Main Cause Of Hospitalization Research Articles

Different Pediatric Acute Care Settings Influence Bronchiolitis Management: A 10-Year Retrospective Study

Bronchiolitis is the main cause of hospitalization in infants. Diagnosis is clinical, and treatment is based on hydration and oxygen therapy. Nevertheless, unnecessary diagnostic tests and pharmacological treatments are still very common. This retrospective study aimed to evaluate whether the setting of bronchiolitis care influences diagnostic and therapeutic choices. The management of 3201 infants, referred to our Italian Tertiary Care Center for bronchiolitis between 2010 and 2020, was analyzed by comparing children discharged from the pediatric emergency department (PEDd group) undergoing short-stay observation (SSO group) and hospitalization. Antibiotic use in PEDd, SSO, and ward was 59.3% vs. 51.6% vs. 49.7%, respectively (p < 0.001); inhaled salbutamol was mainly administered in PEDd and during SSO (76.1% and 82.2% vs. 38.3% in ward; p < 0.001); the use of corticosteroids was higher during SSO and hospitalization (59.6% and 49.1% vs. 39.0% in PEDd; p < 0.001); inhaled adrenaline was administered mostly in hospitalized infants (53.5% vs. 2.5% in SSO and 0.2% in PEDd; p < 0.001); chest X-ray use in PEDd, SSO, and ward was 30.3% vs. 49.0% vs. 70.5%, respectively (p < 0.001). In a multivariate analysis, undergoing SSO was found to be an independent risk factor for the use of systemic corticosteroid and salbutamol; being discharged at home was found to be a risk factor for antibiotic prescription; undergoing SSO and hospitalization resulted as independent risk factors for the use of CXR. Our study highlights that different pediatric acute care settings could influence the management of bronchiolitis. Factors influencing practice may include a high turnover of PED medical staff, personal reassurance, and parental pressure.

Infectious Pneumonia and Lung Ultrasound: A Review.

The application of thoracic ultrasound examination has not long been developed because ultrasound's interaction with the lung does not generate an anatomical image but an artifactual one. Subsequently, the evaluation of pulmonary artifacts and their correlation to specific diseases allowed the development of ultrasound semantics. Currently, pneumonia still represents one of the main causes of hospitalization and mortality. Several studies in the literature have demonstrated the ultrasound features of pneumonia. Although ultrasound cannot be considered the diagnostic gold standard for the study of all lung diseases, it has experienced an extraordinary development and growth of interest due to the SARS-CoV-2 pandemic. This review aims to provide essential information on the application of lung ultrasound to the study of infectious pneumonia and to discuss the differential diagnosis.

La Neonatologia… caso per caso

Neonatal hypotonia, bronchopulmonary dysplasia, necrotizing enterocolitis and persistent hypoglycemia are some of the main topics in neonatology. This work aims to summarize these four neonatal conditions through illustrative clinical cases. The first issue concerns neonatal hypotonia, which can constitute a pivotal sign in the diagnosis of hypoxic ischemic encephalopathy. However, neonatal hypotonia can be present in several other conditions, such as sepsis and neurological or neuromuscular diseases. The second issue is about bronchopulmonary dysplasia, a disease that mainly affects extremely premature infants. Many therapeutic strategies have been proposed to prevent this disease, such as less invasive ventilation and an early use of inhaled and systemic corticosteroids. Long-term respiratory sequelae in infants with bronchopulmonary dysplasia remain one of the main causes of hospitalization in these children in their early years of life. The third issue is necrotizing enterocolitis, a disease that can affect both term and preterm newborns. Multiple risk factors are involved in the pathogenesis of this disease such as an abnormal peripheral perfusion due to congenital heart diseases, small for gestational age (SGA), sepsis, hypoxic-ischemic encephalopathy, chorioamnionitis, intrauterine growth restriction (IUGR). On the other hand, breastfeeding can play as a preventive factor. Finally, the last topic is about the management of persistent hypoglycaemia, a condition that can be caused by the combination of one of the following mechanisms: inadequate glucose supply in an infant with low glycogen stores (preterm, IUGR, SGA); excessive insulin production (maternal diabetes, large for gestational age); failure of counter-regulatory response to hy-poglycaemia (pituitary or adrenal deficiency

