Median Duration Of Hospitalization Research Articles

Anakinra treatment in multisystemic inflammatory syndrome in children (MIS-C) associated with COVID-19.

ObjectiveThe study aimed to report the efficacy and safety of anakinra treatment in patients with the refractory multisystemic inflammatory syndrome in children (MIS-C).MethodsThis is a cross-sectional retrospective study consisting of pediatric patients diagnosed with MIS-C who were treated with anakinra.ResultsAmong the 378 patients diagnosed with MIS-C, 82 patients (21.6%) who were treated with anakinra were included in the study. The median age of patients was 115 (6-214) months. The median duration of hospitalization was 15 (6-42) days. Sixty patients (73.1%) were admitted to the pediatric intensive care unit. Patients were treated with a median dose of 2.7 mg/kg/day anakinra concomitant with IVIG and steroids. Intravenous anakinra was applied to 12 patients while 70 patients received it subcutaneously. Twenty-eight patients required high dose (4–10 mg/kg/day) anakinra. The median day of anakinra initiation was 2 (1-14) days and the median duration of anakinra use was 7 (1-41) days. No injection site reactions were observed while elevated transaminase levels were detected in 13 patients. Seventy-three patients (89.1%) were discharged without any sequela or morbidity. Seven patients (1.8%) died. Abnormal echocardiographic findings continued in two patients (2.4%) (coronary artery dilatation in one, low ejection fraction in one) at discharge and became normal on the 2nd month.ConclusionBased on the results of the study, anakinra was associated with clinical improvements and was safe for most patients with refractory MIS-C.

Outcomes of nonsteroidal anti-inflammatory drug toxicosis treated with therapeutic plasma exchange in 62 dogs.

BackgroundTherapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti‐inflammatory drug (NSAID) overdose in dogs.Hypothesis/ObjectivesDescribe a population of dogs treated with TPE for NSAID overdose.AnimalsSixty‐two dogs with NSAID overdose treated with TPE.MethodsMulticenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose.ResultsThe median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36‐4857 mg/kg), 217 mg/kg (range, 88‐625 mg/kg) and 138 mg/kg (range, 26‐3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1‐20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4‐2.2). The median TPE session duration was 2 hours (range, 1‐4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1‐11 days). Sixty‐one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirty‐one (91.1%) of the 34 dogs with at least 1 follow‐up visit were not azotemic at the time of reevaluation.Conclusions and Clinical ImportanceThis population of dogs managed with TPE had excellent outcomes, even in cases of high NSAID dose ingestion. When TPE is available and the time frame is appropriate, this extracorporeal modality should be considered for the management of NSAID overdose.

SPONGE-assisted versus Trendelenburg position surgery in laparoscopic sigmoid and rectal cancer surgery (SPONGE trial): randomized clinical trial.

In minimally invasive surgery of the sigmoid colon and rectum a retractor sponge has been introduced as an alternative to the Trendelenburg position. This randomized clinical trial (RCT) compared postoperative duration of hospital stay and perioperative outcomes in patients with sigmoid or rectal cancer undergoing sponge-assisted versus Trendelenburg position surgery. The SPONGE trial is a single-centre RCT nested within the Dutch nationwide prospective observational cohort of patients with colorectal cancer, and follows the Trials within Cohorts (TwiCs) design. Patients with sigmoid or rectal cancer undergoing elective laparoscopic or robotic surgery were randomized to either sponge-assisted or Trendelenburg surgery on a 1:1 basis using block randomization. Duration of postoperative hospital stay was the primary outcome and was compared using the Mann-Whitney U test. Secondary endpoints included the proportion of complications, readmissions, or mortality versus the χ2 test in intention-to-treat and per-protocol analyses. This trial was not blinded for patients in the intervention arm or physicians. Between November 2015 and June 2021, 82 patients were randomized to sponge-assisted surgery and 81 to Trendelenburg surgery. After post-randomization exclusion, 150 patients remained for analyses (75 patients per arm). There was no statistically significant difference in median duration of hospital stay (5 days versus 4 days, respectively; P = 0.06), 30-day postoperative complications (30 per cent versus 31 per cent; P = 1.00), readmission rate (8 per cent versus 15 per cent; P = 0.30), or mortality (0 per cent versus 1 per cent, P = 1.00). The per-protocol analysis showed similar results. No adverse device events were seen. Sponge-assisted laparoscopic/robotic surgery does not reduce the duration of hospital stay, or perioperative morbidity or mortality. NCT02574013 (http://www.clinicaltrials.gov).

