Longer Hospital Research Articles

Multidrug-resistant wound infections are associated with greater mortality, larger costs, and longer hospitalizations than susceptible infections in canine patients.

To investigate the prevalence, risk factors, and economic impact of multidrug-resistant (MDR) infections in dogs at a tertiary referral hospital. This was a retrospective cohort study including dogs with positive aerobic culture associated with a traumatic wound or surgical site infection between July 2018 and November 2023. Data collected from medical records included signalment, wound type, culture results, medications (antibiotics, NSAIDs, steroids, immunosuppressives), wound care, hospitalization duration, concurrent illnesses, surgical variables, and cost. Multivariable logistic regression analysis was performed to identify factors associated with MDR development. 80 dogs met the inclusion criteria, and 19 had MDR infections. Multidrug resistance increased the odds of longer hospitalization duration by 2.98 times (95% CI, 1.09 to 8.19), mortality rates by 11.8 times (95% CI, 1.24 to 112.08), and total costs by 3.57 times (95% CI, 1.3 to 9.83). Steroid use within the past year, NSAID or steroid use within 1 week before culture, and initial preculture use of either penicillin or clindamycin in the past 3 months increased the risk of MDR development by 4.51 to 7.4 times (95% CI, 1.71 to 32.09). Multidrug-resistant infections were associated with greater mortality, larger costs, and longer hospitalizations. Risk factors for MDR infections included steroid use within the past year, NSAID or steroid use within 1 week before culture, and either penicillin or clindamycin within 3 months before culture. Multidrug-resistant pathogens have clinical and economic impacts on veterinary healthcare, and there is a need to implement standardized surveillance and prevention programs in veterinary hospitals.

The incidence of acute kidney injury in very-low-birth-weight infants treated early with caffeine.

Acute kidney injury (AKI) in neonates is associated with increased morbidity and mortality, longer hospitalization, and a higher risk for future kidney damage. Caffeine treatmenthas reportedly beenassociated with adecreased AKI occurrence. However, previous studies lack uniformity regarding dosage and timing of administration. This study aimed to assess AKI incidence in very-low-birth-weight (VLBW) preterm infants (< 1500g) treated with early high-dose caffeine and to identify risk factors associated with AKI. A retrospective cohort study of VLBW preterm infants admitted to the Neonatal Intensive Care Unit at the Shaare Zedek Medical Center between January 1, 2017, and December 31, 2019. All VLBW infants born < 32weeks of gestation were treated with a standardized caffeine regimen (20mg/kg bolus; in the first hour of life, maintenance 10mg/kg/day). Maternal and infant data including clinical, demographic, and laboratory measurements were retrieved from electronic medical records. Of 311 VLBW infants admitted, all had adequate serum creatinine and urine output data. Of 301 patients included for analysis, 41 (14%) were diagnosed with AKI, while only 12/301 (4%) were diagnosed during the first week of life. Sixteen infants (5%) had > 1 AKI episode. Seven (7/41, 17%) had AKI stage 1 and seventeen infants (17/41, 42%) had stages 2 and 3. In univariate analysis, sepsis, patent ductus arteriosus, necrotizing enterocolitis (NEC), and hemodynamic instability during the first week of life were more prevalent in the AKI group. Infants with AKI were born with lower birth weights, at earlier gestational weeks, and had lower APGAR and higher CRIB II scores. NEC was the only significant risk factor associated with AKI in multivariate analysis. They also had a higher risk for bronchopulmonary dysplasia (BPD), longer hospitalization, and higher mortality rate. The incidence of AKI in a cohort of VLBW infants universally treated early with caffeine was 14%, while only 4% had AKI during the first week. Infants with AKI had worse outcomes (BPD and mortality) and longer hospitalization.

Awaiting insurance coverage: Medicaid enrollment and post-acute care use after traumatic injury.

Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission. We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization. We linked trauma registry and EMR data to identify patients ages 18 years to 64 years admitted from 2017 to 2021 to a Level I trauma center. Patients admitted without insurance and retroactively insured (RI) during hospitalization were compared with patients with established Medicaid (MI) and those remaining uninsured (UI). We measured postacute care use including home health care, rehabilitation, and skilled nursing facilities. We tested the association between insurance status and discharge disposition and LOS (primary outcome) using multivariable negative binomial regression. Direct costs were compared between groups. We compared 494 RI patients to 1706 MI and 148 UI patients. Retroactively insured patients had longer hospitalization (median LOS [interquartile range], 4 days [2-9 days]) than other groups (MI, 4 [2-8] and UI 2 [1-3]), p < 0.001). Retroactively insured patients were more likely to be discharged with home health care and to inpatient rehabilitation than UI patients (p < 0.001). After adjusting for injury and management characteristics, RI was associated with longer LOS compared with MI for patients discharged to inpatient facilities (p < 0.001). Median costs for RI patients discharged to a facility were $10,284 higher than MI patients, ranging from $8,582 for Injury Severity Score <9 to $51,883 for Injury Severity Score ≥25. Enrollment in Medicaid after traumatic injury is associated with postacute care use, but the current enrollment process may delay discharge. Streamlining insurance enrollment and permitting discharge with pending application status could reduce unnecessary hospital days, saving costs and improving improve patient experience. Prognostic/Epidemiological; Level IV.

