Main Cause Of Hospitalization Research Articles

P-418. A Need for Infection Prevention among Patients with ESKD on Maintenance Dialysis: a First Step in Understanding how SARS-CoV-2 Impacts this Population

Abstract Background Although infections are a main cause of hospitalizations and deaths among patients with end-stage kidney disease (ESKD), contemporary post-pandemic data on the pathogen burden and outcomes among these patients are not well characterized. Identifying patients with ESKD and confirmed maintenance dialysis (MD) from electronic medical records (EMR) is challenging due to fragmented care since the majority ( >85%) receive MD at large dialysis organizations. In this study, patients with ESKD identified from the EMR will be linked to claims to characterize real-world outcomes among patients with confirmed MD by select pathogens to identify novel opportunities for prevention.Table.Clinical Characteristics and Infections Among Patients with ESKD between 2020-2023 Methods As a first step, the infection burden among adolescent and adult patients with a diagnosis of ESKD requiring MD (ICD-10-CM codes N18.6, Z99.2) identified between January 2020-March 2023 within the Loopback Analytics US EMR database was described. Patients were followed for 6 months unless they died or were lost to follow-up. Select infections within 6 months after the ESKD diagnosis date were defined using diagnosis codes or positive laboratory test. Comorbidities, types of vascular access, common pathogens, and proportion of patients with pneumonia were reported. References Results Overall, 65,515 patients with ESKD were identified between 2020-2023 and presented with high comorbidity burden (Table). 29.2% of patients with ESKD had documented central vein catheter, 6.9% had fistulas, 12.6% had hemodialysis without documentation of access type, and 2% had peritoneal dialysis. Follow-up of patients showed S. aureus (4.1%), E. coli (2.0%), C. difficile (2.0%), and K. pneumoniae (1.5%) as common bacterial infections. SARS-CoV-2 was the most common viral infection (6.9%). Moreover, 11.6% were diagnosed with pneumonia within 6 months. Conclusion The infection burden among patients with ESKD suggests a need for additional preventative strategies in this vulnerable group. EMR data linked to claims is needed to identify patients with ESKD and confirmed MD, and quantify healthcare costs. Evaluation of outcomes such as hospitalization rates, cardiovascular events, and survival among patients with ESKD and confirmed MD by infection type, such as SARS-CoV-2, is ongoing. Disclosures Emily A Hu, PhD, MS, Graticule, Inc.: Employee|Graticule, Inc.: Stocks/Bonds (Private Company) Jennifer R Dusendang, MPH, Graticule, Inc.: Employee|Graticule, Inc.: Stocks/Bonds (Private Company) Cátia Ferreira, PhD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Lisa Glasser, MD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Sudhir Venkatesan, MPH, PhD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Carla Talarico, PhD, MPH, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Della Varghese, PhD, MS, PharmD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options

Impact of early discharge from the maternity ward on the risk of neonatal rehospitalization: A case-control study

The time for newborn discharge from the maternity ward has been shortened in recent decades with consequences that are still debated. The primary objective of this study was to establish whether early discharge could be a risk factor for rehospitalization in the neonatal period. Second, we aimed to study the incidence of neonatal hospitalizations and their causes. Next, we tried to determine other possible risk factors for rehospitalization after discharge. This is a retrospective, single-center, case-control study collecting data on newborns rehospitalized in the first 28 days of life at Nancy University Hospital, after their discharge from the maternity ward. These newborns were born between 01/06/2021 and 31/05/2022 and were matched with two healthy infants who did not require rehospitalization according to term and month of birth. A logistic regression model was used to evaluate the association between early discharge and risk of hospitalization. 2,054 healthy full-term babies were born during the study period; 108 (5%) were rehospitalized and compared to 219 randomly selected newborns who did not required hospitalization. Among the 108 cases included, 42 (38.9%) obtained early discharge versus 91 out of 219 (41.6%) controls. Multivariate logistic regression showed no significant association between early discharge and risk of hospitalization (ORa=1.1 [95%CI: 0.7 to 1.8], p = 0.69). However, phototherapy treatment during the maternity ward stay was a significant risk factor for rehospitalization (ORa=5.O [2.5 to 9.9], p < 0.0001). The main causes of hospitalization were jaundice and respiratory infections. Early discharge from the maternity ward does not constitute a risk factor for readmission in the neonatal period in this study. Changes in perinatal practices, such as ambulatory delivery and very early discharge, should be included in revised recommendations.