Surveillance of multi-resistant microrganisms and epidemiological investigation of intensive care unit patients

It is of great importance to detect the presence of microorganisms in healthcare services. On this basis, strategies should be developed to maintain safety inside the hospital environment by preventing the transmission of microorganisms, thus preventing healthcare-associated infections (HAI). In the Intensive Care Unit (ICU), the precocious detection of infection and/or colonization by multidrug-resistant (MDR) microorganisms is key. For this reason, the routine monitoring of patients that are infected or colonized by MDR microorganisms is mandatory. In this context, this study aimed to evaluate the performance of epidemiological surveillance swabs and microbiological cultures in ICU patients in a university public hospital in Belo Horizonte, Minas Gerais State, Brazil. Medical records of patients admitted to the ICU from January 1st, 2018 to December 31st, 2020, submitted to epidemiological surveillance cultures, and presenting factors correlated to the development of HAI were evaluated. This was a descriptive, retrospective and observational, non-interventional study. The study population was composed mainly of male patients (66.3%), with a mean age of 59 years, coming from the Medical Clinic department, and septicemia was the main cause of hospitalization in the ICU. The analyses showed that 9.5% of the patients were colonized by MDR microorganisms. The samples were collected at the ICU, and a higher frequency of gram-negative bacteria was observed, including A. baumannii, P. aeruginosa, K. pneumoniae, and carbapenem-resistant Enterobacteriaceae. The most frequently prescribed antimicrobials were β-lactams and glycopeptides, and the same patient was treated using more than one class of antimicrobials. The surveillance culture is key to understanding the microbiological profile of the institution. The collection of swabs and microbiological cultures from different sites could be used to adopt routines and recommend measures aimed at controlling and reducing the HAI rates as well as the emergence of MDR outbreaks. These procedures could contribute to the creation and maintenance of a safe and effective healthcare service.

A retrospective cohort study of pediatric hospitalization due to dentoalveolar infection before and after a change in national health insurance

This retrospective cohort study aimed to examine trends in pediatric (0–18 years old) hospitalizations due to dentoalveolar infection, before and after the inclusion of pediatric dental care in Israel’s National Health Insurance Law. Data were collected from the medical records of one oral and maxillofacial surgery department. Data were compared between patients hospitalized during 2002–2010 (group A, n = 531) and 2011–2019 (group B, n = 381). The mean age of the cohort was 8 years. A dentoalveolar abscess was the main cause of hospitalizations in both groups. Group B exhibited a higher rate of previous dental treatment in general (p = 0.001), and of previous dental treatment for the tooth responsible for the infection (p = 0.03). The prevalent treatment during hospitalization combined intravenous antibiotics and extraction, with or without drainage (58.1%) for group A; and intravenous antibiotics and drainage (49.4%) for group B (p < 0.01). Dental care provided by the Israel’s National Health Insurance should focus not only on operative treatment but also on oral health promotion and caries prevention, to reduce hospitalizations due to dentoalveolar infections.

Impact of a Very Short-Stay Post-Emergency Geriatric Unit on Early Readmissions.

