Longer Duration Of Hospital Research Articles

Risk factors for in-hospital mortality and prolonged length of stay in older patients with solid tumor malignancies

Hospitalized adult patients with cancer and with major comorbidities have higher mortality rates and longer duration of hospitalization. There is limited understanding of risk factors that contribute to prolonged hospitalization and mortality in older patients with solid tumors. Risk factors associated with in-hospital mortality and prolonged length of stay (LOS) in older patients with cancer were investigated in a retrospective cohort study. Data from the University HealthSystem Consortium database included 386,377 patients age ≥ 65 years with solid tumors hospitalized between 1995 and 2003 at 133 U.S. academic medical centers. The overall mortality rate was 7.3%. Mortality in older patients with cancer was strongly associated with longer LOS. Almost twice as many deaths were observed among those with LOS ≥ 10 days (p<0.0001). Nearly 38% of older cancer patients who died in hospital had potentially curable disease. Primary central nervous system malignancies were most strongly associated with in-hospital mortality (OR=1.81; 1.59-2.07), followed by esophageal (OR=1.74; 1.54-1.97) and lung cancer (OR=1.57; 1.43-1.72). Male gender, African-American race, and Hispanic and Asian race/ethnicity were associated with increased risk of mortality (p<0.0001). Additional risk factors included metastatic disease, infection, neutropenia, renal, lung, hepatic, cerebrovascular disease, arterial/venous thromboembolism, heart failure, and red blood cell transfusion. Risk factors for prolonged LOS included gastric cancer, infection, venous thromboembolism and red blood cell transfusion. Prolonged LOS was strongly associated with mortality. Risk factors such as infection, neutropenia and red blood cell transfusion, when modified, could potentially reduce rates of prolonged LOS and mortality in older patients with cancer.

Temporal changes in resistance mechanisms in colonizing Escherichia coli isolates with reduced susceptibility to fluoroquinolones

The objective of this study was to characterize the temporal variability of fluoroquinolone resistance mechanisms among Escherichia coli colonizing the gastrointestinal tract of hospitalized patients. Patients with new fluoroquinolone-resistant E. coli (FQREC) colonization were followed with serial fecal sampling until discharge or death. Genetic mechanism(s) of resistance for all FQREC isolates was characterized, including mutations in gyrA and parC and efflux pump overexpression. Of 451 subjects, 73 (16.2%) became newly colonized with FQREC. There was significant variability in regard to temporal changes in resistance mechanisms and levofloxacin MICs among isolates from individual patients. Compared to patients with transient colonization, patients with persistent colonization were more likely to have a urinary catheter (P = 0.04), diarrhea (P = 0.04), and a longer duration of hospitalization (22 and 9.0 mean days, respectively; P = 0.01) prior to sampling. Our data demonstrate the significant variability of resistance mechanisms in colonizing E. coli isolates among hospitalized patients.

Clinical presentation, etiology, and survival in adult acute encephalitis syndrome in rural Central India