Is the age at surgery in Crohn’s disease clinically relevant? Differences and peculiarities: a wide single centre experience after long-term follow-up

PurposeThe Montreal classification for Crohn’s disease includes “age at diagnosis” as a parameter but few is reported about the age at surgery. The aim of this study is to evaluate the short- and long-term differences in the postoperative surgical outcome and disease behaviour, according to the age at the first surgery.MethodsPatients consecutively operated for abdominal Crohn’s disease during the period 1986–2012 at our centre were systematically analysed according to their age at first surgery. In our retrospective cohort, the age at first surgery ranged from 13 to 83 years, and patients were arbitrarily divided into four groups: ≤ 19 (G1), 20–39 (G2), 40–59 (G3) and ≥ 60 (G4) years old.ResultsIn total, 1051 patients were included with a median follow-up time of 232 months. The four groups exhibited statistically significant differences in age at diagnosis, smoke habit, time between diagnosis and surgery, disease location and behaviour, history of perianal fistula or abscess, severe malnutrition requiring total parental nutrition before surgery, type of surgery, total length of resected bowel, median duration of hospitalization, incidence of abdominal recurrences and number of surgical recurrences. G1 displays an inverse linear trend with time in the severity of clinical characteristics when compared to G4 groups. On the contrary, the incidence of short-term complications, types of abdominal recurrence and presence of concomitant perianal disease did not vary among groups. In addition, at multivariate analysis, the age at surgery and the disease location were the only independent risk factors for abdominal surgical recurrence.ConclusionDespite first surgery is extremely more frequent between 20 and 59 years, patients from G1 and G4 groups showed clinical differences and peculiarities when compared to the other age groups. The most indolent CD behaviour and occurrence of surgical recurrence was observed in patients having their first abdominal surgery in the elderly, while patients operated before the age of 19 experienced a more aggressive disease course.

Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study

Among hospital-acquired infections, surgical site infections (SSIs) are frequent. SSI in the early post-transplant course poses a relevant threat to transplant recipients. To determine incidence, risk factors for SSI and its association with post-transplant outcomes and pancreas transplant (P-Tx) recipients. Adult simultaneous kidney-pancreas transplantation (SPK-T) and P-Tx recipients with a follow-up of at least 90 days were identified in the Swiss Transplant Cohort Study (STCS) dataset. Except for the categorization of SSIs according to Centers for Disease Control and Prevention (CDC) criteria, all other data were prospectively collected. Risk factors for SSI were investigated with logistic regression. A Weibull accelerated failure-time model was applied to address the impact of SSI on length of stay, correcting for transplant-related complications and delayed graft function. Of 130 transplant recipients, 108 SPK-Tx and 22 P-Tx, 18 (14%) individuals developed SSI within the first 90 days after transplantation. Deep incisional (seven, 38.9%) and organ/space infections (eight, 44.4%) predominated. In the majority of SSIs (11, 61.1%; two SSIs with simultaneous identification of fungal pathogens) bacteria were detected with Enterococcus spp. being most frequent. The median duration of hospitalization after transplantation was significantly longer in recipients with SSI (median: 26 days; interquartile range (IQR): 19-44) than in patients without SSI (median: 17 days; IQR: 12-25; P=0.002). In multivariate analysis, SSI was significantly associated with increased length of stay and prolonged the duration of hospitalization by 36% (95% confidence interval: 4-79). SSI after SPK-Tx and P-Tx occurred at a frequency of 14%. Among pathogens, Enterococcus spp. predominated. SSI was independently associated with a longer hospitalization after transplantation.

Treatment Effect of Qingfei Paidu Decoction Combined With Conventional Treatment on COVID-19 Patients and Other Respiratory Diseases: A Multi-Center Retrospective Case Series.