In 2017, our French 1671-bed university hospital opened a 12-bed unit for very short stays, post-emergency (unit of transitory admission in geriatric [UTAG] area), dedicated to frail patients older than 75 years requiring short-term care. We sought to investigate whether this new organization's shortened length of stay (LOS) was associated or not with a higher rate of readmission. We conducted a retrospective descriptive study based on the daily activity of the UTAG over 6 months including all patients consecutively hospitalized in the unit via the computerized medical file of the hospital. The data collected included the Rockwood score, the primary diagnoses, the LOS and any 1-month readmission. From August 2019 to January 2020, 646 older adult patients were hospitalized in the UTAG. Two-thirds of the hospitalized patients were women; the mean age of this population was 86.7 ± 6.2 years. The main causes of hospitalization were infectious pathologies (19.8%), falls and their consequences (17.3%), and cardiac pathologies (17.2%). The mean LOS was of 2.7 ± 2.0. Seventy readmissions were observed in the month after discharge. One-month readmissions were more frequent when patients had presented with acute heart failure and among nursing home residents. The creation of the UTAG reduced LOS and so contributed to decreased iatrogenic disabilities without putting patients at increased risk of readmission. The development of cardiac and geriatric dedicated outpatient pathways and a community-based geriatric mobile team intervening in nursing homes could optimize the care of frail older adult patients and avoid readmissions.

Severe viral respiratory infections in the pre-COVID era: A 5-year experience in two pediatric intensive care units in Italy.

Viral respiratory infections are one of the main causes of hospitalization in children. Even if mortality rate is low, 2% to 3% of the hospitalized children need mechanical ventilation. Risk factors for admission to the pediatric intensive care unit (PICU) are well known, while few studies have described risk factors for invasive ventilator support and prolonged hospitalization. A retrospective study including all patients aged between 2 and 18 months with a confirmed viral respiratory infection, requiring admission to PICU from September to March between 2015 and 2019, was conducted at Bambino Gesù Children's Hospital in Rome, Italy. One hundred ninety patients were enrolled, with a median age of 2.7months; 32.1% had at least one comorbidity, mainly prematurity. The most frequent isolated viruses were RSV-B, rhinovirus, and RSV-A; 38.4% needed mechanical ventilation. This subgroup of patients had lower median birth weight compared with patients not requiring mechanical ventilation (2800 g vs. 3180 g, p = 0.02); moreover, comorbidities were present in 43.8% of intubated patients and in 24.8% of patients treated with non-invasive ventilation (p = 0.006). Viral coinfection did not result to be a risk factor for mechanical support, while virus-bacteria coinfection was significantly associated with mechanical ventilation (p < 0.001). Similar risk factors were identified for prolonged hospitalization. Early identification of patients who could have a sudden respiratory deterioration and need of mechanical ventilation is crucial to reduce complications due to orotracheal intubation and prolonged hospitalization in PICU. Further studies are needed to define high-risk group of patients and to design targeted interventions.

Relationship between meteorological variables and pneumonia in children in the Metropolitan Region of Porto Alegre, Brazil

This work aims to analyze the relationship between meteorological conditions and the occurrence of hospital admissions for pneumonia in children under 5years of age in the Metropolitan Region of Porto Alegre, Brazil, from 1998 to 2017. To this end, data from hospital admissions obtained from the Unified Health System database (DATASUS) were used and classified into two groups: acute respiratory infections (ARI) and asthma, according to the international classification of diseases, tenth edition (ICD-10). Data regarding meteorological variables were also used: temperature, relative humidity, atmospheric pressure and wind speed, at 12Z and 18Z, as well as the Thermal Comfort Index (TCI), Effective Temperature as a function of the wind (ETw) and Windchill (W). From the data obtained, a descriptive analysis of the diseases and a statistical analysis with the analysis of correlation and main components were performed. Results showed that pneumonia (catalogued in the ICD-10 as J12 to J18) was the main cause of hospitalizations in children. The annual, monthly and daily hospitalization frequency distributions showed higher rates of admissions occurring in the months of May to September. The peaks of admissions and high admissions (HA) occurred mainly in the winter months (June, July and August), and in 1998. Meanwhile, the correlation and principal component analysis showed an increase in hospital admissions due to pneumonia related to a decrease in temperature and ETw and W indices (negative anomalies) and an increase in atmospheric pressure and relative humidity (positive anomalies).