BackgroundAcute encephalitis syndrome (AES) is a constellation of symptoms that includes fever and altered mental status. Most cases are attributed to viral encephalitis (VE), occurring either in outbreaks or sporadically. We conducted hospital-based surveillance for sporadic adult-AES in rural Central India in order to describe its incidence, spatial and temporal distribution, clinical profile, etiology and predictors of mortality. MethodsAll consecutive hospital admissions during the study period were screened to identify adult-AES cases and were followed until 30-days of hospitalization. We estimated incidence by administrative sub-division of residence and described the temporal distribution of cases. We performed viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. The diagnostic tests included RT-PCR (for enteroviruses, HSV 1 and 2), conventional PCR (for flaviviruses), CSF IgM capture ELISA (for Japanese encephalitis virus, dengue, West Nile virus, Varicella zoster virus, measles, and mumps). We compared demographic and clinical variables across etiologic subtypes and estimated predictors of 30-day mortality. ResultsA total of 183 AES cases were identified between January and October 2007, representing 2.38% of all admissions. The incidence of adult AES in the administrative subdivisions closest to the hospital was 16 per 100,000. Of the 183 cases, a non-viral etiology was confirmed in 31 (16.9%) and the remaining 152 were considered as VE suspects. Of the VE suspects, we could confirm a viral etiology in 31 cases: 17 (11.2%) enterovirus; 8 (5.2%) flavivirus; 3 (1.9%) Varicella zoster; 1 (0.6%) herpesvirus; and 2 (1.3%) mixed etiology); the etiology remained unknown in remaining 121 (79.6%) cases. 53 (36%) of the AES patients died; the case fatality proportion was similar in patients with a confirmed and unknown viral etiology (45.1 and 33.6% respectively). A requirement for assisted ventilation significantly increased mortality (HR 2.14 (95% CI 1.0–4.77)), while a high Glasgow coma score (HR 0.76 (95% CI 0.69–0.83)), and longer duration of hospitalization (HR 0.88 (95% CI 0.83–0.94)) were protective. ConclusionThis study is the first description of the etiology of adult-AES in India, and provides a framework for future surveillance programs in India.

Long-term Prognosis of the Jejunal Involvement of Crohn’s Disease

We investigated the prognosis of Crohn's disease (CD) in Korean patients with jejunal involvement. Although jejunal involvement is considered a poor prognostic factor of CD in whites, it has never been validated in Asian populations. We retrospectively reviewed the medical records of 1403 Korean CD patients (median age at diagnosis, 23 years; male patients, 72.3%; median follow-up duration, 65 mo). Probabilities of medication use, surgery, and hospitalization were analyzed by a Cox proportional hazards model and a Poisson regression model. Jejunal involvement was observed in 198 of 1403 (14.1%) patients at diagnosis. There were more ileal location (28.3% vs. 20.6%, P<0.001) and stricturing behavior (16.7% vs. 9.4%, P=0.001) in the jejunal group than in the non-jejunal group. In univariate analyses, the cumulative probabilities of treatment with corticosteroids (P=0.014) and thiopurines (P=0.008), the first major surgery (P=0.021), and the first hospitalization (P=0.015) were significantly higher in the jejunal than in the non-jejunal group. In multivariate analyses, jejunal involvement was independently associated with the more common use of corticosteroids [hazard ratio, 1.24; 95% confidence interval (CI), 1.02-1.50] and thiopurines (hazard ratio, 1.26; 95% CI, 1.06-1.49), higher incidence rates of strictureplasties [relative risk (RR), 2.52; 95% CI, 1.60-3.96] and hospitalizations (RR, 1.29; 95% CI, 1.14-1.47), and longer hospitalization duration (RR, 1.30; 95% CI, 1.25-1.34). Korean CD patients are more likely to have jejunal involvement than western patients. Jejunal involvement is one of the poor prognostic factors in Korean CD patients, as it is in westerners.

Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction.

EUS-guided rendezvous procedure (EUS-RV) can be done by the transhepatic (TH) or the extrahepatic (EH) route. There is no data on the preferred access route when both routes are available. To compare the success, complications, and duration of hospitalization for patients undergoing EUS-RV by the TH or the EH route. Patients with distal common bile duct (CBD) obstruction, who failed selective cannulation, underwent EUS-RV by the TH route through the stomach or the EH route through the duodenum. A total of 35 patients were analysed (17 TH, 18 EH). The mean procedure time was significantly longer for the TH group (34.4 vs. 25.7 min; p = 0.0004). There was no difference in the technical success (94.1 vs. 100%). However, the TH group had a higher incidence of post-procedure pain (44.1 vs. 5.5%; p = 0.017), bile leak (11.7 vs. 0; p = 0.228), and air under diaphragm (11.7 vs. 0; p = 0.228). All bile leaks were small and managed conservatively. Duration of hospitalization was significantly higher for the TH group (2.52 vs. 0.17 days; p = 0.015). EUS-RV has similar success rate by the TH or the EH route. However, the TH route has higher post-procedure pain, longer procedure time, and longer duration of hospitalization. The EH route should be preferred for EUS-RV in patients with distal CBD obstruction when both access routes are technically feasible.