Renal dysfunction contributes to deteriorated survival outcomes in patients with upper and lower gastrointestinal bleeding: insights from a cohort study of 1160 cases

Both acute kidney injury and chronic kidney disease are risk factors for many outcomes of gastrointestinal bleeding (GIB). These are associated with higher mortality, longer hospitalisation, and greater need for transfusion in case of overt GIB. Our study aimed to further evaluate the role of kidney function in several clinical outcomes of GIB patients. The Hungarian Gastrointestinal Bleeding Registry collected data on all-cause GIB between 2019 and 2022. A multi-level data-validation system provided high-quality data, which was retrospectively analysed. Numerous primary (in-hospital mortality, discharge, need for endoscopic intervention, in-hospital rebleeding, length of hospitalisation, need for emergency surgery, need for endoscopic examination and need for intensive care unit) and secondary (detection of Helicobacter pylori (H. pylori), recognition of cancer as the source of bleeding, need for any kind of transfusion or clotting factor, anticoagulation therapy) outcomes were observed. Descriptive statistical tools were used to summarize our data. Among others, estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2) was used as continuous variable, mean, standard deviation, median, interquartile range and minimum/maximum values were calculated. Reduced kidney function was associated with in-hospital mortality (eGFR: 42.63 ± 28.78 ml/min/1.73 m2 vs. 57.08 ± 26.62 ml/min/1.73 m2, p < 0.001), need for red blood cells (RBC) transfusion (eGFR: 51.98 ± 27.90 ml/min/1.73 m2 vs. 60.11 ± 25.06 ml/min/1.73 m2, p < 0.001) and clotting factor supplementation (eGFR: 47.40 ± 27.41 ml/min/1.73 m2 vs. 56.68 ± 27.02 ml/min/1.73 m2, p < 0.001). Better eGFR values at admission were associated with discharge home after proper treatment, compared to any other outcome of the admission (eGFR: 58.12 ± 25.56 ml/min/1.73 m2 vs. 50.23 ± 29.69 ml/min/1.73 m2, p < 0.001), H. pylori positivity (eGFR: 59.63 ± 25.24 ml/min/1.73 m2 vs. 52.76 ± 25.44 ml/min/1.73 m2, p = 0.021) and the need for endoscopic intervention (eGFR: 58.65 ± 26.61 ml/min/1.73 m2 vs. 54.31 ± 27.64 ml/min/1.73 m2, p = 0.008). At admission, patients with better eGFR than 36.64 ml/min/1.73 m2 were discharged to their homes, mortality was higher with eGFR worse than 25.96 ml/min/1.73 m2, more RBC transfusion was needed if eGFR was lower than 49.61 ml/min/1.73 m2. Regulation of anticoagulation was examined extensively. Impaired kidney function at admission results higher in-hospital mortality in overt all-cause GIB and increases the need of RBC transfusion.

P-1190. Viral Codetection in Infants with Respiratory Syncytial Virus (RSV) Infection Is Associated with Decreased Viral Loads, Reduced Mucosal Cytokine Concentrations and Longer Hospitalization

Abstract Background Studies have analyzed the contribution of host and viral factors to RSV disease pathogenesis and severity in children, but the role of RSV/viral co-detection is poorly understood. We investigated the relationship between viral co-detection, RSV viral loads, mucosal cytokine concentrations and disease severity in young children with RSV acute respiratory infection (ARI). Methods We enrolled a convenience sample of previously healthy children &amp;lt; 2 years of age with RSV ARI that were either hospitalized or managed as outpatients at a large pediatric hospital. Nasopharyngeal samples were obtained to assess RSV viral loads by rt-PCR, viral codetection using a multiplex PCR assay, and mucosal cytokine concentrations. We assessed the impact of viral co-detection on RSV viral loads, mucosal cytokine concentrations, and clinical outcomes stratified by age (0-6 and &amp;gt;6-24 months).Figure 1.Mucosal cytokine concentrations according to single RSV detection versus RSV/viral co-detection . The Y axis depicts individual concentrations of mucosal antiviral cytokines (IFN-β and CXCL-10) and of IL-6 expressed as log10 pg/ml, and the x axis the two study groups: single RSV infections and RSV/viral co-detections. Comparisons between groups were made with Mann-Whitney test and statistical significance was set at p&amp;lt; 0.05. Results From February 2013 to March 2020, 483 children with RSV ARI were enrolled (inpatients, n=383; outpatients, n=95). Of those, 108 (22.4%) had viral co-detection. Rhinovirus/Enterovirus (RV/EV) followed by endemic coronaviruses (CoV) were the most common co-detected viruses. Median age was 3.9 months for infants with RSV/viral co-detection vs 2.8 months for with single RSV ARI (p=0.02); with no significant differences in other demographic characteristics (Table 1). RSV loads were higher in single RSV vs RSV/viral co-detection (7.55 vs 7.16 log10 copies/ml, p=0.0009), particularly in infants 0-6 months. Mucosal concentrations of IL-6, CXCL-10, and IFN-β were significantly higher in children with single RSV vs RSV/viral co-detection (Figure 1). Analysis by age showed significant differences of IL-6 and CXCL-10 concentrations in infants 0-6 months, but not in older children. There were no significant differences with respect to need for hospitalization, clinical disease severity or PICU care in infants with single RSV vs RSV/viral codetections, but RSV/viral co-detection was associated with longer hospitalizations (3 vs 2.3 days respectively, p=0.022). Conclusion Concomitant detection of other respiratory viruses in children with RSV ARI was common and associated with reduced RSV viral loads, decreased mucosal proinflammatory and antiviral cytokines, and longer length of stay. Disclosures Diego R. Hijano, MD, MSc, FDA: Grant/Research Support|Merck: Grant/Research Support|National Institute of Health: Grant/Research Support Octavio Ramilo, MD, AstraZeneca: Honoraria|Bill &amp; Melinda Gates Foundation: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|NIH/NIAID: Board Member|NIH/NIAID: Grant/Research Support|NIH/NICHD: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi: Advisor/Consultant|Sanofi: Honoraria Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Astra-Zeneca: Honoraria|Enanta: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi-Pasteur: Advisor/Consultant|Sanofi-Pasteur: Honoraria