Peripheral inflammatory markers during an acute bacterial infection in older patients with and without cognitive dysfunction: A case control study

Dementia is a known risk factor for acute bacterial infections which may also play a significant role in promoting or accelerating cognitive impairment. Pneumonia and urinary tract infections are the main cause of hospitalisation of dementia patients and infections are a major precipitant of delirium. It is well established that peripheral immune signals induce a neuroinflammatory response largely mediated by microglial cells which is amplified with advanced age, neurodegenerative disorders and genetic characteristics. Reversely, the innate immune response to acute bacterial infection is tightly regulated by the brain. It remains unclear whether dysfunctional neural circuits affected by dementia and/or delirium could alter systemic innate immune responses at the periphery. The current study aims to determine if dementia and/or delirium are associated with an altered systemic inflammatory response to an acute bacterial infection. We recruited 46 hospitalised older patients with acute bacterial infections. From these, 29 participants had cognitive dysfunction (6 with delirium, 12 with dementia and 11 with delirium superimposed on dementia) and 17 had normal cognition. We also included a control group of 11 patients with dementia but with no current infection matched for age and educational status. Baseline characteristics were tested between groups using Kruskal-Wallis test and pairwise comparisons were subsequently assessed with Bonferroni correction for multiple comparisons for continuous variables. Chi square test was used to assess differences between groups in categorical data and correlations between peripheral inflammatory parameters were assessed with Spearman's test. The 4 groups with infection and the control group with no infection had similar characteristics except for cognitive function and functionality which was higher for the group of infected cognitively healthy participants. Levels of C-reactive protein were similar between the infected groups and higher than the non-infected dementia group. Infected patients with cognitive dysfunction (delirium and/or dementia) had higher serum levels of IL-6, TNF-alpha and IL-1beta. These participants had reduced expression of miR-145 in circulating exosomes which correlated negatively with miR-155 levels (r = −0.411, p = 0.027). Expression of CR1 in circulating CD14+ monocytes was higher in infected participants with cognitive dysfunction and, in this group, PICALM correlated both with TNF-alpha and IL-6. In contrast to what was observed in participants with normal cognition, expression of CR1 did not correlate with DAP12 in infected participants with cognitive dysfunction. Taken together, our findings suggest that cognitive dysfunction is associated with an exaggerated proinflammatory response during acute bacterial infection with deregulation of several molecular signalling pathways in circulating exosomes and in monocytes.

Hospitalisation for monkeypox in Milan, Italy

During the current multi-country outbreak of human monkeypox the hospitalisation rate observed in Milan, Italy was 8.8%. Bacterial superinfection and severe perianal pain were the main cause of hospitalisation requiring antibiotic treatment and analgesic therapy. One patient was treated with Cidofovir. All hospitalised patients were discharged and the outcome was favourable with full recovery.

Prognostic factors associated with survival and hospitalization time in pediatric canine patients diagnosed with presumptive acute viral gastroenteritis.

Background and Aim:Acute viral gastroenteritis is one of the main causes of hospitalization in dogs during the 1st year of life. This retrospective study aimed to describe a pediatric canine population presumptively diagnosed with acute viral gastroenteritis and to identify potential prognostic factors that influence hospitalization time (HT) and mortality.Materials and Methods:Canine patients up to 12 months of age diagnosed with presumptive acute viral gastroenteritis were searched retrospectively from two veterinary hospitals during a 5-year period (2015–2020). Information regarding patient signalment, prophylactic care, clinical signs, blood test results, presence of systemic inflammatory response syndrome, and additional treatments were recorded to analyze their association with HT and mortality. Only dogs with a complete medical record until death or discharge were included in the study.Results:Ninety-four dogs were identified: 76 dogs (80.9%) survived with a median HT of 5 days (range: 2–16 days) and 18 dogs (19.1%) died with a median HT of 3½ days (range: 1–8 days) after admission. The presence of fever and fresh frozen plasma (FFP) administration was significantly associated with a lower survival rate (p = 0.021 and p = 0.037) in the multivariate analysis. Among survivors, incomplete primo-vaccination, the presence of hematochezia, and FFP administration were considered independent predictors of time to clinical recovery (p = 0.026, p = 0.047, and p = 0.026, respectively), being associated with higher HT.Conclusion:The presence of fever and FFP administration was significantly associated with a lower survival rate. An inadequate primo-vaccination status prior to admission, hematochezia, and FFP administration was associated with longer HT in surviving patients. Further studies are needed to confirm the present results.