Molecular detection and quantification of pertussis and correlation with clinical outcomes in children

Pertussis is an under-recognized serious infection. Conventional cultures are insensitive and of limited utility after antibiotic exposure. We corroborated the utility of real-time polymerase chain reaction (PCR) as a diagnostic tool in pertussis and investigated its role as a prognostic tool by evaluating its benefit in the quantification of pertussis bacterial load. All pertussis-positive PCR tests (n = 104) submitted over 5 years were collected for retrospective study. PCR cycle threshold was compared to quantitative culture in 43. Compared to PCR, the sensitivity of culture was 41%. Our PCR assay reliably quantified bacterial load and was quantitatively reproducible. Higher bacterial load correlated with longer duration of hospitalization (P = 0.0003), and multivariate logistic regression models demonstrated this association to be independent. The study confirmed PCR as a superior diagnostic tool in pertussis. PCR quantification of bacterial load at initial diagnosis predicts later clinical disease severity, suggesting a potential benefit of PCR as a prognostic tool in pertussis.

Pneumonia in childern admitted with lower respiratory tract infections.... A hospital based study

Summary:Background: Pneumonia is a common form of lower respiratory tract infection (LRTI) in children under five years of age and it is the leading cause of morbidity and mortality in this age group. Early management is important in decreasing its complications and mortality.Methods: A cross sectional study of 100 patients, their ages ranged from 2 months to 5 years. They were admitted to Children Welfare Teaching Hospital Medical City–Baghdad in a period from 7th of November 2010 to 5th of May 2011, suffering from Lower Respiratory Tract Infections (fever, cough and tachypnea) and classified into two groups according to chest radiograph (CXR) findings, those with a patch (pneumonia) and others with normal or hyper inflated CXR. The possibility of various demographic and clinical symptoms and signs to predict the presence or absence of the patch were evaluated.Results: From a total of 100 patients enrolled in this study, 42%had a patch and 58% had normal or hyperinflated CXR. Older age, male gender, longer duration of hospitalization, high level of paternal education and family history of same disease are significantly associated with the presence of patch. Signs and symptoms like deterioration in the level of consciousness, lung crepitation and decrease in air entry and convulsion are significantly associated with the presence of the patch.Conclusion: Pneumonia is frequent in children with LRTI. Presence of convulsions, deterioration in the level of consciousness, lung crepitation and decrease in air entry in a child with LRTI may raise the suspicion of having pneumonia. Factors like older age, male gender, and high level of paternal education were associated with increase the susceptibility to have pneumonia in children with LRTI. Key word: children; predictors; pneumonia.

2828 – Comparison of clinical and sociodemographic features of bipolar disorder according to gender

Although the lifetime prevalence of bipolar disorder is not different between men and women, some of the features of the disease vary between the genders. To compare the clinical and sociodemographic features of bipolar disorder according to gender. In this study the data of 125 bipolar disorder tip I patients who had been admitted to Department of Psychiatry of Gulhane Military Medical Faculty between 2009–2011 were examined. Data of these patients were obtained by examining the patients files. 95 of 125 patients (%76.0) were male, and 30 (%24.0) were female. Age of disease onset in bipolar male patients was 22,5 ± 6,9; %6.3 had a history of suicid attempt and %11.6 had a history of substance abuse. Age of disease onset in bipolar female patients was 28,7 ± 9.7. %23.3 had a history of suicide attempt. There was no history of substance abuse in female patients. Psychotic features and history of substance abuse were more prominent in men. The later age of disease onset and longer duration of hospitalization were determined in women. Our results were appeared to be in line with the results of the studies about gender differences in bipolar disorder. Making prospective studies about this subject is considered to be useful to determine the epidemiological characteristics of mood disorders.

