Median Length Research Articles

Exploring 6years of colorectal cancer surgery in rural Italy: insights from 648 consecutive patients unveiling successes and challenges.

The multidisciplinary management of patients suffering from colorectal cancer (CRC) has significantly increased survival over the decades and surgery remains the only potentially curative option for it. However, despite the implementation of minimally invasive surgery and ERAS pathway, the overall morbidity and mortality remain quite high, especially in rural populations because of urban - rural disparities. The aim of the study is to analyze the characteristics and the surgical outcomes of a series of unselected CRC patients residing in two similar rural areas in Italy. A total of 648 consecutive patients of a median age of 73years (IQR 64-81) was enrolled between 2017 and 2022 in a prospective database. Emergency admission (EA) was recorded in 221 patients (34.1%), and emergency surgery (ES) was required in 11.4% of the patients. Tumor resection and laparoscopic resection rates were 95.0% and 63.2%, respectively. The median length of stay was 8days. The overall morbidity and mortality rates were 23.5% and 3.2%, respectively. EA was associated with increased median age (77.5 vs. 71 ys, p < 0.001), increased mean ASA Score (2.84 vs. 2.59; p = 0.002) and increased IV stage disease rate (25.3% vs. 11.5%, p < 0.001). EA was also associated with lower tumor resection rate (87.3% vs. 99.1%, p < 0.001), restorative resection rate (71.5 vs. 89.7%, p < 0.001), and laparoscopic resection rate (36.2 vs. 72.6%, p < 0.001). Increased mortality rates were associated with EA (7.2% vs. 1.2%, p < 0.001), ES (11.1% vs. 2.0%, p < 0.001) and age more than 80years (5.8% vs. 1.9%, p < 0.001). In rural areas, high quality oncologic care can be delivered in CRC patients. However, the surgical outcomes are adversely affected by a still too high proportion of emergency presentation of elderly and frail patients that need additional intensive care supports beyond the surgical skill and alternative strategies for earlier detection of the disease.

Epidemio-clinical aspects and neuro-meningeal tuberculosis prognosis in Batna

Neuromeningeal tuberculosis is rare, affecting around 1-2% of all tuberculosis cases and 5% of extra pulmonary tuberculosis cases. Our aim is to describe the epidemio-clinical, prognostic and evolutionary aspects of neuromeningeal tuberculosis. Materials and methods: To determine the spectrum of etiological agents of HIV-negative encephalitis and meningoencephalitis in Batna, we conducted a prospective study using an expanded testing approach. Patients were recruited from three departments (intensive care unit, infectious diseases department, pediatrics) during the period from April 1, 2012, to August 31, 2015. Data were collected according to the FLIPS case definition with a standardized form. We sought to identify etiological pathogens following a standardized procedure and to describe the epidemiological, clinical and biological features and outcomes associated with different causes. Results: A total of 141 patients with infectious encephalitis and meningoencephalitis were included in the study. Bacterial etiology was determined in 65/141 (46.1%) of whom 30 cases (21.3%) were of tuberculous origin; 21 confirmed and/or probable cases 9 possible cases with high clinical, epidemiological and radiological probability. The median age was 30.5 (0-83), predominantly female 12/18, 23.3% comorbidity with a frequency of motor deficits (86.7%) and psychiatric disorders (26.8%), respiratory involvement was present in 60% of cases, pleocytosis was present in 22/25 (73.4%). hyperalbuminorachy in 66. 7%, and hypoglycorachia in (46.7%). Anti-tuberculosis treatment was instituted in 90% of cases,17.6% were initially admitted to an intensive care unit, and the median length of hospital stay was 38.5 (1-146). death was identified in 46.6%, with 10% having sequelae. Conclusion: In our study, in addition to viruses, bacteria (especially intracellular) can be responsible for encephalitis and meningoencephalitis, in varying proportions. The most frequent and leading form of bacterial meningoencephalitis in adults is tuberculosis, the prognosis of which depends on early treatment.

A Comparison of Efficacy between Low-dose Dexmedetomidine and Propofol for Prophylaxis of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.

The efficacy of dexmedetomidine and propofol in preventing postoperative delirium is controversial. This study aims to evaluate the efficacy of dexmedetomidine and propofol for preventing postoperative delirium in extubated elderly patients undergoing hip fracture surgery. This randomized controlled trial included participants undergoing hip fracture surgery. Participants were randomly assigned to receive dexmedetomidine, propofol, or placebo intravenously during intensive care unit (ICU) admission (8 p.m. to 6 a.m.). The drug dosages were adjusted to achieve the Richmond Agitation Sedation Scale (RASS) of 0 to -1. The primary outcome was postoperative delirium. The secondary outcomes were postoperative complications, fentanyl consumption, and length of hospital stay. 108 participants were enrolled (n = 36 per group). Postoperative delirium incidences were 8.3%, 22.2%, and 5.6% in the dexmedetomidine, propofol, and placebo groups, respectively. The hazard ratios of dexmedetomidine and propofol compared with placebo were 1.49 (95% CI, 0.25, 8.95; p = 0.66) and 4.18 (95% CI, 0.88, 19.69; p = 0.07). The incidence of bradycardia was higher in the dexmedetomidine group compared with others (13.9%; p = 0.01) but not for hypotension (8.3%; p = 0.32). The median length of hospital stays (8 days, IQR: 7, 11) and fentanyl consumption (240 µg, IQR: 120, 400) were not different among groups. This study did not successfully demonstrate the impact of nocturnal low-dose dexmedetomidine and propofol in preventing postoperative delirium among elderly patients undergoing hip fracture surgery. While not statistically significant, it is noteworthy that propofol exhibited a comparatively higher delirium rate. Ekkapat G, Kampitak W, Theerasuwipakorn N, Kittipongpattana J, Engsusophon P, Phannajit J, et al. A Comparison of Efficacy between Low-dose Dexmedetomidine and Propofol for Prophylaxis of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial. Indian J Crit Care Med 2024;28(5):467-474.