Carbapenem-resistant bacteria in an intensive care unit: prevalence and associated factors

Antimicrobial resistance is a global threat that requires different care and factors involved including a unified, multidimensional approach, with greater epidemiological surveillance. The objective this study was to review the prevalence and factors associated with healthcare-related infections (HAI) caused by bacteria resistant to carbapenems in adult patients admitted to the Intensive Care Unit (ICU). This was a cross-sectional study accomplished through the review of electronic medical records and microbiological tests of patients admitted to the ICU of a hospital in southern Santa Catarina between 2010 and 2017. Demographic, clinical and antimicrobial use data were part of the variables of interest. A total of 1,273 HAI cases were included, 11.5% of the hospital infection rate. The mean age of patients was 60.4±18.5 years; 58.7% of the patients were men. The main cause of hospitalization was cardiac-related diseases (35.8%) and the median hospital stay was 31 days. Of the total number of cases, 24% were due to carbapenem resistance. HAIs caused by Escherichia coli, coagulase-negative Staphylococcus/Staphylococcus aureus and Streptococcus sp. were the pathogens that showed greater resistance to carbapenems. Resistance to carbapenems was associated with longer hospital stay (p=0.014), surgical procedure (p&lt;0.001), use of nasoenteral tube (p=0.048) and death (p=0.003). There was a high rate of infection by bacteria resistant to carbapenems. The observed rate of HAIs increased in frequency significantly over the duration of the study period.

The Relationship between Gut Microbiota and Respiratory Tract Infections in Childhood: A Narrative Review

Respiratory tract infections (RTIs) are common in childhood and represent one of the main causes of hospitalization in this population. In recent years, many studies have described the association between gut microbiota (GM) composition and RTIs in animal models. In particular, the “inter-talk” between GM and the immune system has recently been unveiled. However, the role of GM in human, and especially infantile, RTIs has not yet been fully established. In this narrative review we provide an up-to-date overview of the physiological pathways that explain how the GM shapes the immune system, potentially influencing the response to common childhood respiratory viral infections and compare studies analysing the relationship between GM composition and RTIs in children. Most studies provide evidence of GM dysbiosis, but it is not yet possible to identify a distinct bacterial signature associated with RTI predisposition. A better understanding of GM involvement in RTIs could lead to innovative integrated GM-based strategies for the prevention and treatment of RTIs in the paediatric population.

Anaphylaxis in Brazil between 2011 and 2019.

BackgroundThere is a lack of population‐based studies of anaphylaxis from low‐ and middle‐income countries. This hampers public health planning and investments and may influence availability of adrenaline auto‐injectors.ObjectiveWe conducted the first national population‐based study of anaphylaxis hospitalization in Brazil.MethodsDescriptive study using routinely reported data to the Brazilian Hospital Information System for the years 2011–2019. Information available is coded based on the International Classification of Diseases (ICD)‐10 and covers main cause of hospitalization (primary cause) and any conditions contributing to it (secondary cause).ResultsOver 9 years, we identified 5716 admissions due to anaphylaxis for all causes. The average hospitalization rate related to anaphylaxis was 0.71/100,000 population per year, with a 2.4% (95% CI 1.9%, 2.9%) increase per annum over the study period. Admissions were more frequent among females (52.8%), except for cases due to insect sting. Most admissions occurred in adulthood, from 30 to 59 years (36.3%) but 13.8% in preschool children (0–4 years). There were more young children admitted for food‐related anaphylaxis, and more adults admitted for drug/iatrogenic‐related anaphylaxis. There were 334 cases (5.8% of admissions) of fatal anaphylaxis over the study period, with increased case fatality rate over time.Conclusions and Clinical RelevanceThis is the first study of anaphylaxis hospital admissions using nation‐wide data from a low‐ or middle‐income country. Hospital admissions and fatalities from anaphylaxis in Brazil appear to be increasing.