Background: Qingfei Paidu decoction (QFPDD) has been widely used in treating coronavirus disease 2019 (COVID-19) in China. However, studies on the treatment effect of COVID-19 patients and other respiratory diseases have not been well demonstrated. Our study aims to determine the treatment effect of QFPDD in combination with conventional treatment on COVID-19 patients and other respiratory diseases. Methods: This retrospective study recruited COVID-19 patients who were treated with QFPDD for at least two courses (6 days) from seven hospitals in five provinces from January 21 to March 18 2020. Demographic, epidemiological, clinical, laboratory, computed tomography characteristics, treatment, and outcome data were collected and analyzed. The improvements in clinical symptoms before and after QFPDD treatment were compared. Results: Eight COVID-19 patients were included in this study. Of them, six were males (75.0%). The median age of the patients was 66 (60–82) years. Four patients were classified as mild and moderate cases (50.0%); there were two severe cases (25.0%) and critical cases (25.0%). The most common symptom was cough (7 [87.5%]), followed by fever (6 [75.0%]), fatigue (4 [50.0%]), asthma (4 [50.0%]), and anorexia (3 [37.5%]). Abnormal findings included decrease in neutrophils (3 [37.5%]), lymphocytes (2 [25.0%]), alkaline phosphatase (3 [37.5%]), lactic dehydrogenase (4 [50.0%]), erythrocyte sedimentation rate (2 [25.0%]), and C-reactive protein (5 [83.3%]) at admission. After one course (3 days) of QFPDD, nasal obstruction and sore throat completely disappeared, and fever (5 [83.3%]), fatigue (2 [50.0%]), and cough (2 [28.6%]) were improved. After two courses (6 days), the fever disappeared completely in all patients, and the other symptoms showed a tendency to improve. In non-severe patients, 87.5% baseline symptoms completely disappeared. In severe patients, 61.1% of the baseline symptoms completely disappeared after patients were administered QFPDD for two courses. Of the abnormal indicators, 55.6% returned to normal levels. The median duration to complete fever recovery was 1.0 day. The median durations of viral shedding and hospitalization were 10.5 and 21.5 days, respectively. None of the patients worsened and died, and no serious adverse events occurred related to QFPDD during hospitalization. Conclusion: QFPDD combined with conventional treatment improved clinical symptoms in COVID-19 patients with other respiratory diseases, and no serious adverse reactions associated with QFPDD were observed. Larger sample studies confirm our findings in the future.

Transurethral suturing of bladder following transurethral excision of female vesico-urachal diverticula: a novel technique with long-term follow-up results.

This study aims to describe and evaluate outcomes of transurethral surgery-natural orifice transluminal endoscopic surgery (TUS-Notes) technique in patients treated with transurethral excision of vesico-urachal diverticula (VD). Patients who underwent TUS-Notes following transurethral VD excision due to recurrent urinary tract infection (rUTI) since 2013 were included in this prospective non-randomized cohort study. Under cystoscopic guidance VD and surrounding bladder wall was resected until the fatty tissue using monopolar resectoscope. The specimen was removed with a grasper through the cystoscope. TUS-Notes technique was performed with Minimal Suturing Device (MSD-Ney®). The needle of the suture was shaped according to suturing position and loaded into MSD-Ney. They were inserted into the bladder under cystoscopic guidance transurethrally. Once the defect was sutured properly, an extracorporeal knot was prepared and tied. The length of the operation (LOO), and perioperative complications according to the Clavien-Dindo grading system were noted. The integrity of the bladder was checked with cystography to assess objective cure. Subjective cure was evaluated with Patient Global Impression of Improvement (PGI-I) scale. The follow-up period of 65 participants varied from three months to eight years. The median LOO was 37min. A Clavien grade-3 complication was observed in one patient. Peroperative failure was not noted. The median duration of hospital stays, and catheterization time was three days. Objective cure rate and subjective cure rates were 100%. UTI was not noted after surgery. Transurethral complete excision of VD is an acceptable technique to prevent rUTI. The TUS-Notes technique provides a successful minimal invasive treatment option for the treatment of bladder defects. Transurethral suturing of urinary bladder.

Inhaled nitric oxide for treating pain crises in people with sickle cell disease.

Inhaled nitric oxide for treating pain crises in people with sickle cell disease.

The effect of cryopreserved and noncryopreserved stem cells on the outcome of autologous stem-cell transplantation in multiple myeloma patients

Background The CD34+ stem cells are either noncryopreserved (non-CP) or cryopreserved (CP) in autologous stem-cell transplantation (ASCT). Some retrospective studies have shown that engraftment failure and engraftment rate are similar in CP cells and infusion reactions are lower in CP cells due to the absence of dimethyl sulfoxide. Objective In this study, we presented our clinical experience comparing the outcomes and safety of ASCT with CP and non-CP stem cells. Patients and methods A total of 163 patients were enrolled between January 2019 and June 2021. Duration of neutrophil/platelet engraftment, rates of infusion-related reactions, febrile neutropenia, and duration of hospitalization were compared between the CP and non-CP groups. Results Fifty five (33.7%) received CP cells, 108 (66.3%) received non-CP cells. The median dose of CD34+ cells was similar in both groups (P=0.755). The median duration of neutrophil and platelet engraftment was not statistically significantly different in CP and non-CP groups (P=0.896 and 0.183, respectively). No statistical difference was observed in the median duration of hospitalization between the two groups [CP: 16 (13–26) vs. non-CP: 15 (11–31) days, P=0.124]. The febrile neutropenia rate was higher in the CP group, but there was no statistical difference between the two groups (CP: 56.4% vs. non-CP, 48.1%, P=0.301). The rates of infusion-related reaction such as nausea, vomiting, and rash were higher in the CP group (21.8 vs. 12%), with no statistically significant difference (P=0.159). Conclusion Non-CP cells have similar outcomes to CP cells and lower toxicity than CP cells, which are safe and effective in ASCT.

Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children.

OBJECTIVESThe appropriate approach for surgical repair of coarctation of the aorta with a ventricular septal defect (VSD) remains controversial. This study evaluated the outcomes of primary repair of VSDs with periventricular device closure without cardiopulmonary bypass through a left thoracotomy in patients without arch hypoplasia.METHODSWe selected 21 patients aged <1 year, including 7 neonates, who underwent repair of coarctation of the aorta with periventricular device closure of a VSD.RESULTSThe median occluder size was 6 (range, 5–8) mm. The median mechanical ventilation time was 14 (range, 2–68) h, and the median duration of hospital stay was 11 (range, 7–16) days. No reoperations were required to correct VSD shunting, and the median residual shunt size was 1 (range, 1–2) mm. The median follow-up period was 13 (range, 4–31) months. No late deaths were reported, and no haemodynamically significant pressure gradient at the anastomotic site was observed. The median distal aortic arch z-score was 0.39 (range, −0.1–to 0.9). Only 1 patient had a permanent pacemaker implanted towards the end of the follow-up period.CONCLUSIONSPeriventricular device closure can be used safely for closure of VSD in children with coarctation of the aorta without a hypoplastic aortic arch, even in neonates, to reduce the risk of prolonged cardiopulmonary bypass. This hybrid approach can be performed with a low incidence of rhythm disturbances and residual shunting. However, a meticulous assessment of the VSD anatomy is essential to avoid any unfavourable events.

PB2272: THERAPY AND HOSPITAL MORTALITY PREDICTORS IN HEMATOLOGICAL PATIENTS WITH 4 GRADE NEUTROPENIA AND CONCOMITANT CORONAVIRUS INFECTION

Background: According to published data, cancer patients are 5 times more likely to contract coronavirus infection (COVID-19) than non-cancer patients. Aims: To assess and identify predictors of hospital mortality in hematological patients with grade 4 neutropenia and concomitant coronavirus infection. Methods: A prospective study included 130 patients (55% women, 45% men) aged 18 to 91 years (median 59) with acute leukemia (AL) and lymphoproliferative diseases (LPD) who had grade 4 neutropenia and coronavirus infection (COVID-19) and were observed from April 2020 to December 2021 at Moscow City Clinical Hospital 52 (Russia). The study also included a reference group of 130 patients matched by sex, age and diagnosis, with AL/LPD and COVID-19, but without grade 4 neutropenia. The statistical analysis was an intention to treat analysis with adjustment for false discovery rate. Results: AML prevailed in the AL group (80.6%), aggressive non-Hodgkin’s lymphomas in the LPD group. Distribution by disease status: 62 patients (47.7%) on chemotherapy (CT), 19 (14.6%) in remission, 23 (17.8%) with disease progression, 19 (14.6%) with newly diagnosed disease, 7 (5.3%) with a relapse. The patients had a high NEWS score (7.5) and a high Charlson comorbidity index (5). The majority had moderate or severe lung tissue damage (CT2 in 44 (33%), CT3 in 25 (20%), CT4 in 13 (10%)). There were increases in the levels of C-reactive protein (> 100 g/L in 55% of patients, mean 241.5 g/L), LDH (506 U/L), D-dimer (1866), procalcitonin (> 0.5 ng/mL in 73%). IL-6 and IL-1b blockers were used for hypercytokinemia; the dose of IL blockers was reduced in view of grade 4 neutropenia. Empiric antibiotic therapy for complications was used in 91.5% of patients. Antifungal therapy was carried out in 65% of cases. Sepsis developed in 63 (48.5%) patients. The median duration of hospitalization in patients with grade 4 neutropenia was 18 days. Transfer to the ICU was required in 78 (60%) patients in the total group and in 41 patients (52.5%) among those older than 60 years. Mortality in ICU patients: 80.7%, mortality in patients older than 60 years: 92.7%. In non-ICU patients with AL and LPD younger than 60 years, the mortality rate was 0%. Mechanical ventilation was used in 48.5% of cases. Mortality was lower in vaccinated patients than in unvaccinated ones (40% vs 51%). The mortality rates in the main group (AL 48.6%, LPD 51.7%, Fig. 1) and the reference group (AL 37.5%, LPD 13.8%, Fig. 2) showed that the presence of grade 4 neutropenia increased the risk of death almost twofold: the relative risk was 1.9 (95% CI 1.3–2.6), p=0.0001. According to the results of multivariate analysis (logistic regression), the predictors of hospital mortality in the main group were ICU stay (odds ratio 12.1 (1.4–24.0), p=0.0001), sepsis (3.0 (1.1–7.7), p=0.001), and age > 65 (3.0 (0.9–7.5), p=0.001). Severe disease progression/relapse is also a predictor of mortality (close to statistical significance). Image:Summary/Conclusion: Coronavirus infection with severe neutropenia (caused by tumor progression and/or combination chemotherapy) is a significant adverse factor of hospital mortality in patients with hematological cancers. Predictors of hospital mortality are age over 60 years, sepsis, ICU stay, and the absence of remission.