515. Neurological Complications in Children Hospitalized for Influenza, 2010 to 2022, the Canadian Immunization Monitoring Program Active (IMPACT)

Abstract Background Influenza-associated neurological complications are rare, but can cause significant morbidity and mortality. We aimed to estimate the proportion of children with neurological complications among those hospitalized for influenza and to identify associated risk factors. The secondary objective was to compare the risk of severe outcomes among children with neurological complications to that of those without. Methods Prospective active surveillance was conducted in 12 pediatric hospitals from the Immunization Monitoring Program, ACTive (IMPACT), representing &amp;gt;90% of all tertiary pediatric beds in Canada. We included patients aged ≤ 16 years hospitalized for microbiologically confirmed influenza during the 2010-11 to 2021-22 influenza seasons. Regression analyses were used to calculate adjusted odds ratios (aORs) for factors associated with neurological complications (seizure, meningitis, encephalitis, myelitis, encephalopathy, radiculopathy, cerebral edema, hydrocephalus, or stroke). The risk of severe outcomes (intensive care unit admission, mechanical ventilation, or death) in children with neurological complications was compared to that of children without these complications using the Chi-square and Wilcoxon tests. Results Among the 9533 children hospitalized for influenza, 1228 (12.9%) had neurological complications. Children with neurological complications had longer hospitalization (6.3 days vs 4.5 days, p &amp;lt; 0.001) and were at higher risk of intensive care unit admission (31.8% vs 14.1%, p &amp;lt; 0.001), mechanical ventilation (20.5% vs 4.4%, p &amp;lt; 0.001), and death (2.2% vs 0.3%, p &amp;lt; 0.001). In a multivariable model adjusting for IMPACT site and influenza type, factors associated with neurological complications were: pre-existing neurological condition (aOR 4.19, 95% CI 3.61-4.86); age between 6 and 24 months (aOR 1.62, 95% CI 1.29-2.03) and age between 2 and 4 years (aOR 1.36, 95% CI 1.09-1.71). Conclusion More than one in ten children hospitalized for influenza developed neurological complications and these were associated with higher risk of severe outcomes. Risk factors identified for neurological complications were age between 6 months and 4 years and the presence of a pre-existing neurological condition. Disclosures Shaun Morris, MD, MPH, DTM&amp;H, FRCPC, FAAP, GSK Canada: Advisor/Consultant|GSK Canada: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi Canada: Advisor/Consultant|Sanofi Canada: Honoraria Jesse Papenburg, MD, MSc, Merck: Honoraria|Merck: Site investigator, RCT

Prognostic factors and long-term outcome in dogs diagnosed with primary and secondary immune thrombocytopenia in Ireland.