Milder disease trajectory among COVID-19 patients hospitalised with the SARS-CoV-2 Omicron variant compared with the Delta variant in Norway.

Using individual-level national registry data, we conducted a cohort study to estimate differences in the length of hospital stay, and risk of admission to an intensive care unit and in-hospital death among patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant, compared with patients infected with Delta variant in Norway. We included 409 (38%) patients infected with Omicron and 666 (62%) infected with Delta who were hospitalised with coronavirus disease 2019 (COVID-19) as the main cause of hospitalisation between 6 December 2021 and 6 February 2022. Omicron patients had a 48% lower risk of intensive care admission (adjusted hazard ratios (aHR): 0.52, 95% confidence interval (CI): 0.34-0.80) and a 56% lower risk of in-hospital death (aHR: 0.44, 95%CI: 0.24-0.79) compared with Delta patients. Omicron patients had a shorter length of stay (with or without ICU stay) compared with Delta patients in the age groups from 18 to 79 years and those who had at least completed their primary vaccination. This supports growing evidence of reduced disease severity among hospitalised Omicron patients compared with Delta patients.

Prevalence of communicable and non-communicable diseases among adult immigrants from Venezuela at a university hospital in Colombia from 2017 to 2018.

Since 2015 immigration has increased significantly into Colombia. As immigrants who are not insured to the national health system present to public hospitals for medical care. However, there is little knowledge about the prevalence of communicable and non-communicable diseases amongst them. Ours was a cross-sectional study at a university hospital reviewing 154 medical records of Venezuelan immigrants treated by the Internal Medicine Specialty between 2017 & 2018. Non-communicable diseases representing 66.3% are the main cause of hospitalization, possibly owing to poor primary care.

Predictors of hospital readmission after fractures: One-year follow-up study

OBJECTIVE: Identify the incidence and predictive factors for readmissions of elderly hospitalized with fractures.METHOD: Prospective cohort study on 376 elderly people from a trauma referral large hospital in central Brazil. Data were collected from medical records of elderly people with radiological diagnosis of fractures. Readmission that occurs up to one year after the first discharge was defined the outcome variable. Pre- and post-admission characteristics were analyzed as predictive factors. Multiple analysis was performed using robust Poisson regression.RESULTS: The main cause of hospitalization was fracture of the femur (53.2%) and the most frequent trauma mechanism was fall from standing height (72.9%). The incidence of readmission was 20.7%, of which 30.5% were related to the fracture itself, with emphasis on Surgical Site Infection. The predictors of readmissions were: age range 60 to 69 years, COPD, delirium and fracture of the femur.CONCLUSIONS: The incidence of readmissions was high, with various causes and associated conditions pre-admission (age range 60–69, presenting COPD) and post-admission (delirium). The monitoring of these factors in the hospital environment is essential for prevention of readmissions.

Serum interleukin 38 (IL-38) as a new potential biomarker of pediatric asthma

BackgroundBronchial asthma is considered the most prevalent chronic respiratory disease worldwide and is one of the main causes of hospitalization in the pediatric population. Serum interleukin 38 (IL-38) levels are elevated in several inflammatory and autoimmune diseases. However, its exact role in the pathogenesis of these diseases is unclear.ObjectivesTo investigate the role of IL-38 as a potential biomarker in pediatric patients with bronchial asthma.MethodsSerum IL-38 levels were measured in 73 pediatric patients with bronchial asthma (34 atopic and 39 non-atopic) and 30 age- and sex-matched healthy control subjects using enzyme-linked immunosorbent assay.ResultsSerum IL-38 levels were significantly higher in patients with bronchial asthma compared to the control group (p < 0.001). A significant negative correlation was found between serum IL-38 levels and both relative and absolute eosinophilic counts in the atopic group (R = −0.575, p < 0.001 and R = −0.474, p = 0.005, respectively).ConclusionIL-38 could be a useful prognostic and therapeutic biomarker of atopic asthma in pediatric patients.