The role of the serum inflammatory markers for predicting the tubo-ovarian abscess in acute pelvic inflammatory disease: a single-center 5-year experience

To compare patients with tubo ovarian abscess (TOA) and non-TOA acute pelvic inflammatory disease (PID) and to determinate admitted day laboratory cut-off values for the TOA. Files of inpatients admitted to our clinic with the diagnoses of PID and/or TOA between the years of 2006 and 2011. Laboratory and culture results were obtained from the database of hospital. A total of 73 patients diagnosed with PID and/or TOA were evaluated. Patients who were diagnosed with TOA and PID by physical and sonographic examination were assigned to group 1 and group 2, respectively. Both groups were compared in terms of laboratory, clinical, and epidemiological parameters. Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found. Mean age of patients was determined as 41.4 ± 7.7 in group 1 and as 35.1 ± 6.8 in group 2. Abscess was detected more frequently in patients with low socio-cultural level, and this was found to be statistically significant. The diameter of abscess was found to be ≥5 cm in 39 (88.6 %) patients and <5 cm in 5 (11.4 %) patients. The average length of hospital stay was statistically significantly increased in patients with an abscess of ≥5 cm in size compared to patients with an abscess of <5 cm. When C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte counts were statistically evaluated by ROC curves, diagnostic ability of CRP, ESR and leukocyte count was found to be 73, 87, and 58 %. CRP has a specificity of 63 % and a sensitivity of 72 % if cut-off value is considered as 11.5 mg/L whereas ESR has a specificity of 83 % and a sensitivity of 79 % if cut-off value is considered as 19.5 mm/1/2 h. ESR >19.5 mm/1/2 h and CRP >11.5 mg/L were the best predictors of TOA. The high level of CRP and ESR was associated with longer duration of hospitalization and disease severity, and these levels were statistically significantly associated with TOA size of ≥5 cm.

Suicide mortality and risk factors in the 12 months after discharge from psychiatric inpatient care in Korea: 1989–2006

This study aimed to determine the suicide mortality within 1 year after discharge from psychiatric inpatient care and identify the risk factors for suicide completion during this period. A total of 8403 patients were admitted to general hospitals in Seoul, Korea, for psychiatric disorders from January 1989 to December 2006. The suicide mortality risk of these patients within 1 year of discharge was compared with that of gender- and age-matched subjects from the general population of Korea. The standardized mortality ratios (SMR) for suicide in the year following discharge were 49.7 for males and 45.5 for females. Patients aged 15–24 years had the highest risk for suicide. Among the different diagnostic groups, patients with personality disorders, schizophrenia, or affective disorders had the highest risk for suicide completion. Suicidal ideation at admission and inpatient stay more than 1 month were also associated with increased risk of suicide. In Korean psychiatric patients, the SMR is much higher in young female patients, a high percentage of patients commit suicide by jumping, and there is a stronger association of long duration of hospitalization and suicide. These factors should be considered in the development and implementation of suicide prevention strategies for Korean psychiatric patients.

Risk Factors for Developing Pneumonia in Patients with Diabetes Mellitus Following Acute Ischaemic Stroke

To evaluate markers of infection and identify risk factors for the development of pneumonia following acute ischaemic stroke in patients with diabetes mellitus. Patients with diabetes mellitus (n = 106) who were hospitalized after acute ischaemic stroke with (n = 32) or without (n = 74) pneumonia at admission were included in the study. Levels of C-reactive protein (CRP) and interleukin-6 (IL-6), white blood cell (WBC) count, mean body temperature and severity of stroke on the National Institutes of Health Stroke Scale were measured at the time of admission. The degree of disability according to the modified Rankin Scale was assessed after 30 days. Raised levels of IL-6 and CRP, older age, more severe stroke, longer duration of hospitalization and dysphagia were significantly associated with the development of pneumonia. Patients with pneumonia had significantly worse outcomes compared with nonpneumonia patients after 1 month. Raised WBC count and mean body temperature were not significant predictors of pneumonia. Markers of infection, more severe ischaemic stroke, dysphagia and older age may help in predicting the occurrence of pneumonia at stroke onset.