Prevalence and associated factors with rhabdomyolysis

Introduction: Rhabdomyolysis (RB) is a frequent syndrome defined as skeletal muscle injurywhereby intramuscular molecules, such as myoglobin and creatine phosphokinase, are released into the bloodstream. This study aimed to identify the prevalence of RB and associated factors to this outcome in in-hospital patients. Methods: This is an observational study - cross-sectional, retrospective, with a descriptive and analytical approach. The sample was composed of all in-hospital patients from a Brazilian public hospital that presented serum creatine- phosphokinase measures recorded in medical records in the period from April 2020 to september 2021. Descriptive analysis was carried out with frequencies (absolute and relative) and means±standard deviation. The Chi-square test was used to infer the association to RB, and the variables presenting p-value ≤ 0.2 were included in a multivariate logistic regression technique applied to investigate the interaction among the selected independent variables and the RB. Results: Among 388 patients included in the present study, the prevalence of RB was 3.89% and the mortality rate was 39.43%. The main cause of hospitalization was circulatory system-related diseases. The frequency of RB was higher in males and in younger adults. The variables sex, age group, presence of comorbidities, trauma as the hospitalization cause, and history of recent exhaustive physical effort were significantly associated with RB. Conclusion: Our data share light on the profile of hospitalized patients prone to develop RB, a relevant clinical condition that could be unrecognized in many mild cases, but also lead to acute signals of renal failure. Additionally, our data brings a better understanding regarding mortality associated with RB, requiring greater attention from health professionals and managers.

Relationship of Crohn’s disease and acute pancreatitis in pediatric practice: literature review

Inflammatory bowel diseases (IBD) are a certain group of pathologic conditions of the gastrointestinal tract (GIT), including Crohn’s disease (CD) and ulcerative colitis (UC). In the modern world, vigilance for these diseases is growing, because their characteristic feature is the involvement of other organs in the pathological inflammatory process, as well as the development of local and systemic complications. As a rule, in children CCD occurs mainly at the age of 12-16 years. Recently, the attention of the medical world has been drawn to the issue of extraintestinal manifestations of CD. Pathological manifestations associated with lesions of the skin and mucous membranes, eyes, bone and joint system, pancreas, negatively affect both physical and psychological health of the child. Such pathology associated with pancreatic malfunction, such as acute pancreatitis (AP) often occurs in patients with inflammatory bowel disease and is one of the main causes of hospitalization for diseases of the digestive system. According to statistics, the incidence ranges from 15 to 40 cases per 100,000 per year in European countries. According to the Gastroenterological Society, there are different variations in the course of acute pancreatitis, whether occurring in patients with IBS due to the disease itself or as a side effect of drug therapy. However, IBD patients are at increased risk of developing both acute and chronic pancreatitis. In this review, we consider the relationship and mutual influence of these two pathologies.

Application of a Machine Learning Predictive Model for Recurrent Acute Pancreatitis.

Acute pancreatitis is the main cause of hospitalization for pancreatic disease. Some patients tend to have recurrent episodes after experiencing an episode of acute pancreatitis. This study aimed to construct predictive models for recurrent acute pancreatitis (RAP). A total of 531 patients who were hospitalized for the first episode of acute pancreatitis at the Affiliated Hospital of Southwest Medical University from January 2018 to December 2019 were enrolled in the study. We confirmed whether the patients had a second episode until December 31, 2021, through an electronic medical record system and telephone or WeChat follow-up. Clinical and follow-up data of patients were collected and randomly allocated to the training and test sets at a ratio of 7:3. The training set was used to select the best model, and the selected model was tested with the test set. The area under the receiver operating characteristic curves, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, decision curve, and calibration plots were used to assess the efficacy of the models. Shapley additive explanation values were used to explain the model. Considering multiple indices, XGBoost was the best model. The area under the receiver operating characteristic curves, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model in the test set were 0.779, 0.763, 0.883, 0.647, 0.341, and 0.922, respectively. According to the Shapley additive explanation values, drinking, smoking, higher levels of triglyceride, and the occurrence of ANC are associated with RAP. The XGBoost model shows good performance in predicting RAP, which may help identify high-risk patients.