P1091: FEASIBILITY OF ASCT AFTER ANTI-PD-1 THERAPY FOR R/R CLASSICAL HODGKIN LYMPHOMA

Background: Immunotherapy with checkpoint inhibitors (anti-PD-1) is highly effective in relapsed/refractory (R/R) classical Hodgkin Lymphoma (cHL) and leads to more than 70% overall response rate. However, long-term progression-free survival rate is not sufficient. Consolidation with ASCT after anti-PD-1 could be a very promising option even among previously chemorefractory patients. Nevertheless, there is not enough experience about the safety and feasibility of ASCT after anti-PD-1 in the context of possible immune-related adverse events (AE). Aims: to assess the safety and feasibility of ASCT after anti-PD-1 therapy in patients with R/R cHL. Methods: We retrospectively analysed patients with cHL who previously underwent ASCT from November 2018 until December 2021 after treatment with anti-PD-1. A median patient age was 34 years (range, 20-55), 22 patients were female, 21 - male. Patients received anti-PD-1 as monotherapy (n=17), combination of anti-PD-1 and chemotherapy (n=4), anti-PD-1 monotherapy followed by combination of anti-PD-1 and chemotherapy (n=14), anti-PD-1 monotherapy followed by salvage therapy (n=3) and other (n=2). A median number of anti-PD-1 cycles was 6 (range, 1-45). The median time from the last dose of anti-PD1 was 69 days (range, 14-365). Conditioning regimen for ASCT consisted of BeEAM (n=12), BeAC (n=30) and other (n=1). Safety assessment was performed by Common Terminology Criteria for Adverse Events (CTCAE) (v5.0). Results: Forty-three eligible patients were enrolled in this analysis. A median time to engraftment was 10.5 days (range, 9-26). A median time to platelet count > 20x109/L was 13.5 days (range, 7-43). A median use of G-CSF after high-dose chemotherapy followed by ASCT was 9 days (range, 0-26). PEG-G-CSF (empegfilgrastim 7.5 mg/ml once) was used in 10 patients (23.3%). Plerixafor was used in 6 patients (14%). Neutropenic fever was observed in 32 patients (74.4%). Documented infections were reported in 19 patients (44.2%) among which were 5 cases of clostridial colitis (11.6%). A median intravenous administration of antibiotics was 8 days (range, 0-23). Grade 3-4 mucositis and enteropathy was reported in 2 patients (4.6%) and 6 (14%), respectively. Other non-hematological toxicity was observed in 10 patients (23.4%): 8 patients (18.6%) developed engraftment syndrome (that was successfully treated with steroids), grade 4 autoimmune toxic myocarditis was reported in 1 patient (2.3%). One death due to grade 5 autoimmune myocarditis in combination with grade 5 autoimmune pneumonitis was reported (2.3%). A median duration of hospitalization was 25 days (range, 14-72). Transplant-related mortality (TRM) was reported in 2 patients (4.6%). Image:Summary/Conclusion: The obtained data on safety of ASCT after anti-PD-1 treatment generally correspond to the data of international studies. Toxicity profile tends to be very similar to the published data about ASCT without anti-PD-1 previous treatment, especially in terms of TRM. However, we observe a high incidence of engraftment syndrome that can lead to fulminant immune-related AE (myocarditis and pneumonitis) probably. Attention should be paid to the defining of optimal “wash-out” period after last dose of anti-PD-1 and early defining of possible life-threatening immune related AE (especially myocarditis and pneumonitis).

Clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 at Case Hospital, Uganda.