The objectives of this study were to describe the outcome and prognostic factors in dogs diagnosed with primary and secondary immune thrombocytopenia (ITP). Medical records of dogs diagnosed with primary and secondary ITP in a referral hospital in Ireland were retrospectively evaluated. Short- and long-term survivals were analysed using Cox proportional-hazards regression models. Medical records from 49 dogs were included. Primary and secondary ITP were diagnosed in 81.25% and 18.75% of dogs, respectively. The survival rate was 69% at 2 weeks (95% confidence interval [CI]: 0.54 to 0.80), 63% at 3 months (95% CI: 0.48 to 0.75) and 51% at 2 years (95% CI: 0.37 to 0.65). The overall median survival time was 985 days (primary ITP only: 1084 days; secondary ITP only: 225 days). Dogs surviving 30 days post-diagnosis had a median long-term survival time of 10 years. A lower haematocrit was negatively associated with survival [hazard ratio (HR) 0.96, 95% CI: 0.92 to 0.99]. Neutrophilia (HR: 0.44, 95% CI: 0.20 to 0.96) was associated with a 66% decreased risk of death. Band neutrophilia was associated with shorter hospitalisation (regression coefficient -3.56, 95% CI: -5.70 to -1.42). Presence of petechiae and ecchymoses (regression coefficient 2.41, 95% CI: 0.41 to 4.42), and the use of a second-line immunosuppressive agent (SLI) (regression coefficient 2.11, 95% CI: 0.11 to 4.12) were significantly associated with longer hospitalisation but not with survival. A lower haematocrit was the only variable associated with a worse prognosis in dogs diagnosed with ITP. Dogs with confirmed secondary ITP had an overall shorter median survival time. Dogs surviving over 30 days had an excellent prognosis.

P-107. Serious Injection-Related Infections in Hospitalized Adults with Opioid Use Disorder Enrolled in an Ongoing Randomized Clinical Trial: A Focus on Staphylococcus aureus

Abstract Background Staphylococcus aureus (SA) causes the majority of serious injection-related infections (SIRI) in persons with opioid use disorder (OUD). Invasive SA infections are typically treated with prolonged IV antibiotic courses; increasingly oral transitions are considered though prospective clinical trial data are limited. Outpatient parenteral antibiotic therapy (OPAT) may be denied to persons with OUD and SIRI despite increasing evidence that it may be feasible and safe. Our ongoing study evaluates the efficacy and cost-effectiveness of an integrated outpatient care model combining Buprenorphine for OUD with OPAT (B-OPAT; NCT04677114) compared to Treatment As Usual (TAU) in persons hospitalized with OUD and SIRI. Here we present preliminary data on the prevalence of SA infections, treatment outcomes, and adverse events (AE) in the ongoing B-OPAT study. Methods This study is a randomized, 2-arm superiority trial enrolling hospitalized adults with OUD and SIRI. Participants are randomized 1:1 to discharge with B-OPAT or TAU. SIRI details, planned and completed days of IV antibiotic therapy, and AEs are collected at baseline and through the 12-week post-discharge intervention. Results From March 2021 – March 2024, 58 persons were randomized (B-OPAT: 29; TAU: 29), with 39 (67%) having SA infections (B-OPAT: 18; TAU: 21), and of those 24 (61%) due to Methicillin-resistant SA (MRSA). Baseline characteristics stratified by SA are shown in Table 1. In patients with SA, average hospital length of stay was longer and fewer days of IV antibiotics were missed in both BOPAT and TAU (Figure 1). In BOPAT 1 person received oral antibiotic transition, and 8 in TAU, all with SA. Over 12-weeks post-discharge, B-OPAT had 13 serious adverse events (SAE) including 1 death in non-SA; 8 SAE were in those with SA. TAU had 17 SAE, 13 in those with SA including 3 deaths (Table 2). Conclusion Our ongoing clinical trial enrolling hospitalized persons with OUD and SIRI shows that SA accounts for the majority of infections overall, and that SA may be associated with longer hospitalizations and higher morbidity. Importantly, our study may contribute prospective safety and other clinical trial data to inform the practice of oral transitions for invasive SA infections. Disclosures Sharon Walsh, PhD, Astra Zeneca: Advisor/Consultant|Braeburn Pharmaceuticals: Advisor/Consultant|Cerevel Therapeutics: Advisor/Consultant|Lundbeck: Advisor/Consultant|Opiant Pharmaceuticals: Advisor/Consultant Michelle Lofwall, MD, Berkshire Biomedical: Advisor/Consultant|Braeburn Pharmaceuticals: Advisor/Consultant|Journey Colab: Advisor/Consultant

Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer

In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations. The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL. Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) ≥1 (p=0.046) and number of stapler firings ≥3 (p=0.002) were associated with AL. In multivariate analysis, only GPS ≥1 was significantly associated with increased AL (p=0.033; OR=4.225; 95% CI 1.122 to 15.905). DS creation is effective for avoiding reoperation for AL. Preoperative GPS ≥1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS.