Critical patients in general hospitalization wards: a descriptive analysis of factors inherent to the transfer to a closed unit

Unplanned transfers from the General Ward to Critical Care Units occur due to a deterioration in the patient's clinical status. They are of great interest because of their negative impact, associated with longer hospital stays and higher mortality. To report the frequency at which these transfers occur, characteristics of these patients and causes of the transfer. Identify shortcomings in the care process that may allow improvement strategies. cross-sectional study. Cases were considered those who, during the first 24 hours of hospitalization in the General Ward, required transfer to the ICU between January - December 2022 in a high-complexity hospital in Buenos Aires. Results: Of 8317 admissions, 124 were transferred to the ICU, with a rate of 14 per 1000 and an average of 70 years. The most frequent comorbidities were high blood pressure, heart failure, cancer and overweight-obesity. The main causes of hospitalization were respiratory and gastrointestinal symptoms. 67% had non-alarming results in the NEWS score prior to transfer to the ICU. The most frequent causes were respiratory failure, hemodynamic instability and requirement for monitoring. Average hospital stay was 10 days and in-hospital mortality was 26%. Respiratory decompensation in elderly male patients was the most common cause of transfer to a Closed Unit. One of the shortcomings of the care process seems to be the NEWS score, where in 67% of cases it did not warn about the high requirement of patient monitoring.

The Influence of Adherence to a Mediterranean Diet on Decompensation in Patients with Chronic Heart Failure.

Chronic heart failure (CHF) is a major health problem, representing the main cause of hospitalization in people over 65 years of age. Several studies have associated the Mediterranean diet with a cardioprotective function, improving prognoses in patients with high cardiovascular risk. Our main objective is to determine whether higher adherence to the Mediterranean diet is associated with a lower severity of CHF, based on the number of decompensations and disease complications. This study was a single-center retrospective cohort study conducted at the Virgen del Rocío Hospital (Seville). Adherence to a Mediterranean diet was determined by the Mediterranean Diet Adherence Screener (MEDAS) in patients with chronic heart failure in a state of clinical stability, the number of decompensations in the 12 months before inclusion, cardiac biomarkers (NT-proBNP and CA125), evaluation of dyspnea, and quality of life assessment according to NYHA and KCCQ scales and analytical profiles. Seventy-two patients were included (35 with high adherence to the Mediterranean diet and 37 with low adherence). The mean age was 81.29 ± 0.86 years. A trend towards fewer decompensations (1.49 ± 0.14 vs. 1.92 ± 0.17, p = 0.054) and lower NT-proBNP values (2897.02 ± 617.16 vs. 5227.96 ± 1047.12; p = 0.088) was observed in patients with high adherence compared to those with low adherence to the Mediterranean diet. Our results suggest that patients with CHF and high adherence to the Mediterranean diet have a tendency towards an improved cardiac profile, indicated by fewer decompensations and lower NT-proBNP levels. Future clinical trials are needed to substantiate these hypotheses.

Thoracic Fluid Content as an Indicator of High Intravenous Diuretic Requirements in Hospitalized Patients with Decompensated Heart Failure.

Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to diuretic treatment, which may be due to diuretic resistance (DR). Such cases require high doses of diuretic medications and combination therapy with diuretics of different mechanisms of action. Although certain predisposing factors for diuretic resistance have been identified (such as hypotension, type 2 diabetes, impaired renal function, and hyponatremia), further research is needed to identify other pathophysiological markers of DR. Objective: This study aims to identify admission markers that can predict a high requirement for intravenous diuretics in hospitalized patients with decompensated heart failure. Methods: This study included 102 adult patients hospitalized for ADHF. At admission, patients underwent clinical assessment, laboratory parameter evaluation (including the N-terminal prohormone of brain natriuretic peptide [NT-proBNP] levels), and hemodynamic assessment using impedance cardiography (ICG). Hemodynamic profiles were based on the use of parameters such as heart rate (HR), blood pressure (BP), and thoracic fluid content (TFC) as markers of volume status. The analysis included 97 patients with documented doses of intravenous diuretic use. Patients were stratified into two groups based on median diuretic consumption (equivalent to 540 mg of intravenous furosemide): the high-loop diuretic utilization (LDU) group (n = 49) and the low-LDU group (n = 48). Results: Compared to low-LDU patients, high-LDU patients had greater thoracic fluid content at admission, both quantitatively (37.4 ± 8.1 vs. 34.1 ± 6.9 kOhm-1; p = 0.024) and qualitatively (TFC ≥ 35 kOhm-1: 59.2% vs. 33.3%; p = 0.011). Anemia was more common in the high-LDU group (67.4% vs. 43.8%; p = 0.019), as was elevated NT-proBNP (≥median of 3952 pg/mL: 60.4% vs. 37.5%; p = 0.024). High LDU was associated with a significantly longer hospitalization duration (12.9 ± 6.4 vs. 7.0 ± 2.6 days; p < 0.001). Logistic regression analysis identified anemia, elevated NT-proBNP, and high TFC as predictors of high LDU (HR: 2.65, 2.54, and 2.90, respectively). In a multifactorial model, only high TFC remained an independent predictor (HR: 2.60, 95% CI 1.04-6.49; p = 0.038). Conclusions: TFC was the sole independent admission marker of a high requirement for intravenous diuretics in patients hospitalized for decompensated heart failure. An objective assessment of volume status by impedance cardiography may support intensive personalized decongestion therapy.

