, CMV is never eradicated due to viral latency and periodic reactivation. Transplantation and associated therapies hinder immune surveillance of CMV. CD4 T cells are an important part of control of CMV reactivation. We therefore investigated how CMV impacts differentiation, functionality, and expansion of protective CD4 T cells from recipients of heart or kidney transplant in the first year post-transplant without evidence of CMV viremia. We analyzed longitudinal peripheral blood samples by flow cytometry and targeted single cell RNA sequencing coupled to T cell receptor (TCR) sequencing. At the time of transplant, CD4 T cells from CMV seropositive transplant recipients had a higher degree of immune aging than the seronegative recipients. The phenotype of CD4 T cells was stable over time. CMV-responsive CD4 T cells in our transplant cohort included a large proportion with cytotoxic potential. We used sequence analysis of TCRαβ to identify clonal expansion and found that clonally expanded CMV-responsive CD4 T cells were of a predominantly aged cytotoxic phenotype. Overall, our analyses suggest that the CD4 response to CMV is dominated by cytotoxicity and not impacted by transplantation in the first year. Our findings indicate that CMV-responsive CD4 T cells are homeostatically stable in the first year after transplantation and identify subpopulations relevant to study the role of this CD4 T cell population in post-transplant health.

C78 PREVALENCE AND MECHANISMS OF SEVERE MITRAL AND TRICUSPID REGURGITATION IN A HEART FAILURE OUTPATIENTS POPULATION

Abstract Introduction Mitral regurgitation (MR) and tricuspid regurgitation (TR) are a known cause of morbidity and mortality in heart failure (HF) patients. Maximal up–titration of guideline–directed medical therapy (GDMT) for HF may not be enough to reduce the severity of the valve’s incompetence and patients’ symptoms. The development and successful results of transcatheter therapies for mitral/tricuspid disease have opened new therapeutic opportunities when surgery is not feasible. Accurate valve regurgitation’s mechanisms evaluation is essential to choose the best treatment option. This study aims at evaluating the prevalence and underlying mechanisms of at least moderate–to–severe (≥3+/4+) MR and/or TR in a cohort of HF outpatients. Methods We retrospectively analyzed the medical records of 1260 outpatients evaluated by our HF unit between January 2020 and June 2021. All patients with echocardiographic evidence of ≥ 3+/4+ MR and/or TR were included (treated ones were excluded), and a thorough echocardiographic images review was conducted. A full collection of patients’ clinical, laboratory and therapy regimens details was performed as well. Results Of the 1260 analyzed patients, 173 (13.7%) exhibited ≥3+/4+ MR and/or TR and were included in the registry. Table 1 shows the main clinical/echocardiographic characteristics. Mean age was 80±7 years, median ejection fraction was 45% (IQR=33–55). All patients were treated with maximal tolerated doses of GDMT and, if appropriate, with cardiac devices/myocardial revascularization. ≥3+/4+ MR and/or TR was observed in 92 (7.3%) and 117 (9.3%) patients, respectively. Patients with isolated significant MR were 56 (4.4%), with isolated significant TR were 81 (6.4%); the remaining 36 (2.8%) had both MR/TR. Among patients with significant MR, 50 (54%) had functional/secondary valvular defect (details in Figure 2): the majority (41,82%) presented a ventricular etiology (asymmetric tethering in 18/41) while 9 (18%) an atrial one (atriogenic tethering in 3/9). Conclusion Despite optimized GDMT, the prevalence of patients with hemodynamically significant valvular defects was considerably high in our HF population. This is the first registry to comprehensively detail atrioventricular valve regurgitations’ mechanisms in a wide real–life cohort of HF outpatients. Further studies are needed to identify reasons for potential undertreatment and patients who would benefit the most from percutaneous correction of their valvular defects.

Pediatric Portal Hypertension: Etiology and Management

AbstractPortal hypertension is a known cause of morbidity and mortality in children. With a paucity of data and no standardized algorithm for treatment, a comprehensive understanding of this disease process is necessary for pediatric interventional radiologists, hepatologists, and surgeons who collaborate to care for these patients. While associations can be drawn to adult disease, the specifics of pediatric portal hypertension necessitate a separate, multidisciplinary approach. This review provides a summary and update on the evaluation, management, and treatment of pediatric portal hypertension.