Risk factors and preventive measures for severe orofacial and neck infections: a three-year observational study

BackgroundThe purpose of this study was to identify the risk factors of severe orofacial and neck infections and the factors that could prevent them and reduce their severity.MethodsA three-year prospective observational study was conducted from 8.15.2016 to 8.31.2019 at a tertiary care hospital. 94 patients participated the study. The criteria for inclusion in the study were that the patients were adults with neck and severe orofacial infections that required treatment in hospital. Patients under the age of 18 and patients who did not consent to participate in the study were excluded. The responses to the questionnaire designed for this study were collected, as was supplemental data from medical records. The patient data were analyzed. Length of stay (LOS), intensive care unit (ICU) stay, complications and mortality were used as the main outcome variables, and various pre-admission factors and clinical and laboratory parameters were used as the predictor variables. The method used was univariate analysis.ResultsIn 79 (84.0%) cases, surgery confirmed an abscess and pus. Age (p = 0.001) and underlying diseases (p = 0.024) contributed to complications. Bulging of the lateral pharyngeal wall or laryngeal swelling on admission was significantly related to the need for intensive care treatment (p < 0.001). The spaces most often involved were the submandibular (n = 15; 16.0%), sublingual (n = 15; 16.0%) and parapharyngeal (n = 14; 14.9%) spaces. Sixty-three cases (67.0%) were of odontogenic origin, and 58.5% of the patients reported having attended previous health care appointments due to an acute dental problem. The patients with odontogenic infections had poor oral hygiene and most likely did not brush their teeth daily (p = 0.029). “Dishwater” pus was associated with longer hospitalization (p < 0.001), intensive care treatment (p < 0.001), and surgical revisions (p < 0.001). One lethal outcome (1.1%) was reported.ConclusionAge and underlying illnesses should be considered complicating factors, and lateral pharyngeal or laryngeal edema should be considered risk factors for ICU treatment. This study also emphasized the preventive role of good dental hygiene and the importance of patients’ follow-up treatment after acute dental interventions.

Ten Machine Learning Models for Predicting Preoperative and Postoperative Coagulopathy in Patients With Trauma: Multicenter Cohort Study.

Recent research has revealed the potential value of machine learning (ML) models in improving prognostic prediction for patients with trauma. ML can enhance predictions and identify which factors contribute the most to posttraumatic mortality. However, no studies have explored the risk factors, complications, and risk prediction of preoperative and postoperative traumatic coagulopathy (PPTIC) in patients with trauma. This study aims to help clinicians implement timely and appropriate interventions to reduce the incidence of PPTIC and related complications, thereby lowering in-hospital mortality and disability rates for patients with trauma. We analyzed data from 13,235 patients with trauma from 4 medical centers, including medical histories, laboratory results, and hospitalization complications. We developed 10 ML models in Python (Python Software Foundation) to predict PPTIC based on preoperative indicators. Data from 10,023 Medical Information Mart for Intensive Care patients were divided into training (70%) and test (30%) sets, with 3212 patients from 3 other centers used for external validation. Model performance was assessed with 5-fold cross-validation, bootstrapping, Brier score, and Shapley additive explanation values. Univariate logistic regression identified PPTIC risk factors as (1) prolonged activated partial thromboplastin time, prothrombin time, and international normalized ratio; (2) decreased levels of hemoglobin, hematocrit, red blood cells, calcium, and sodium; (3) lower admission diastolic blood pressure; (4) elevated alanine aminotransferase and aspartate aminotransferase levels; (5) admission heart rate; and (6) emergency surgery and perioperative transfusion. Multivariate logistic regression revealed that patients with PPTIC faced significantly higher risks of sepsis (1.75-fold), heart failure (1.5-fold), delirium (3.08-fold), abnormal coagulation (3.57-fold), tracheostomy (2.76-fold), mortality (2.19-fold), and urinary tract infection (1.95-fold), along with longer hospital and intensive care unit stays. Random forest was the most effective ML model for predicting PPTIC, achieving an area under the receiver operating characteristic of 0.91, an area underthe precision-recallcurve of 0.89, accuracy of 0.84, sensitivity of 0.80, specificity of 0.88, precision of 0.88, F1-score of 0.84, and Brier score of 0.13 in external validation. Key PPTIC risk factors include (1) prolonged activated partial thromboplastin time, prothrombin time, and international normalized ratio; (2) low levels of hemoglobin, hematocrit, red blood cells, calcium, and sodium; (3) low diastolic blood pressure; (4) elevated alanine aminotransferase and aspartate aminotransferase levels; (5) admission heart rate; and (6) the need for emergency surgery and transfusion. PPTIC is associated with severe complications and extended hospital stays. Among the ML models, the random forest model was the most effective predictor. Chinese Clinical Trial Registry ChiCTR2300078097; https://www.chictr.org.cn/showproj.html?proj=211051.

A randomized trial comparing endovascular and surgical management of ruptured intracranial aneurysms excluded from previous trials.