Data on clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in private health facilities in Uganda is scarce. We conducted a retrospective cohort study of patients hospitalized with COVID-19 at Case Hospital, Kampala, Uganda, between June 2020 and September 2021. Data of 160 participants (median age 45 years (interquartile range [IQR]: 37–57) and 63.5% male) was analyzed. Seventy-seven (48.1%) participants had non-severe, 18 (11.3%) severe, and 83 (51.9%) critical COVID-19 illness. In 62 participants with chest computed tomography findings, 54 (87%) had bilateral disease, with 22 (35%) having ground-glass opacities. The median duration of hospitalization was 5 days (IQR: 3–9 days). Overall, 18 (11.3%) participants died. Survival at 14 and 28 days was 89% and 72%, respectively. Factors strongly associated with all-cause mortality were as follows: age >50 years (odds ratio [OR]: 8.6, 95% confidence interval [CI]: 1.1–69.2, and p=0.042), having at least 1 comorbidity (OR: 3.2, 95% CI: 1.1–8.9, and p=0.029), hypertension (OR: 3.2, 95% CI: 1.2–8.6, and p=0.024), diabetes mellitus (OR: 2.9, 95% CI: 1.0–8.5, andp=0.056), and oxygen saturation <92% (OR: 5.1, 95% CI: 1.8–14.4, and p=0.002). In this private health facility, mortality was about 1 in 10 patients, and more people presented with critical illness in the second wave of the pandemic, and most deaths occurred after 2 weeks of hospitalization.

Pattern and short-term outcome of pediatric kidney disease at national referral hospital in Bhutan: an observational study

Introduction: The epidemiology of kidney diseases in children can vary widely across geographic regions. The main purpose of this study was to determine the pattern and short-term outcome of kidney disease among children hospitalized at the national referral hospital in Bhutan. Methods: All admitted children aged one month to 12 years with kidney disease, from January to December 2018, were included in the study. Diagnostic criteria were applied to all the patients on admission to determine study eligibility and subsequent demographic and clinical data were collected using a structured interviewer administered pro forma. Results: A total of 128 (7.8%) children met diagnostic criteria for kidney disease among 1648 hospitalized children during the study period. The median age at presentation was 2.5 years (interquartile range 0 to 8). The commonest disease was acute kidney injury (48, 37.5%) followed by acute glomerulonephritis (37, 28.9%), urinary tract infection (37, 28.9%), congenital anomalies of kidney and urinary tract (11, 8.6%) and nephrotic syndrome (11, 8.6%). Median duration of hospital stay was 8 days (IQR 4 to 14.8). Four (3.1%) patients were referred to India for specialist care, 5 (3.9%) underwent dialysis and 28 (21.9%) died. Of the 28 patients who died, 26 (92.9%) had acute kidney injury and 2 (7.1%) had chronic kidney disease. Conclusions: Pediatric kidney diseases comprise a significant proportion of disease burden at the national referral hospital. Education of primary healthcare providers about the epidemiologic burden of pediatric kidney diseases is needed to reduce kidney-related morbidity and mortality.

Epidemiological characteristics, clinical course, and laboratory investigation of pediatric COVID-19 patients in a tertiary care center in Saudi Arabia.

BackgroundSince the initial emergence of the novel SARS-CoV-2 coronavirus responsible for the 2019 coronavirus disease (COVID-19) pandemic, many studies have been exploring the nature and characteristics of this virus and its associated clinical manifestations. The present study aimed to describe the clinical presentation and outcomes of COVID-19 infections in pediatric patients.MethodsA retrospective review of findings associated with 143 pediatric patients (age <14 years) with a confirmed COVID-19 diagnosis who had undergone inpatient or outpatient treatment at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between March 2020 and October 2020, was conducted. The analyzed data included patient demographic information, pre-existing medical conditions, symptoms, interventions, and outcomes.ResultsThe median age of this patient population was 7 years. Of these 143 patients, 67 (46.8%) had known pre-existing medical conditions including bronchial asthma (12.8%), chronic lung disease (CLD) (3%), congenital heart disease (CHD) (17%), primary immunodeficiencies (1.5%), malignancies (9.8%), and 7.5% were post-transplant patients. Thirty-seven patients (26%) were overweight or obese. Sixty-three of these patients (51%) were symptomatic, with the most common symptom being fever (55%). Ultimately, 45 patients (31%) required admission to the hospital, with a median duration of hospitalization of 9.6 days for admitted patients. There were no documented cases of infection-related mortality among this pediatric cohort, although 11 patients experienced post-infectious complications that primarily manifested as a loss of taste and smell.ConclusionThese findings suggest that pediatric COVID-19 patients tend to experience mild forms of the disease, without any significant differences in disease severity as a function of patient gender or immune status.