Acute Kidney Injury in Patients With Suspected Pulmonary Embolism: A Retrospective Study of the Incidence, Risk Factors, and Outcomes in a Tertiary Care Hospital in Saudi Arabia.

BackgroundPulmonary embolism (PE) is a known cause of morbidity and mortality. A diagnosis of PE is made by computed tomography pulmonary angiogram (CTPA) or a ventilation-perfusion (V/Q) scan. This study aimed to assess the incidence and predictors of acute kidney injury (AKI) in patients with suspected PE.MethodsThis study was a retrospective study including patients with suspected PE who underwent a CTPA and/or a V/Q scan from 2015 to 2020. The patients were grouped into CTPA or V/Q scan. Creatinine levels were obtained before and after the procedure. AKI was defined based on an increased serum creatinine by 0.3 mg/dL within 48 hours.ResultsA total of 752 patients were included in the study. The majority (n = 688) underwent a CTPA as a diagnostic modality in patients suspected to have pulmonary embolism (PE), and a V/Q scan was used in 73 patients. Of the 752 patients, there were eight patients who underwent both diagnostic modalities. PE was diagnosed in 121 (16.1%) patients. The incidence of AKI was observed in 15.8%. PE was suspected more frequently in the female group (n = 481, 64%), with a 50% reduction of AKI risk, compared with the male group (p-value = 0.004, OR = 0.522, 95% CI = 0.337-0.81). The presence of diabetes mellitus (DM) and hypertension (HTN) was associated with AKI (p-value < 0.001). Of the AKI group, 43 (36.1%) patients had malignancy. The presence of malignancy was a predictor of increased AKI risk (p-value = 0.014, OR = 1.74, 95% CI = 1.21-2.70). A small proportion (2.1%, n = 16) required dialysis. Patients who developed AKI had a 30-day mortality of 20.2% compared with 5.1% for the group without AKI.ConclusionIn our sample, clinicians suspected PE more frequently in the female group. The overall incidence rate of AKI in patients suspected of having PE was 16.1%. The presence of diabetes mellitus and hypertension was associated with AKI. However, DM and HTN were not predictors of AKI. The risk of AKI requiring dialysis was relatively low (2.1%). There was no relationship between the diagnostic modalities and PE, and AKI, suggesting that clinicians overestimate the fear of contrast-induced AKI (CI-AKI).

Outcomes of Cytomegalovirus Monitoring in Autologous Transplantation: A Single Institution Experience

Introduction: Identification of patients seropositive for cytomegalovirus (CMV) prior to stem cell transplant (SCT) is a well-accepted practice across institutions designed to reduce a known cause of morbidity and mortality in this population, but the role of monitoring and preemptive approaches to CMV identification and treatment are controversial and not standardized in autologous transplantation. The preemptive approach necessitates the use of significant resources and requires persistent patient involvement. Patients undergoing autologous SCT are at a relatively low risk for CMV reactivation, especially those seronegative for CMV at the time of transplant. Here, we show that the necessity of routine monitoring of autologous transplant patients is of minimal clinical value.Methods: To determine the efficacy of the CMV monitoring protocol currently in place at our institution in detecting patients who would later develop CMV reactivation and disease following autologous SCT, we retrospectively analyzed the charts of 218 adult patients between 11/1/14 and 8/1/19 who underwent transplant at St. Louis University Hospital. No patients underwent CD34 selected stem cell infusions. The protocol stipulated the following: CMV IgG/IgM and CMV DNA PCR prior to preparative regimen followed by weekly CMV DNA PCR to day +30 . We correlated the predictive ability of positive results on any of these screening tests to identify whether patients would later develop quantifiable CMV DNA PCR positivity, clinical manifestations of CMV disease, and/or require pharmacologic treatment for CMV.Results: Quantifiable pre-BMT DNA PCR was positive in only 0.46% of patients, and 97.79% of patients were DNA PCR negative prior to transplant. CMV IgG was positive in 56.4% patients, and only 22.1% of patients in this group went on to develop a quantifiable post-transplant PCR. Of the remaining 43.6% of patients initially testing negative for CMV IgG, no patients went on to develop a quantifiably positive post-transplant PCR. Regardless of seropositivity, only 0.08% of the 1,191 PCRs performed during the study period were found to be quantifiable. Further, no patients in our cohort developed CMV disease or required CMV treatment during the monitoring period. This trend persisted despite stratification by age, diagnosis, transplant number, and preparative regimen.Conclusion: When clinically-significant CMV is defined by cases requiring treatment or the development of end-organ disease, no screening tests performed elicited clinical action. Laboratory-based CMV surveillance, based on our data, has minimal diagnostic implications and represents an overly-stringent practice in a set of patients already utilizing a substantial share of healthcare resources. We believe that pre-transplant screening for CMV IgM serology and CMV DNA PCR can be safely eliminated in the autologous SCT population at our institution while CMV IgG still plays a role in determining candidacy for CMV-negative blood products. We also propose the elimination of serial post-transplant monitoring with DNA PCR in patients without clinical signs, symptoms, or pathologic findings suggestive of CMV disease. We have changed the protocol to test for CMV PCR only if there are clinical scenarios that indicate a utility, such as prolonged fever post-transplant, unexplained cytopenias, or unexplained pneumonitis, colitis, or hepatitis. By extension, other centers should consider determining the necessity of CMV screening in their autologous transplant population given the potential resource conservation and reduction in healthcare expenditures. DisclosuresFesler: abbvie: Consultancy, Speakers Bureau; incyte: Consultancy, Speakers Bureau; sanofi: Speakers Bureau; morphosys: Speakers Bureau; epizyme: Consultancy; jazz: Consultancy; Skipta: Consultancy; Best Doctors: Consultancy; Aptitude Health: Consultancy; Care Dx: Consultancy; Opinionsite: Consultancy. Goldenberg: Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.