497 Ebf in Nicu and Normal Nursery Babies in Iran

IntroductionExclusive breastfeeding (EBF) that means “no supplemental liquids or solid foods other than medications or vitamins” is what recommended by WHO for the first 6 months of life to decrease...

Étude prospective observationnelle des hyperkaliémies secondaires aux inhibiteurs de l’enzyme de conversion chez des patients ayant une maladie rénale chronique hospitalisés

ObjectiveTo study the incidence and risk factors of angiotensin converting enzyme inhibitors-induced hyperkalemia in hospitalized patients with hypertension and preexisting chronic renal failure. MethodologyTwo-months prospective observational study was used including all hospitalized patients older than 18 years with a history of hypertension, non-dialyzed chronic renal failure and who had angiotensin converting enzyme prescription at the time of the admission. Hyperkalemia greater than or equal to 5mmol/L was detected in these patients. The studied variables were demographic, clinical, biological and therapeutic. ResultsEight patients, among 27 included, had a hyperkalemia (2963 %). They were 73±15 years old. Factors that predispose to hyperkalemia were present in all patients. Hyperkalemia was associated in six cases with decompensation of renal function. The age was associated with hyperkalaemia in patients treated with angiotensin converting enzyme inhibitors (RC=1.21; IC95 1,11-1,46; P=0,021). Diabetes is a possible risk factor (OR=59 021 et, 95 0.93 to 2410, P=0.053). Compared with patients who did not develop hyperkalemia, the occurrence of hyperkalemia in patients included was associated with a longer duration of hospitalization (OR=130, 95 112 to 160, P=0. 022). ConclusionThe prescription of angiotensin converting enzyme inhibitors in the elderly with chronic renal failure and diabetes requires careful monitoring of serum potassium.

Identifying the Incidence of and Risk Factors for Reamputation Among Patients Who Underwent Foot Amputation

Many patients who have lower-extremity amputations secondary to peripheral vascular disease or diabetes require reamputation eventually. This study was designed to identify the incidence of and risk factors for ipsilateral reamputation after forefoot amputation, to evaluate whether postoperative infection increases the risk of reamputation, and to evaluate whether the risk of reamputation was reduced by the duration of antimicrobial therapy after amputation. A retrospective analysis of patients who underwent foot amputation for nontraumatic reason from January 2002 to December 2004 at the Veterans Affairs Pittsburgh Healthcare System was performed. Among 116 patients, 57 (49.1%) had ipsilateral reamputation within 3 years after their first surgeries; 78.9% received reamputation in the first 6 months; 53 (45.7%) died within 3 years; and 16 (13.8%) developed postoperative infections. Upper level of amputation, long duration of hospitalization, insulin-dependent diabetes, and gangrene on physical examination on admission were risk factors for reamputation in univariate analysis. Gangrene (odds ratio: 3.81, 95% confidence interval: 1.60-9.12, P = 0.003) and insulin-dependent diabetes (odds ratio: 2.93, 95% confidence interval: 1.26-6.78, P = 0.012) were risk factors in multivariate analysis. Postoperative infection did not increase the risk of reamputation. Longer than 2-week course of antibiotic use after amputation did not prevent reamputation. Approximately one-half of patients required ipsilateral reamputation and died in 3 years. Gangrene on admission and history of insulin-dependent diabetes were significant risk factors (P = 0.003, P = 0.028). Long duration of antibiotic use after amputation and postoperative infection did not change the risk of reamputation.