Effect of prucalopride to improve time to gut function recovery following elective colorectal surgery: randomized clinical trial.

Delayed return to gut function and prolonged postoperative ileus (PPOI) delay recovery after colorectal surgery. Prucalopride is a selective serotonin-4-receptor agonist that may improve gut motility. This was a multicentre, double-blind, parallel, placebo-controlled randomized trial of 2 mg prucalopride versus placebo in patients undergoing elective colorectal resection. Patients with inflammatory bowel disease and planned ileostomy formation were excluded, but colostomy formation was allowed. The study medication was given 2 h before surgery and daily for up to 6 days after operation. The aim was to determine whether prucalopride improved return of gut function and reduced the incidence of PPOI. The primary endpoint was time to passage of stool and tolerance of diet (GI-2). Participants were allocated in a 1 : 1 ratio, in blocks of 10. Randomization was computer-generated. All study personnel, medical staff, and patients were blinded. This study was completed between October 2017 and May 2020 at two tertiary hospitals in New Zealand. A total of 148 patients were randomized, 74 per arm. Demographic data were similar in the two groups. There was no difference in median time to GI-2 between prucalopride and placebo groups: 3.5 (i.q.r. 2-5) versus 4 (3-5) days respectively (P = 0.124). Prucalopride improved the median time to passage of stool (3 versus 4 days; P = 0.027) but not time to tolerance of diet (2 versus 2 days; P = 0.669) or median duration of hospital stay (4 versus 4 days; P = 0.929). In patients who underwent laparoscopic surgery (125, 84.5 per cent), prucalopride improved median time to GI-2: 3 (2-4) days versus 4 (3-5) days for placebo (P = 0.012). The rate of PPOI, complications, and adverse events was similar in the two groups. Prucalopride did not improve time to overall recovery of gut function after elective colorectal surgery. Registration number: NCT02947269 (http://www.clinicaltrials.gov).

EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience

Placement of a lumen-apposing metal stent (LAMS) between the gastric pouch and the excluded stomach allows for EUS-guided transgastric interventions (EDGIs) in patients with Roux-en-Y gastric bypass (RYGB). Although EUS-guided transgastric ERCP (EDGE) outcomes have been reported, data are scant on other endoscopic interventions. We aimed to evaluate the outcomes and safety of EDGIs. This retrospective study involved 9 centers (United States, 8; Europe, 1) and included patients with RYGB who underwent EDGIs between June 2015 and September 2021. The primary outcome was the technical success of EDGIs. Secondary outcomes were adverse events (AEs), length of hospital stay, and fistula follow-up and management. Fifty-four EDGI procedures were performed in 47 patients (mean age, 61 years; 72% women), most commonly for the evaluation of a pancreatic mass (n= 16) and management of pancreatic fluid collections (n= 10). A 20-mm LAMS was used in 26 patients and a 15-mm LAMS in 21, creating a gastrogastrostomy in 37 patients and jejunogastrostomy in 10. Most patients (n= 30, 64%) underwent a dual-session EDGI, with a median interval of 17 days between the 2 procedures. Single-session EDGI was performed in 17 patients, of whom 10 (59%) had anchoring of the LAMS. The most common interventions were diagnostic EUS (with or without FNA or fine-needle biopsy sampling; n= 28) and EUS-guided cystgastrostomy (n= 8). The mean procedural time was 97.6 ± 78.9 minutes. Technical success was achieved in 52 patients (96%). AEs occurred in 5 patients (10.6%), of which only 1 AE (2.1%) was graded as severe. Intraprocedural LAMS migration was the most common AE, occurring in 3 patients (6.4%), whereas delayed spontaneous LAMS migration occurred in 2 (4.3%). Four of the 5 LAMS migration events were managed endoscopically, and 1 required surgical repair. LAMS anchoring was found to be protective against LAMS migration (P= .001). The median duration of hospital stay was 2.1 ± 3.7 days. Of the 17 patients who underwent objective fistula assessment endoscopically or radiologically after LAMS removal, 2 (11.7%) were found to have persistent fistulas. In 1 case the fistula was intentionally left open to assist with weight gain. The other fistula was successfully closed endoscopically. EDGI is effective and safe for the diagnosis and management of pancreaticobiliary and foregut disorders in RYGB patients. It is associated with high rates of technical success and low rates of severe AEs. LAMS migration is the most common AE with evidence that anchoring can be protective against its occurrence. Persistent fistulas may occur, but endoscopic closure seems to be effective.

A Single-Centered Cohort Study on Favipiravir Safety and Efficacy in Pediatric Patients with COVID-19.