Current Opinion on the use of Direct Oral Anticoagulants for the Prophylaxis of Venous Thromboembolism among Medical Inpatients.

Venous thromboembolism (VTE) is a known cause of morbidity and mortality, especially among acutely ill medical patients. Although VTE prophylaxis is part of post-discharge clinical care in surgical patients, there is controversy regarding its use in acutely ill medical patients and the current guideline statements suggest against its routine use. Recent clinical trials (APEX, MAGELLAN and MARINER) compared the safety and efficacy of direct oral anticoagulants (including betrixaban and rivaroxaban) with the standard of the care, enoxaparin, to identify the risk–benefit tradeoff. In this review, we summarized the key findings from these trials and substudies and recent updates in society guidelines regarding VTE prevention. In addition, we discussed the potential barriers, cost-effectiveness, and COVID-19 with respect to the implementation of extended-duration or post-discharge usage of direct oral anticoagulants.

Adverse Drug Reaction due to Antidepressants among Patients with Depression in a Private Psychiatric Hospital of Nepal.

Background Adverse drug reactions (ADRs) are the known cause of morbidity and mortality, resulting in increased hospitalization, healthcare costs, complications, and decreased adherence in patients with depression. This study is aimed at evaluating adverse drug reactions due to antidepressants among patients with depression in the psychiatric hospital of Nepal. Methods A hospital-based prospective observational study was conducted among 47 patients using purposive sampling techniques among patients with depression visiting a private psychiatric hospital. The causality, severity, and preventability assessment of reported ADRs was performed using the Naranjo scale, modified Hartwig Siegel's Severity Assessment Scale, and Schumock and Thornton scale, respectively. The data collected were entered into and analyzed using IBM-SPSS 20.0. Results The incidence rate of ADR was found to be 4.54%, with females having a higher incidence rate of 5.56%. A total of 54 ADRs were reported. The majority of them were probable (30, 55.55%), moderate (36, 66.66%) and probably preventable (24, 44.44%). Most of the ADRs were managed either by stopping (19, 35.18%) or substituting (19, 35.18%) the suspected drug and 66.66% of the ADRs were recovered. Selective serotonin reuptake inhibitors (SSRIs) were associated with a higher number of ADRs i.e. 34. Conclusion The findings highlight the need for regular intensive monitoring of ADRs in psychiatric outpatients by clinical pharmacists for early detection and reduction of risk caused by ADRs associated with antidepressants.