MAJOR ADVERSE EVENTS WITH THE USE OF FINERENONE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A META-ANALYSIS OF CARDIOVASCULAR OUTCOME TRIALS

Objective: Type 2 diabetes mellitus (T2DM) is recognized as the main cause of chronic kidney disease (CKD) and end-stage renal disease worldwide, carrying enormous human and financial costs. Mineralocorticoid receptor antagonists (MRAs) have been shown to decrease proteinuria and albuminuria, posing a favorable effect against the progression of CKD. Recently, we welcomed the publication of two large randomized controlled trials (RCTs), namely FIGARO-DKD and FIDELIO-DKD, addressing the cardio-renal efficacy of finerenone, a newer MRA, in patients with T2DM. Herein we sought to assess major adverse events with the use of finerenone in patients with T2DM. Design and method: We pooled data from the two relevant, published RCTs with finerenone in patients with T2DM, to provide pooled effect estimates for its cardio-renal efficacy and safety. We utilized data from published reports, also searching relevant supplementary appendices for any missing data. We assessed the following safety outcomes: acute kidney injury (AKI), hospitalization due to AKI, hyperkalemia, hospitalization due to hyperkalemia, all-cause death, hospitalization for any cause Results: We demonstrated that finerenone increased the risk for hyperkalemia by two times compared to placebo (RR = 2.03, 95% CI; 1.82–2.26, I2 = 0%, p &lt; 0.00001), while it also significantly increased the risk for hospitalization due to hyperkalemia (RR = 5.86, 95% CI; 2.99 – 11.47, I2 = 0%, p &lt; 0.00001). We have also documented that finerenone did not significantly affect the risk for development of AKI (p = 0.94) or hospitalization in the context of AKI (p = 0.92). In addition, finerenone resulted in a marginally non-significant reduction in the risk for all-cause death, equal to 10% (p = 0.05). Conclusions: Finerenone appears to provide significant cardiovascular and renal benefits for patients with T2DM. However, extra caution is required, since hyperkalemia appears to be the most important side effect with the use of finerenone, representing also the main cause of hospitalization due to a drug side effect. Large-scale use of potassium-binding drugs, such as patiromer or zirconium, as adjunct to finerenone might be a reasonable treatment combination in high-risk patients for hyperkalemia.

Evidence of protective effects of recombinant ADAMTS13 in a humanized model of sickle cell disease.

Sickle cell disease (SCD) is an inherited red blood cell disorder that occurs worldwide. Acute vaso-occlusive crisis is the main cause of hospitalization in patients with SCD. There is growing evidence that inflammatory vasculopathy plays a key role in both acute and chronic SCD-related clinical manifestations. In a humanized mouse model of SCD, we found an increase of von Willebrand factor activity and a reduction in the ratio of a disintegrin and metalloproteinase with thrombospondin type 1 motif, number 13 (ADAMTS13) to von Willebrand factor activity similar to that observed in the human counterpart. Recombinant ADAMTS13 was administered to humanized SCD mice before they were subjected to hypoxia/reoxygenation (H/R) stress as a model of vaso-occlusive crisis. In SCD mice, recombinant ADAMTS13 reduced H/R-induced hemolysis and systemic and local inflammation in lungs and kidneys. It also diminished H/R-induced worsening of inflammatory vasculopathy, reducing local nitric oxidase synthase expression. Collectively, our data provide for the firsttime evidence that pharmacological treatment with recombinant ADAMTS13 (TAK-755) diminished H/R-induced sickle cell-related organ damage. Thus, recombinant ADAMTS13 might be considered as a potential effective disease-modifying treatment option for sickle cell-related acute events.