Many patients with ruptured intracranial aneurysms (RIAs) underrepresented or excluded from previous randomized controlled trials (RCTs) comparing surgery with endovascular treatment (EVT) are still considered for surgical clipping, but the best management of these patients remains unknown. The International Subarachnoid Aneurysm Trial-2 was a randomized trial comparing surgical versus EVT of RIAs considered for surgical clipping, despite the results of previous RCTs, and also eligible for EVT. The primary endpoint was death or dependency according to the modified Rankin Scale score (mRS score > 2) at 1 year. Secondary endpoints included 1-year angiographic results and length of hospital stay. The primary hypothesis was that endovascular management would decrease the number of poor outcomes (mRS score > 2) from 30% to 23%, necessitating 1896 patients. The trial was interrupted after 10 years because of slow recruitment. Primary analysis was by intent-to-treat. There was no blinding. From November 2012 to December 2022, 270 patients were recruited at 6 North American and European centers. After exclusions, 263 patients were randomly allocated to receive surgery (n = 133) or EVT (n = 130). There were 12 crossovers (9 from surgery to EVT). The primary outcome was reached in 40 of 133 surgical patients (30%, 95% CI 23%-38%) compared with 35 of 130 EVT patients (27%, 95% CI 20%-35%) (p = 0.572). Residual aneurysms at 1 year were less frequent with surgery (10/118 [8%, 95% CI 5%-15%]) than EVT (22/109 [20%, 95% CI 14%-29%]) (p = 0.015). Additional procedures (ventricular drainage and decompressive craniotomy, p < 0.05) and hospitalization > 20 days were more frequent in the surgery group (69/133 [52%, 95% CI 43%-60%]) than in the EVT group (38/130 [29%, 95% CI 22%-38%]) (p < 0.001). This prematurely interrupted trial showed more frequent additional procedures and longer hospitalizations but better 1-year angiographic results with surgery. The primary clinical outcome, death or dependency at 1 year, was similar for EVT and surgery.

COVID-19 pulmonary phenotypes and longitudinal patterns in the first wave of the pandemic.

The long-term evolution of COVID-19 in patients hospitalized during the pandemic's first wave remains largely unexplored. This study aimed to identify COVID-19 pulmonary phenotypes and their longitudinal patterns over a 12-month follow-up. COVID-19 patients discharged from Pisa University Hospital (Italy) between March-September 2020, were evaluated at T3, T12, and T24 months post-discharge. Assessments included spirometry, lung volumes, DLCO, and chest CT for those with persistent pneumonia signs (PS). Latent transition analysis (LTA) identified COVID-19 phenotypes and longitudinal patterns based on PS and lung function (PFTs). Risk factors for these patterns were evaluated using multinomial logistic regression. Of 307 discharged patients, 175, 136, and 33 were followed-up at T3, T12, and T24, respectively. At T12, 21.6% had impaired DLCO, 4.4% a restrictive ventilatory pattern, and 31,6% still had PS, persisting until T24. LTA identified three cross-sectional phenotypes at both T3 and T12 (no PS with normal PFTs; PS with normal PFTs; PS with impaired PFTs), and four longitudinal patterns from T3 to T12: persistence of no PS with normal PFTs (47.9%); resolution of both PS and PFTs (15.4%); persistent PS (36.7%), either with (11%) or without (25.7%) impaired PFTs. The last two patterns correlated significantly with longer hospitalization, more comorbidities, and severe COVID-19. In our cohort of COVID-19 patients hospitalized during the pandemic's first wave, we observed distinct pulmonary phenotypes and longitudinal recovery patterns. More comorbidities and severe acute disease correlated with worse progression up to 24 months, suggesting long-term monitoring for such patients.

Evaluation of the Bacterial Infections and Antibiotic Prescribing Practices in the Intensive Care Unit of a Clinical Hospital in Romania.

Introduction: Healthcare-associated infections (HAIs) are associated with increased mortality, antimicrobial resistance, and high antibiotic use. Methods: The characteristics of bacterial resistance and antibiotic consumption in the intensive care unit (ICU) of a clinical hospital in Romania were evaluated. Demographic data of patients, identified bacteria, antibiotics administered, and their sensitivity profiles were collected and analyzed. Results: One hundred and twenty-five patients, with a median age of 68 years, mostly male (60%), were included in the study. More than one-third of the patients died. The deceased patients were older (median age of 74 years), had longer hospitalization (median of 9 days) and bacteria detected (55.3%), and had higher antibiotic consumption than the discharged patients. The most frequent bacteria identified in our cohort were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in deceased patients and Klebsiella pneumoniae, Escherichia coli, Staphylococcus hemolyticus, and Enterococcus faecalis in the survived group. The top three antibiotics used were ceftriaxone, metronidazole, and meropenem. Resistance to antibiotics was observed in 44.3% of the deceased group and 37.5% of patients who were discharged (χ2 = 5.5, p = 0.0628). Discussion: A positive monotonic association was observed between the number of hospitalization days and the number of antibiotic doses, with a higher correlation coefficient for deceased patients (0.6327, p < 0.0001) than in survived group (0.4749, p < 0.0001). Conclusions and Future Trends: This study provides a real picture of HAIs, the characteristics of bacteria, and the consumption of antibiotics in an ICU of a clinical hospital in Romania. The data obtained are similar to those from other international studies, but further studies are needed to reflect the real situation in Romania.

Seizures and status epilepticus in anti-NMDA receptor encephalitis.