Assessment of renal impairment using estimated glomerular filtration rate among type 2 diabetes mellitus patients in North-East Ethiopia: a cross-sectional study

BackgroundChronic kidney disease (CKD) is the known cause of morbidity and mortality among diabetes mellitus (DM) patients. Targeted screening of renal impairment based on estimated glomerular filtration rate (eGFR) among DM patients has potential benefits in early identification and treatment of CKD. Hence, this study was aimed to estimate the magnitude of renal impairment using eGFR among type 2 DM patients.MethodsAn institution-based cross-sectional study was conducted from February-1 to April 30/2020 among 422 type 2 DM patients in Northeast Ethiopia. Data were collected by the semi-structured questioner and serum creatinine measurement. The collected data were edited into Epi-data manager version 4.4.1.0, and the analysis was performed by SPSS-25. The Simplified Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI), and Cockcroft-Gault (C-G) equations were used to calculate eGFR.ResultsOf all study participants, 82(19.4%), 92(21.8%), and 103(24.4%) had eGFR < 60 ml/min/1.73 m2, according to the MDRD, CKD-EPI, and C-G equations, respectively. Female sex, (MDRD:AOR = 4.44, 95%CI:1.97–9.97, CKD-EPI:AOR = 3.17, 95%CI:1.27–6.17, and C-G:AOR = 2.65, 95%CI:1.35–5.21), duration ≥ 10 years (MDRD:AOR = 3.38, 95%CI:1.45–7.92, CKD-EPI:AOR = 3.09, 95%CI:1.07–7.77, and C-G:AOR = 2.92, 95%CI:1.29–6.61), age ˃60 years (MDRD:AOR = 2.29, 95%CI:1.09–4.77, CKD-EPI:AOR = 4.12, 95%CI:1.68–6.78, and C-G: AOR = 3.42, 95%CI:1.77–6.60), hypertension (MDRD:AOR = 3.12, 95%CI:1.51–6.45, CKD-EPI: AOR = 4.21,95%CI:2.07–7.98, and C-G:AOR = 3.99, 95%CI:2.08–7.65), poor glycemic control (MDRD:AOR = 2.82, 95%CI:1.13–7.05, and C-G:AOR = 2.34, 95%CI:1.09–5.04), and body mass index (MDRD:AOR = 1.11, 95%CI:1.01–1.22, and CKD-EPI:AOR = 2.43, 95%CI:1.27–5.76) were significantly associated with renal impairment.ConclusionRenal impairment was prevalent among type 2 DM patients. Older age, female sex, duration, hypertension, poor glycemic control, and BMI were significantly associated with renal impairment.

Testicular torsion: epidemiological risk factors for orchiectomy in pediatric and adult patients.

Testicular torsion is a known cause of morbidity in pediatric patients, but the burden in the adult population is poorly understood. We sought to determine the incidence of testicular torsion and risk factors for orchiectomy in a population encompassing all ages. A cohort analysis of 1625 males undergoing surgery for torsion was performed using the 2011 and 2012 Healthcare Cost and Utilization Project Nationwide Emergency Departments Sample. Patient and hospital factors were examined for association with orchiectomy vs. testicular salvage. The estimated yearly incidence of testicular torsion was 5.9 per 100,000 males ages 1-17 years and 1.3 per 100,000 males ≥18 years. Among those undergoing surgical intervention, orchiectomy was performed in 33.6%. The risk of orchiectomy was highest in patients 1-11 years of age and patients over 50 years of age (46.0% and 69.7% of patients, respectively). Orchiectomy was also associated with public insurance (Medicaid/Medicare) or self-pay as primary payer. While testicular torsion is less common in the adult population, the rate of orchiectomy is high. Those with disadvantaged payer status are also at increased risk for testicular loss.

Impact of prior diaphragm plication on subsequent stages of single ventricle palliation