Causes of Hospitalization in Children with Down Syndrome.

Background and Objectives: Down syndrome (DS) is the most common chromosomal disorder in the world. It is caused by the imbalance of the chromosomal constitution of 21 by free trisomy, translocation or mosaicism. Children and adolescents with Down syndrome have immune dysregulation and are more susceptible to infections. This study aims to evaluate hospitalizations of children and adolescents with DS in the pediatric ward of Botucatu Clinics Hospital (HCFMB) and to classify the population of children included in the study according to age, diagnosis, outpatient follow-up, length of stay and need for the intensive care unit (ICU). Thus, it will be possible to improve care for these children, aiming to reduce these hospitalizations. Materials and Methods: This study was an observational, cross-sectional study, with retrospective data collected from the last nine years of hospitalization, from January 2013 to December 2021, from children and adolescents with DS in the pediatric ward, emergency room, and the ICU of HCFMB. Children hospitalized in this period in the pediatric ward and ICU, in the age range of 30 days to 15 years, were included in this study. The evaluation of comorbidities that culminated in the need for hospitalization in this population can be the focus of actions to improve the diagnoses and conducts for this population, which can prevent worsening illness and hospitalizations in future populations. Results: In this analysis, 80 children with DS were evaluated, with a total of 283 hospitalizations. The most prevalent age group was 1 to 3 years, and the main cause was due to problems in the respiratory system (99 cases). Among the respiratory causes, the main cause of hospitalization was due to pneumonia in 50% of cases, followed by acute respiratory failure in 14%. The average hospitalization time was 8 days, and in 49 hospitalizations, the children required the ICU. The main cause of hospitalization in the ICU was due to respiratory causes (36%), followed by cardiac malformations (14%). During the ICU hospitalizations, there were 13 deaths, and we observed a higher prevalence of heart conditions and, in some cases, positive urine cultures in these children. Conclusions: The Hospital serves as a reference for pediatric hospitalizations within its region and beyond, owing to its specialized capabilities. The main causes of hospitalization were those related to the respiratory system and cardiac malformations. Roughly one-third of the children required admission to the intensive care unit.

The cost of care for children hospitalized with respiratory syncytial virus (RSV) associated lower respiratory infection in Kenya

BackgroundRespiratory syncytial virus (RSV) is one of the main causes of hospitalization for lower respiratory tract infection in children under five years of age globally. Maternal vaccines and monoclonal antibodies for RSV prevention among infants are approved for use in high income countries. However, data are limited on the economic burden of RSV disease from low- and middle-income countries (LMIC) to inform decision making on prioritization and introduction of such interventions. This study aimed to estimate household and health system costs associated with childhood RSV in Kenya.MethodsA structured questionnaire was administered to caregivers of children aged < 5 years admitted to referral hospitals in Kilifi (coastal Kenya) and Siaya (western Kenya) with symptoms of acute lower respiratory tract infection (LRTI) during the 2019–2021 RSV seasons. These children had been enrolled in ongoing in-patient surveillance for respiratory viruses. Household expenditures on direct and indirect medical costs were collected 10 days prior to, during, and two weeks post hospitalization. Aggregated health system costs were acquired from the hospital administration and were included to calculate the cost per episode of hospitalized RSV illness.ResultsWe enrolled a total of 241 and 184 participants from Kilifi and Siaya hospitals, respectively. Out of these, 79 (32.9%) in Kilifi and 21(11.4%) in Siaya, tested positive for RSV infection. The total (health system and household) mean costs per episode of severe RSV illness was USD 329 (95% confidence interval (95% CI): 251–408 ) in Kilifi and USD 527 (95% CI: 405– 649) in Siaya. Household costs were USD 67 (95% CI: 54–80) and USD 172 (95% CI: 131– 214) in Kilifi and Siaya, respectively. Mean direct medical costs to the household during hospitalization were USD 11 (95% CI: 10–12) and USD 67 (95% CI: 51–83) among Kilifi and Siaya participants, respectively. Observed costs were lower in Kilifi due to differences in healthcare administration.ConclusionsRSV-associated disease among young children leads to a substantial economic burden to both families and the health system in Kenya. This burden may differ between Counties in Kenya and similar multi-site studies are advised to support cost-effectiveness analyses.