Staphylococcus aureus infection: Clinical profile and outcome among children admitted to a tertiary care hospital in developing economy

Abstract Aim This study was conducted to determine the clinical profile and outcome of Staphylococcus aureus bacteremia in children admitted to tertiary care hospital in mid-Himalayan ranges in India. Material and methods All children ≤16 years of age admitted to pediatric ward from January 2006 to December 2011 with positive blood culture for S. aureus were reviewed. Results 126 children (87 males & 39 females), median age 49 months (range 1 day–16 years) with S. aureus bacteremia (SAB) were identified, accounting for 9% of all positive blood cultures. 11% patients had MRSA. A focus clinically consistent with staphylococcal infection was identified in 74 cases of which 78.3% had multiple foci. Respiratory pathology was more common than musculoskeletal symptoms. Children with a focus had longer duration of hospital stay. Children without focus mostly presented with Protein Energy Malnutrition (PEM) with pneumonia and gastroenteritis out of which 61.5% were admitted in shock. 21.4% patients were neonates out of which one-third were without focus. Neonates had a much higher mortality (37%) compared to older infants and children (OR 28% (95% CI = 10–73); ×2 = 5.8; p = 0.015). Absence of focus of infection in newborn (and, therefore, failure to receive intravenous anti-staphylococcal antibiotics at admission), malnutrition, decompensated shock at presentation, and need for mechanical ventilation were associated with high mortality. Morbidity during follow-up was noted in 11.1% patients. Conclusions SAB carries very high mortality in neonates, malnourished children, and children without focus of sepsis in developing countries. Specific anti-staphylococcal antibiotics should be considered in empirical treatment of sepsis among them.

Drainage in Cholecystectomy: Required or Not? A Comparative Randomized Study in Northern Indian Subjects

Background: Routine abdominal drainage after laparoscopic cholecystectomy is an issue of considerable debate in surgical fraternity. So a comparative study was planned as an effort to solve the controversy regarding the need of drainage in cholecystectomy. Aim: The aim of the study was to evaluate merits and demerits of drainage vs nondrainage in patients undergone cholecystectomy. Materials and methods: Study was carried out in the Department of General Surgery, MM Institute of Medical Sciences and Research between June 2009 and October 2011 on 40 cases of symptomatic gall stone disease. Cases were divided randomly into two equal groups. Group A containing 20 cases with drain placed and group B containing 20 cases without drainage. Subjects were observed for postoperative morbidity in the form of pain–incidence and severity, duration of postoperative hospital stay, analgesia requirement, postoperative nausea, vomiting and antiemetics required. Results: Mean operative time in groups A and B was 93 and 86 minutes respectively. Gallbladder rupture was most common complication encountered in both the groups. At 12th postoperative hour, 90% of patients of group A and 95% of patients of group B had pain in abdomen. Conclusion: We found no significant advantage of using drainage after laparoscopic cholecystectomy, as there was higher incidence of postoperative pain and longer duration of hospital stay with its use. Therefore, its routine use cannot be recommended as a means to reducing postoperative morbidity.

Tu1699 The Relationship Between Meal Intake and Stent Expansion Three- Days After Wallflex Duodenal Stent Placement in 23 Malignant Gastric-Duodenal Obstructions

elucidated the indication criteria of ESD and examined its usefulness for early gastric cancer in elderly patients ( 65 years) by comparison with non-elderly patients. Methods: The subjects were selected from 515 consecutive lesions with early gastric cancer for which ESD was performed between June 2002 and February 2010. Results: In the elderly, four (1.0%) were from the elderly with a Performance Status: PS of 3. The number of PS increased to six (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. In the elderly, 76.9% were from the elderly with preexisting comorbidity. In the non-elderly, 43.4% were from the non-elderly with preexisting comorbidity. There were no differences between the two groups in the distribution of the following: location of gastric lesions where ESD was performed, macroscopic type, tumor size, histological type, depth of invasion, and category of lesions. Overall, the two groups had no significant difference in their durations of hospitalization. However, the elderly with perforation had significantly longer duration of hospitalization compared to the elderly without perforation. The elderly and non-elderly groups also had no significant difference in their operating times for ESD or in the incidence rates of complications. In the elderly, 10.2% were from the elderly who had anti-coagulant therapy. In the non-elderly, 1.4% were from the non-elderly who had anti-coagulant therapy. The percentage was significantly higher in the elderly. In patients with anti-coagulant therapy, the durations of hospitalization were 15.5 and 10.0 days in the elderly and nonelderly groups, respectively. The duration tended to be longer in the elderly but no significant difference was found. Overall, there was no significant difference in the incidence of postoperative hemorrhage. There was postoperative hemorrhage in 5.1% of the lesions in the elderly group and 4.9% of the lesions in the non-elderly group. None of the non-elderly with postoperative hemorrhage had received anti-coagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were from the elderly who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group. Conclusion: We conclude that the following should be considered when making the final decision of performing ESD in elderly patients. These patients should have a PS of 0, 1, or 2. One should determine whether or not anti-coagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.