BackgroundPhrenic nerve injury is a known cause of morbidity after single ventricle palliation. Previous studies have shown that hemidiaphragm plication improves short-term outcomes. The effect of plication on the outcomes of subsequent stages of single ventricle palliation is unknown. MethodsFrom 1997 to 2015, 1146 patients underwent surgical management of single ventricle physiology at our institution. We reviewed the records of 30 patients who had undergone diaphragm plication for phrenic nerve injury before Fontan completion. Each patient was compared with 2 propensity-matched controls identified from patients who underwent the Glenn or Fontan procedure during the same period without diaphragm plication. Propensity matching was achieved for each test subject using the nearest neighbor algorithm. Data are presented as the median and quartiles or numbers and percentages. ResultsThe cohort included 18 boys (60%). Of the 30 patients, 19 (63%) had undergone plication after first-stage palliation. Of these, 13 have undergone completion Fontan, 5 were awaiting Fontan at the last follow-up, and 1 had died. An additional 11 patients had undergone plication after Glenn and proceeded to Fontan completion. Thus, 24 patients with diaphragm plication have undergone Fontan completion. No difference was found in pulmonary pressure or resistance between the plicated patients and their propensity-matched controls. Both groups had comparable chest tube output and hospital lengths of stay. Equal proportions of patients in both groups required pulmonary vasodilator therapy and/or supplemental oxygen at hospital discharge. ConclusionsPrior diaphragm plication does not adversely affect Fontan completion in children with single ventricle physiology. The hospital course during subsequent stages of palliation for plicated patients was no different than that of matched controls.

Respiratory Syncytial Virus hospitalization burden: a nation-wide population-based analysis, 2000-2017

Respiratory Syncytial Virus (RSV) is a known cause of morbidity among young children, while RSV-related disease in the elderly is not fully recognized. Several RSV candidate vaccines for infants, pregnant women and adults are under development. We aimed to estimate nationwide age-specific hospitalizations and seasonal trends, to help determine the optimal age for vaccination. Hospitalizations with a primary RSV-related diagnoses were retrieved from the National Hospital Database for the years 2000-2017. Data were analyzed by year, month and age group to determine hospitalization rates and seasonal trends. During the analysis period, 39,156 hospitalizations received primary RSV-related ICD-9 diagnostic codes. The highest mean yearly hospitalization rate occurred among infants <1 year of life (1,218.4 per 100,000). Within the first year of life, the highest mean yearly hospitalization rate was observed in the second month of life (3,541.5 hospitalizations per 100,000). Hospitalization rates for individuals ≥5 years old increased during the study period, primarily among patients ≥65 years of age, reaching hospitalization rate of 9 per 100,000 in 2017. A clear seasonal pattern was observed. An effective vaccine for infants and pregnant women has the potential to reduce hospitalizations burden. RSV-related hospitalizations burden among adults requires additional research.

399-P: Nurse-Driven Intervention Using Real-Time Data to Improve Hypoglycemia Rates in a Respiratory Care Unit

Background: Hypoglycemia is a known cause of morbidity and mortality in the hospital setting. Nursing initiated interventions to reduce hypoglycemia rates have rarely been reported. Methods: At our institution, hypoglycemia rate is defined as the percentage of patients with diabetes mellitus (DM) with one or more blood glucose (BG) &amp;lt; 70mg/dl after 24 hours of admission. Nursing units are given monthly hypoglycemia rates, retrospectively. An electronic hypoglycemia tracker tool was developed for hypoglycemia monitoring. This tool prompted nursing staff on the Respiratory Care Unit (RCU) to assess for causes of hypoglycemia. This study was a unit based quality improvement project. Results: RCU’s baseline monthly hypoglycemia rates before intervention were: 23%, 38%, and 25% in January-March 2019, respectively. Hypoglycemia tracker results after 1 month of use demonstrated that &amp;gt; 50% of hypoglycemia occurrences were preceded by BG &amp;lt; 100mg/dl before becoming overtly hypoglycemic. Staff nurses accessed real-time data using the inpatient diabetes dashboard, beginning in April 2018, to assess BG trends on RCU patients currently admitted. Patients deemed at risk for hypoglycemia had the provider notified to intervene with reduced insulin dosage or another intervention if appropriate. Three months after intervention, monthly hypoglycemia rates decreased to 0%, 4% and 7% in April- June 2019, respectively. The RCU has been able to sustain improvement with an average hypoglycemia rate April-December 2019 of 9%. Conclusion: Causes of hypoglycemia in the hospital setting need to be assessed in order to determine successful prevention strategies. Tools, like hypoglycemia tracker tool, has helped units assess the causes of hypoglycemia so that some events can be prevented. Traditionally providers are tasked with managing DM in the hospital. This quality improvement project showed that nurses can have an impact on preventing hypoglycemia. Disclosure A. Hasse: None. R. Schulman: None. T. Calder: None.