Hospitalization Causes and Epidemiological Characteristics Among Patients With End-Stage Renal Disease: A Six-Year Retrospective Study.

Chronic kidney disease (CKD) leads to a high rate of complications requiring hospital admission for advanced management. Therefore, this study aims to analyze the main causes of hospitalization following the initiation of renal replacement therapy (RRT). This observational and descriptive study utilized a non-probabilistic quota sampling method, reviewing a total of 423 medical records from General Regional Hospital 1 of the Mexican Social Security Institute in Querétaro. The study evaluated the frequency and causality of hospitalizations during a retrospective period from 2018 to 2023. There were 1,162 hospitalization events involving 423 patients; 71.63% of patients started RRT with peritoneal dialysis, while 26% began with hemodialysis. The leading cause of hospitalization was electrolyte imbalance (397; 34.17%), followed by peritonitis associated with peritoneal dialysis (351; 30.21%), change to hemodialysis (270; 23.24%), Tenckhoff catheter dysfunction (209; 17.99%), and fluid overload (205; 17.64%). The group with the highest number of events was renal-related complications, followed by infectious causes. Hospitalizations in end-stage CKD patients often arise from the complex renal pathophysiology and complications related to acute and decompensated renal function. This condition refers to the kidneys' failure to maintain essential physiological functions despite ongoing treatment, leading to issues such as electrolyte imbalances, fluid overload, and uremic syndrome. To reduce morbidity and mortality, measures such as enhanced training in ambulatory dialysis, improved catheter care, and early infection detection are crucial. A comprehensive approach that addresses both acute issues and preventive strategies is essential for improving clinical outcomes and quality of life for these patients.

Acute Abdomen in Crohn’s Disease Patients: Short- and Long-Term Outcomes

Abstract The aim of the study was to determine long-term outcome in Crohn’s disease patients hospitalised for acute abdominal pain. Retrospective chart review was made of consecutive Crohn’s disease patients hospitalised for acute abdominal pain at the tertiary referral centre in Eastern Europe. Between 2015 and 2020, 65 patients with Crohn’s disease were admitted at least once to the emergency room because of acute abdominal pain. Thirteen were admitted twice, eight — three times, three — four times, and three — five times. Most patients had ileal involvement. There were two intra-abdominal abscesses. Fifty-three of 65 underwent abdominal imaging. Forty-five were treated with antibiotics (65%), 17 with steroids (26%), eight received a nasogastric tube and three — parenteral nutrition. Six underwent an intestinal resection during the initial hospitalisation (9%). The hospitalisation length median was eight days and significantly longer in those who underwent surgery (28 vs. 9, p = 0.003). The median follow-up time was 42.8 months. During the follow-up period, 26 (40%) readmitted for abdominal emergencies, 14 underwent surgery — either at the initial or later hospitalisation (21%). Thirteen of 14 surgeries were emergencies, and three were concluded by ostomy formation (21%). One developed postoperative intra-abdominal complication, and two died postoperatively (14%). Complicated disease was associated with hospital readmission (HR, 5.8, 95% CI:1.4–23.3; p = 0.013) and enhanced probability to undergo intestinal surgery (HR, 10.3, 95% CI: 2.4–44.1; p = 0.002). An elevated CRP was associated with decreased risk of hospital readmission (HR, 0.08, 95% CI: 0.01–0.55; p = 0.010). Ileocolic disease was the main cause of hospitalisation for acute abdominal pain. Complicated (stricturing or penetrating) disease should be diagnosed early and surveilled closely.

Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre

BackgroundLiver surgery is associated with a significant hospital stay regardless the type of liver resection. A large incision is essential for open liver surgery which is a major factor in the course of the patient’s recovery. For patients with small parenchyma liver lesions requiring surgical resection, robotic surgery potentially offers the opportunity to transform the patient’s post-operative course. A day-case robotic liver resection pathway was formulated and implemented at our institution when patients were planned for discharge within 24 h of admission for liver surgery.MethodsSingle surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery.ResultsThis is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien–Dindo grade III or above complications, no 30-day readmission and 90-day mortalities.ConclusionThis case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner.

Zedoary turmeric oil injection ameliorates lung inflammation via platelet factor 4 and regulates gut microbiota disorder in respiratory syncytial virus-infected young mice

BackgroundRespiratory syncytial virus (RSV)-induced lung inflammation is one of the main causes of hospitalization and easily causes disruption of intestinal homeostasis in infants, thereby resulting in a negative impact on their development. However, the current clinical drugs are not satisfactory. Zedoary turmeric oil injection (ZTOI), a patented traditional Chinese medicine (TCM), has been used for clinical management of inflammatory diseases. However, its in vivo efficacy against RSV-induced lung inflammation and the underlying mechanism remain unclear.PurposeThe present study was designed to confirm the in vivo efficacy of ZTOI against lung inflammation and intestinal disorders in RSV-infected young mice and to explore the potential mechanism.Study design and methodsLung inflammation was induced by RSV, and cytokine antibody arrays were used to clarify the effectiveness of ZTOI in RSV pneumonia. Subsequently, key therapeutic targets of ZTOI against RSV pneumonia were identified through multi-factor detection and further confirmed. The potential therapeutic material basis of ZTOI in target tissues was determined by non-target mass spectrometry. After confirming that the pharmacological substances of ZTOI can reach the intestine, we used 16S rRNA-sequencing technology to study the effect of ZTOI on the intestinal bacteria.ResultsIn the RSV-induced mouse lung inflammation model, ZTOI significantly reduced the levels of serum myeloperoxidase, serum amyloid A, C-reactive protein, and thymic stromal lymphoprotein; inhibited the mRNA expression of IL-10 and IL-6; and decreased pathological changes in the lungs. Immunofluorescence and qPCR experiments showed that ZTOI reduced RSV load in the lungs. According to cytokine antibody arrays, platelet factor 4 (PF4), a weak chemotactic factor mainly synthesized by megakaryocytes, showed a concentration-dependent change in lung tissues affected by ZTOI, which could be the key target for ZTOI to exert anti-inflammatory effects. Additionally, sesquiterpenes were enriched in the lungs and intestines, thereby exerting anti-inflammatory and regulatory effects on gut microbiota.ConclusionZTOI can protect from lung inflammation via PF4 and regulate gut microbiota disorder in RSV-infected young mice by sesquiterpenes, which provides reference for its clinical application in RSV-induced lung diseases.

Clinical outcomes of COVID-19 in patients with sickle cell disease in French Guiana

Clinical outcomes of COVID-19 in patients with sickle cell disease in French Guiana

Acute viral bronchiolitis in infants: A narrative literature review

Severe acute bronchiolitis is mostly caused by the respiratory syncytial virus (RSV) and is the main cause of hospitalization in children under one year old. Although it has a low mortality rate, it has a high morbidity rate, requiring early diagnosis through a detailed clinical history and physical examination. A narrative review of fourteen articles found in the PubMED/MEDLINE, SciELO and BVS electronic databases was therefore carried out, with the aim of reviewing the most up-to-date literature on the subject. Currently, the monoclonal antibody Palivizumab is the main agent used to prevent bronchiolitis and is available for patients at high risk of developing the serious disease. In addition, the Abryso vaccine was recently approved by the National Health Surveillance Agency (Anvisa) and will be administered to pregnant women in the last trimester of pregnancy, with the aim of preventing the disease in newborns. Finally, it was found that the appropriate management of acute viral bronchiolitis consists of supportive measures such as hydration, nutritional support and oxygenation when necessary, while the use of corticosteroids and bronchodilators has not been shown to reduce the length of hospital stay or the natural course of the disease.