Early HHV-6 replication is associated with morbidity non-related to CMV infection after kidney transplantation

Human herpesvirus type 6-(HHV-6) has been associated with morbidity after liver transplantation. OBJECTIVE: The aim of this study was to determine the HHV-6 seroprevalence among donor-recipient pairs, analyze the incidence of early active infection, its clinical manifestation, interaction with CMV, and the related morbidity in the first year after kidney transplantation. METHODS: 46 donor-recipient pairs had IgG evaluated by ELISA before transplantation: HHV-6(Pambio - USA) and CMV-(Roche - USA). A frozen whole blood sample collected weekly (from the 1st to the 6th week) was retrospectively tested for HHV-6 viral load (VL) determination by real time quantitative PCR (qPCR, Nanogen - Italy). Patients were preemptively surveyed for CMV by pp65 antigenemia (Ag, APAAP, immunohistochemistry, Biotest - Germany) from the 4th to the 12th week after transplantation. Active infection was defined as qPCR-HHV6+ (viral-load/mL-VL) and Ag+ (+cells/100.000 granulocytes), for HHV-6 and CMV, respectively. DCMV was defined as simultaneous positive antigenemia and suggestive signs/symptoms. Concerning +qPCR-HHV6, associated factors, clinical manifestation, interaction with CMV and morbidity were searched. RESULTS: Pre-transplant HHV-6 seroprevalence was significantly higher among kidney recipients compared to their donors (82.6x54.8%; p = 0.005 [3.9 (1.4-10.4)]). Active infection by this virus occurred in 26.1% (12/46), with no association with previous IgG (p = 0.412). Median VL was 125 copies/mL (53-11.264), and the median Ag was 21 +cells (2-740). There was no association between HHV-6 and CMV activation after transplantation (p = 0.441), neither concerning DCMV (p = 0.596). Median highest Ag+ and days of ganciclovir treatment were similar between qPCR-HHV6 + or - (p = 0.206 and p = 0.124, respectively). qPCR-HHV6+ was associated with higher incidence of bacterial (p = 0.009) and fungal (p = 0.001) infections, and higher number (p = 0.001) of hospital admission and longer duration of hospitalization over the first 6 and 12 months post-transplantation (p = 0.033 and p = 0.001). CONCLUSION: Latent HHV-6 infection is more common among recipients than donors before transplantation. Early active infection by this pathogen after transplantation does not increase DCMV incidence or severity during the first 3 months of follow-up. However, early HHV-6 replication is associated with other infections and hospitalizations in the first year.