Seizures, including status epilepticus (SE), are common in anti-NMDA receptor encephalitis (NMDARE). We aimed to describe clinical and electrographic features of patients with seizures with NMDARE, determine factors associated with SE, and describe long-term seizure outcomes. We retrospectively identified patients with seizures in the setting of NMDARE treated at inpatient Mayo Clinic sites during the acute phase of encephalitis between October 2008 and March 2023. Seizure semiology, clinical symptoms, electrographic features, neuroimaging, treatment course, complications, and outcome were abstracted. We compared clinical features between patients with and without SE. We identified 29 patients with seizures during acute NMDARE. Temporal onset was the most common EEG localization (n = 14, 48.3%). Subclinical seizures were recorded in 15 (51.7%). Twelve (41.4%) patients had SE, which was associated with temporal T2-signal hyperintensity, seizures with unilateral clonic and/or tonic movements, multiple seizure foci on EEG, temporal and midline/central onset seizures, higher acute CASE scores, intensive care unit (ICU) admission, longer length of hospitalization, and need for post-hospitalization rehabilitation. One patient (3.4%) died during the acute encephalitis. One patient (3.4%) developed chronic epilepsy. The remaining patients were seizure-free at the last follow-up (median 23months, range 2-163months). SE was not associated with differences in outcome at last follow-up. Seizures in NMDARE are frequently temporal onset. SE is common and associated with higher likelihood of ICU level care, longer hospitalization, and higher need for post-hospital rehabilitation. Despite the significant short-term impact of SE, long-term outcome was not affected, and seizure prognosis was favorable.

Examining the impact of rhythmic breathing and progressive muscle relaxation on acute pain following inguinal hernia repair: a parallel randomized clinical trial

BackgroundAcute postoperative pain is often reported after repair of inguinal hernia and can negatively impact patient satisfaction and clinical outcomes. This includes delayed wound healing, longer hospitalization, and increased health care costs. Non-pharmacological techniques like Progressive Muscle Relaxation (PMR) and Rhythmic Breathing (RB) have been suggested as possible interventions for managing this type of pain. The purpose of this study was to examine the effects of PMR and RB on postoperative pain following repair of inguinal hernia.MethodsThis parallel randomized controlled trial was conducted to examine 120 patients in the age range of 18 to 75 years with inclusion criteria: Repair of Inguinal Hernia under general anesthesia and no addiction to drugs and narcotics. These patients were randomly assigned to one of three groups: the RB group, PMR group, or the control group (which received standard care). The RB and PMR interventions were administered at 3, 6, 12, and 24 h after surgery. The primary outcome measure was the intensity of pain at the surgical site, assessed using the Visual Analog Scale (VAS). The secondary outcome measure was the amount of rescue analgesic (Pethidine). The one-way analysis of variance, Chi-square, post-hoc test, and repeated measures ANOVA were used for data analysis.ResultsFollowing the interventions, participants in both the RB and PMR groups exhibited significantly lower levels of acute pain after inguinal hernia repair compared to the control group across all four time periods, except at 12 h postoperatively in the RB group. However, there was no statistically significant difference between the RB and PMR groups. Additionally, the amount of pethidine consumed in the control group was significantly higher compared to the two experimental groups.ConclusionsBased on the results, both RB and PMR were found to be effective techniques in reducing patients’ pain. Therefore, it is recommended that healthcare team members, particularly nurses, actively learn and teach both RB and PMR.Trial registrationRegistered in the Iranian registry of clinical trials (www.irct.ir) in 31/01/2023 with the following code: IRCT20200206046395N2.

Urinary tract infections among under-five children with congenital anomalies of kidney and urinary tract in hospitalized patients in Addis Ababa

BackgroundCongenital anomalies of the kidney and urinary tract (CAKUT) and urinary tract infections (UTIs) are significant clinical concerns in children. Children who have UTIs are also at risk of developing long-term complications, notably kidney disease and scarring UTIs. The purpose of this study was to assess the prevalence of urinary tract infection and its determinants among under-five children with congenital anomalies of kidney and urinary tract in Addis Ababa.MethodsA health institution-based retrospective cross-sectional study was employed on 389 randomly selected medical records of children with CAKUT, out of a total of 850 cases. The children were admitted to Tikur Anbesa and Menelik II Hospitals between January 1, 2018, and December 31, 2022. The study hospitals were purposively selected as they were the only referrals in the nation for CAKUT cases. Sociodemographic, clinical, and laboratory characteristics were captured using a data extraction sheet created in the Kobo Toolbox and transferred to SPSS for analysis. Binary logistic regression analysis was used to evaluate the associations of variables with a p-value of ≤ 0.05 and a confidence interval of 95%.ResultsThe majority of the study participants (336 [86.4%]) were males. A total of 194 (49.8%) children were older than 25 months, with a median age of 23 (95% CI: 22–27) months, and 117 (30.1%) (95% CI = 25.4–35.2) participants were positive for urinary tract infection (UTI). Forty were culture-positive out of 103 urine specimens tested, where, Escherichia coli (60%) was the most frequently isolated bacteria followed by Klebsiella pneumonia (20%), Enterobacter spp, (12.5%), and Staphylococci spp. (7.5%). Factors associated with UTI among CAKUT children were found to be being female (AOR = 4.3, 95% CI = (1.4–13.07), children having Posterior Ureteral Valve (PUV) (AOR = 4.8, 95% CI = (2.32–9.93), duration of hospitalization (> 4 days) (AOR = 3.08, 95% CI = (1.52–6.24), and children having fever (AOR = 5.8, 95% CI = (2.81–11.97).ConclusionIn this study, almost one-third of the children developed UTIs, and female sex, longer hospitalization, PUV, and fever were identified as independent risk factors of UTIs. This emphasizes special attention should be given to high-risk children.