COVID-19 admissions: Trying to define the real impact of infection in hospitalized patients

Several studies have suggested that the hospitalization rate for COVID-19 in children and adolescents may reflect the prevalence of the infection rather than the severity of the disease. The aim of this study was to describe the clinical features of hospitalised paediatric patients with SARS-CoV-2 infection in order to understand if the infection was the reason for admission. Retrospective cohort study including patients aged 0-18 years with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) admitted to a tertiary care children's hospital in Spain between 01/01/2020 and 12/31/2021. 228 patients were included, corresponding to 150 cases of COVID-related admission (SARS-CoV-2 infection as main cause of hospitalization) and 78 of non-COVID-related admission (SARS-CoV-2 infection unrelated to the hospitalization). In the group of COVID-related admissions, 58 patients had comorbidities. Forty-nine patients had acute respiratory disease (pneumonia, bronchospasm or bronchiolitis). Multisystem inflammatory syndrome in children was diagnosed in 27 and was significantly more frequent in the first year of the pandemic (wild type virus). Eighty percent of patients with acute respiratory disease needed respiratory support, mostly low-flow oxygen therapy. The severity of the disease was similar in all virus variants. Two patients (both with severe comorbidities) died from COVID-related conditions. In our study, one third of the patients were admitted with SARS-CoV-2 infection but not because of it. Acute respiratory disease was less frequent and had a better prognosis compared to the adult population, while MIS-C was a major cause of morbidity and hospitalization. The fatality rate was extremely low.

Non-Donors of Organs and Tissues Due to Medical Refusal in a Transplant Referral Service

Obtaining organs for transplants through a deceased donor occurs exclusively through donation. However, some open protocols with potential donors do not become effective donors due to medical refusal. Our aim was to identify the profile of non-donors of organs and tissues due to medical refusal in a state reference service for transplants. This is a cross-sectional study with retrospective data collection from medical records of patients who died and had a protocol opened to evaluate brain death and procurement of organs and tissues in 2019. The sample consisted of 27 patients, the majority of whom were female, aged over 71 years, had primary education, and were married. The main causes of medical refusal were age above the recommended age and septicemia. Brain death was mostly confirmed within 12 hours, and the main cause of hospitalization was a vascular event. Identifying the profile of non-donors due to medical refusal is necessary for services to identify possible misattributed medical contraindications and thus contribute to reducing the disproportion between supply and demand for organs and tissues for transplants.

Ingresos COVID-19: intentando comprender el impacto real de la infección en pacientes hospitalizados

Ingresos COVID-19: intentando comprender el impacto real de la infección en pacientes hospitalizados

MAIN CAUSES OF HOSPITAL ADMISSIONS OF CHILDREN AND ADOLESCENTS AGED 0 TO 18 IN THE CITY OF CAMPINA GRANDE/PB, FROM 2020 TO 2022: A CROSS-SECTIONAL STUDY

Introduction: Pediatric diseases and their main causes of hospitalization are directly related to simple outpatient measures, sensitive to basic care. However, there were changes in the epidemiological and clinical scenario of hospitalizations for these diseases, with the advent of the covid-19 pandemic. Objective: To study the causes of hospital admissions for children and adolescents aged 0 to 18 years old and their evolution from 2020 to 2022, in the city of Campina Grande/PB. Methodology: This is a descriptive, cross-sectional and retrospective study, carried out with data obtained from the Hospital Information System (SIH), searching for the main causes of hospital admissions for children and adolescents admitted to pediatric reference services in Campina Grande. The variables used were biological characteristics (sex, age) and clinical characteristics (number of hospitalizations; length of stay; hospital discharge conditions; deaths). Results: The main cause of hospitalization in the group of pediatric diseases in the three years studied was pneumonia due to non-specific microorganisms (PNM), corresponding to 9.9% of hospitalization cases in 2020; 12.5% in 2021 and 15.8% in 2022. Another important highlight was lymphoid leukemia (ALL), which accounted for 2.6% of cases in 2020; 4.2% in 2021 and 4.3% in 2022. In the group of neonatal and infant diseases, the main causes of hospitalizations were disorders related to short-term pregnancy and low birth weight, represented by 10.3% of cases in 2020, 7.4% in 2021 and 6.4% in 2022. Discussion: The consequences of the pandemic were the progressive increase in the incidence of respiratory diseases, with the return of classes and exposure to viruses and bacteria, after isolation prolonged social. In addition to the progressive increase in the incidence of premature births, directly related to teenage pregnancy, considered a public health problem. And the incidence of ALL, which was underdiagnosed in 2020, as most resources were directed to the pandemic. Conclusion: the pandemic impacted pediatric epidemiology, increasing the number and profile of hospitalizations, mainly due to respiratory diseases and oncological diseases.