Tu1700 Carbon Dioxide Versus Air Insufflation on Patient Comfort Post-Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

conventional endoscopic mucosal resection (EMR). In the present study, we elucidated the indication criteria of ESD and examined its usefulness for early gastric cancer in elderly patients (65 years) by comparison with non-elderly patients. Methods: The subjects were selected from 515 consecutive lesions with early gastric cancer for which ESD was performed between June 2002 and February 2010. Results: In the elderly, four (1.0%) were from the elderly with a Performance Status: PS of 3. The number of PS increased to six (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. In the elderly, 76.9% were from the elderly with preexisting comorbidity. In the non-elderly, 43.4% were from the non-elderly with preexisting comorbidity. There were no differences between the two groups in the distribution of the following: location of gastric lesions where ESD was performed, macroscopic type, tumor size, histological type, depth of invasion, and category of lesions. Overall, the two groups had no significant difference in their durations of hospitalization. However, the elderly with perforation had significantly longer duration of hospitalization compared to the elderly without perforation. The elderly and non-elderly groups also had no significant difference in their operating times for ESD or in the incidence rates of complications. In the elderly, 10.2% were from the elderly who had anti-coagulant therapy. In the non-elderly, 1.4% were from the non-elderly who had anti-coagulant therapy. The percentage was significantly higher in the elderly. In patients with anti-coagulant therapy, the durations of hospitalization were 15.5 and 10.0 days in the elderly and nonelderly groups, respectively. The duration tended to be longer in the elderly but no significant difference was found. Overall, there was no significant difference in the incidence of postoperative hemorrhage. There was postoperative hemorrhage in 5.1% of the lesions in the elderly group and 4.9% of the lesions in the non-elderly group. None of the non-elderly with postoperative hemorrhage had received anti-coagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were from the elderly who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group. Conclusion: We conclude that the following should be considered when making the final decision of performing ESD in elderly patients. These patients should have a PS of 0, 1, or 2. One should determine whether or not anti-coagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.

Early HHV-6 replication is associated with morbidity non-related to CMV infection after kidney transplantation

Human herpesvirus type 6-(HHV-6) has been associated with morbidity after liver transplantation. ObjectiveThe aim of this study was to determine the HHV-6 seroprevalence among donorrecipient pairs, analyze the incidence of early active infection, its clinical manifestation, interaction with CMV, and the related morbidity in the first year after kidney transplantation. Methods46 donor-recipient pairs had IgG evaluated by ELISA before transplantation: HHV-6-(Pambio – USA) and CMV-(Roche – USA). A frozen whole blood sample collected weekly (from the 1st to the 6th week) was retrospectively tested for HHV-6 viral load (VL) determination by real time quantitative PCR (qPCR, Nanogen – Italy). Patients were preemptively surveyed for CMV by pp65 antigenemia (Ag, APAAP, immunohistochemistry, Biotest – Germany) from the 4th to the 12th week after transplantation. Active infection was defined as qPCR-HHV6+ (viral-load/mL-VL) and Ag+ (+cells/100.000 granulocytes), for HHV-6 and CMV, respectively. DCMV was defined as simultaneous positive antigenemia and suggestive signs/symptoms. Concerning +qPCR-HHV6, associated factors, clinical manifestation, interaction with CMV and morbidity were searched. ResultsPre-transplant HHV-6 seroprevalence was significantly higher among kidney recipients compared to their donors (82.6×54.8%; p=0.005 [3.9 (1.4–10.4)]). Active infection by this virus occurred in 26.1% (12/46), with no association with previous IgG (p=0.412). Median VL was 125 copies/mL (53–11.264), and the median Ag was 21 +cells (2–740). There was no association between HHV-6 and CMV activation after transplantation (p=0.441), neither concerning DCMV (p=0.596). Median highest Ag+ and days of ganciclovir treatment were similar between qPCR-HHV6 + or − (p=0.206 and p=0.124, respectively). qPCR-HHV6+ was associated with higher incidence of bacterial (p=0.009) and fungal (p = 0.001) infections, and higher number (p=0.001) of hospital admission and longer duration of hospitalization over the first 6 and 12 months post-transplantation (p=0.033 and p=0.001). ConclusionLatent HHV-6 infection is more common among recipients than donors before transplantation. Early active infection by this pathogen after transplantation does not increase DCMV incidence or severity during the first 3 months of follow-up. However, early HHV-6 replication is associated with other infections and hospitalizations in the first year.