Factors affecting survival of foals with pneumonia in a referral hospital

BackgroundPneumonia is a common condition in ailing neonatal foals, and it remains an important cause of morbidity and mortality in this veterinary patient group. Factors affecting the survival of young foals with pneumonia have not been thoroughly investigated. The aim of this study was to explore the potential prognostic factors associated with survival of these foals. Fifty foals under one month of age with pneumonia were included in this retrospective clinical study. The foals were divided into groups based on survival (survived to discharge or died/euthanised during hospitalisation). Multiple clinical and laboratory variables were investigated as risk factors with univariate logistic regression analyses and subsequently with multivariate analyses. If a variable showed prediction potential in regression analysis, a receiver operating characteristic (ROC) analysis was conducted.ResultsIn univariate analysis, odds (OR, 95% CI) of non-survival were associated with higher respiratory rate (RR) on the first day after admission to hospital (D1) (1.32, 1.07–1.62, P = 0.009, for each 5-unit increase) and positive bacterial blood culture (12.08, 1.88–77.67, P = 0.009). Odds of non-survival were decreased for Standardbred breed (0.11, 0.01–0.96, P = 0.046) and for foals with longer hospitalisation, with each additional day in hospital further reducing the odds (0.59, 0.40–0.86, P = 0.006). In multivariate analysis, odds of non-survival were associated only with higher RR on D1 (1.36, 1.07–1.71, P = 0.011, for each 5-unit increase). In ROC analysis, optimal cut-off value for RR was ≥ 55/min with sensitivity 75.0% and specificity 76.3%. Based on predictive values, RR < 55/min on D1 favoured survival.ConclusionsHigher RR on D1 is a predictor of non-survival in foals with pneumonia in this study, increasing the odds of death by 36% for each 5-unit increase in RR. Respiratory rate below 55/min on D1 favours survival. These findings could assist in early identification of foals that are at increased risk of mortality, thereby aiding in treatment decisions.

Factors Associated with Malnutrition in Older Patients with Type 2 Diabetes in Bangkok, Thailand

OBJECTIVE: Malnutrition is a widespread but often neglected concern among older individuals with type 2 diabetes mellitus (T2DM), especially in Thailand, where research on this issue is limited. In this group, malnutrition can result in adverse outcomes, such as diminished physical function, decreased quality of life, longer hospitalizations, and increased mortality. This study aimed to examine the prevalence of malnutrition and the factors contributing to it among older adults with T2DM.METHODS: This cross-sectional study was conducted in August and September 2024 at our local hospital. Older patients diagnosed with T2DM for at least 6 months were included in the analysis. Nutritional status was evaluated using the Global Leadership Initiative on Malnutrition criteria, which assess weight loss, low body mass index, and reduced muscle mass. Logistic regression was used to determine predictors of malnutrition.RESULTS: Of the 176 participants, 30.1% were malnourished. Factors significantly associated with malnutrition included being underweight (adjusted odds ratio [AOR]: 11.07, 95% CI: 2.69–45.53), being married (AOR: 5.29, 95% CI: 1.14–24.64), living with diabetes for more than 10 years (AOR: 2.99, 95% CI: 1.23–7.25), poor medication adherence (AOR: 2.55, 95% CI: 1.06–6.17), and having a glomerular filtration rate below 60 (AOR: 4.70, 95% CI: 1.95–11.34).CONCLUSION: Malnutrition is prevalent in older individuals with T2DM. Routine nutritional evaluations should be implemented to reduce health risks and improve patient outcomes in this population.

Safety and Tolerability of Intravenous Lidocaine Infusions as Opioid Adjunct for Children Hospitalized With Sickle Cell Vaso-Occlusive Pain.

Sickle cell disease (SCD) vaso-occlusive episode (VOE) pain is treated with opioids, and non-opioid adjuvants may reduce pain severity without opioid side effects. We retrospectively investigated the safety and tolerability of intravenous lidocaine infusions as an adjunct to opioids in children and adolescents during VOE hospitalizations. In 2 years, lidocaine was administered in 64.6% of 260 admissions. There were no serious toxicities; overall, 82.2% of recipients chose to receive lidocaine during subsequent admissions. Lidocaine infusions were associated with longer hospitalizations, potentially reflecting selection bias. The efficacy of adjuvant lidocaine infusions during VOE should be studied prospectively.