Coronavirus disease 2019 (COVID-19) affects the pediatric population. Due to limited data, this study aimed to evaluate the safety and efficacy of favipiravir in the hospitalized pediatric population diagnosed with COVID-19. The present retrospective cohort study was conducted on pediatric patients aged 1 - 18 years with a diagnosis of COVID-19 admitted to Mofid Children's Hospital, Tehran, Iran. Favipiravir was administrated at a dose of 60 mg/kg/day (max: 3200 mg/day) on the first day and then 23 mg/kg/day (max: 1200 mg/day) for 7 to 14 days. The patients were evaluated regarding the need for invasive mechanical ventilation, intensive care unit admission, duration of hospital stay, and mortality. Safety was measured by the occurrence of related adverse drug reactions (ADRs). A total of 95 patients were included in the study. Favipiravir was administered to 25 patients. The need for invasive mechanical ventilation was reported in 4 (16.00%) and 11 (15.71%) patients in the favipiravir and control groups, respectively (P = 1.000). The median duration of hospital stays was significantly higher in patients who received favipiravir than in the controls (P = 0.002). No difference was observed in the mortality rate (P = 0.695). The ADRs, including decreased appetite, hypotension, and chest pain, were more prevalent in patients who received favipiravir than in the controls (P < 0.05). The administration of favipiravir in the pediatric population is associated with higher ADR occurrence with no positive effect on the need for invasive mechanical ventilation, hospital stay, and mortality. Further randomized controlled trials are necessary for better judgment.

Hospital Admissions of Huntington's Disease Patients in a Huntington's Disease Centre Between 2011 and 2016: A Retrospective Analysis.

BackgroundHuntington's Disease (HD) is a relentlessly progressive genetic neurodegenerative disorder with characteristic motor, psychiatric, and behavioral abnormalities that inevitably results in severe disability and death. Many patients have multiple hospital admissions during the disease course, but there is limited information which problems lead to hospitalization.ObjectivesTo assess acute reasons for hospital admissions, discharge routes, and clinical characteristics of HD patients in a retrospective analysis.MethodsWe reviewed all medical records of patients with an established diagnosis of Huntington's Disease and hospital admissions between 2011 and 2016 in our local hospital‐based database.ResultsThere were 135 hospital admissions in 53 HD patients during the review period, representing a median of two admissions per patient. Median duration of hospitalization was seven days. The most frequent reason for admission was a worsening of HD motor symptoms (n = 77, 57.0%) such as chorea, parkinsonism, gait problems, falls, and dysphagia. Psychiatric symptoms related to HD were the second most common reason for admission (n = 58, 43.0%). Infections (including aspiration pneumonia) and traumas/surgical procedures were only responsible for 6.7% and 5.9% of admissions, respectively. Emergency admissions were not common (42.2%), and the majority of patients were able to return to their previous residency upon discharge (85.2%, home or nursing home). Recurrent admissions were associated with worse motor function and functional capacity.ConclusionsWorsening of motor and psychiatric symptoms associated with Huntington's Disease were the most common reasons for hospital admissions. Therefore, our data highlight the importance of optimal symptom control in HD patients.

Coinfection of leptospirosis and coronavirus disease 2019: A retrospective case series from a coastal region in South India.

During the monsoon season of 2020, the coastal areas of South India were endemic to both leptospirosis and coronavirus disease 2019 (COVID‐19). This study aimed to investigate the clinical features and outcomes of patients infected with both infections. A retrospective review of charts of all patients with COVID‐19 who were also diagnosed with leptospirosis by immunoglobulin M enzyme‐linked immunosorbent assay was undertaken. The clinical features, laboratory report, treatment details, and outcomes of all the included patients were recorded. The collected data were summarized as the frequency with percentage for categorical data and the mean or median for continuous data. Twenty‐four cases of coinfections were admitted between July and November 2020. Most of these patients were categorized as severe COVID‐19 (n = 15, 62.5%). Acute kidney injury was seen in 79.2% (n = 19) patients, while raised bilirubin was present in 79.2% (n = 19) of the patients. All patients had raised C‐reactive protein, while all but one had raised procalcitonin. Thrombocytopenia, leucocytosis, and leukocytopenia were seen in 91.7% (n = 22), 45.8% (n = 11), and 12.5% (n = 3) of the patients. The median duration of hospital stay was 11 (8.25–15) days. A total of 79.2% (n = 19) of the patients improved and were discharged, while 20.8% (n = 5) died during the hospital stay. In conclusion, patients with fever and atypical manifestations such as hepatic dysfunction, renal dysfunction, and thrombocytopenia should be evaluated for leptospirosis even if they are COVID positive.