Robotic-assisted treatment of paraesophageal hernias in the emergency setting: a retrospective study.

Emergency treatment of paraesophageal hernias can be carried out through laparotomy or minimally invasive approaches, however, evidence in this regard is weak. The aim of our study was to assess safety and feasibility of the robotic-assisted treatment of paraesophageal hernias in the emergency setting. At the Bellinzona e Valli Regional Hospital, Switzerland, we conducted a retrospective analysis of patients operated on from January 2020 to January 2024 with robotic surgery for emergency presentation of paraesophageal hernias. Demographic and clinical details, operative techniques, and postoperative outcomes were collected and analyzed. Out of 82 patients who underwent robotic-assisted paraesophageal hernia repair, 17 were treated in the emergency setting. Median age was 79years (IQR 77-85), 3 (17.6%) patients were male, and median BMI was 23.9kg/m2 (IQR 21.0-26.0). Most frequent presentation symptoms were pain (100%), regurgitation (88.2%), and dyspnea (17.6%). No intraoperative complication, conversion to open surgery or stomach resections were recorded. Two complications of grade 3 according to the Clavien-Dindo classification and one of grade 2 occurred; all were successfully treated until resolution. The median length of hospital stay was 8days (IQR 5-16). After a mean follow-up of 15.9months (IQR 6.5-25.6) only two small axial asymptomatic recurrences that required no treatment. Despite limitations, our study demonstrated a very low rate of intra- and postoperative complications, likely supporting the safety and feasibility of robotic-assisted treatment for paraesophageal hernias in emergency settings. Larger studies with a control arm are needed to validate our initial findings.

Patient characteristics and predictors of mortality among children hospitalised with tuberculosis: A six-year case series study in Uganda.

The high case-fatality rates among children with tuberculosis (TB) are reportedly driven by in-hospital mortality and severe forms of TB. Therefore, there is need to better understand the predictors of mortality among children hospitalised with TB. We examined the patient clinical profiles, length of hospital stay from date of admission to date of final admission outcome, and predictors of mortality among children hospitalised with TB at two tertiary hospitals in Uganda. We conducted a case-series study of children below 15 years of age hospitalised with TB, from January 1st, 2016, to December 31st, 2021. Convenience sampling was done to select TB cases from paper-based medical records at Mulago National Referral Hospital (MNRH) in urban Kampala, and Fort Portal Regional Referral Hospital (FRRH) in rural Fort Portal. We fitted linear and logistic regression models with length of stay and in-hospital mortality as key outcomes. Out of the 201 children hospitalised with TB, 50 were at FRRH, and 151 at MNRH. The male to female ratio was 1.5 with median age of 2.6 years (Interquartile range-IQR 1-6). There was a high prevalence of HIV (67/171, 39%), severe malnutrition reported as weight-for-age Z-score <-3SD (51/168, 30%). Among children with pulmonary TB who initiated anti-tuberculosis therapy (ATT) either during hospitalisation or within seven days prior to hospitalisation; cough (134/143, 94%), fever (111/143, 78%), and dyspnoea (78/143, 55%) were common symptoms. Children with TB meningitis commonly presented with fever (17/24, 71%), convulsions (14/24 58%), and cough (13/24, 54%). The median length of hospital stay was 8 days (IQR 5-15). Of the 199 children with known in-hospital outcomes, 34 (17.1%) died during hospitalisation. TB meningitis was associated with in-hospital mortality (aOR = 3.50, 95% CI = 1.10-11.17, p = 0.035), while male sex was associated with reduced mortality (aOR = 0.33, 95% CI = 0.12-0.95, p = 0.035). Hospitalisation in the urban hospital predicted a 0.48-day increase in natural log-transformed length of hospital stay (ln-length of stay) (95% CI 0.15-0.82, p = 0.005), but not age, sex, HIV, malnutrition, or TB meningitis. In-hospital mortality was high, and significantly driven almost four times higher by TB meningitis, with longer hospital stay among children in urban hospitals. The high in-hospital mortality and long hospital stay may be reduced by timely TB diagnosis and treatment initiation among children.

Effect of IWATE laparoscopic difficulty score on postoperative outcomes and costs for robotic hepatectomy: Are complex resections more expensive?

The IWATE criteria, a four-level classification system for laparoscopic hepatectomy, measures technical complexity but lacks studies on its impact on outcomes and costs, especially in robotic surgeries. This study evaluated the effects of technical complexity on perioperative outcomes and costs in robotic hepatectomy. Since 2013, we prospectively followed 500 patients who underwent robotic hepatectomy. Patients were classified into four levels of IWATE scores; (low [0-3], intermediate [4-6], advanced [7-9], and expert [10-12]) determined by tumor characteristics, liver function and resection extent. Perioperative variables were analyzed with significance accepted at a p-value ≤.05. Among 500 patients, 337 (67%) underwent advanced to expert-level operations. Median operative duration was 213 min (range: 16-817 min; mean ± SD: 240 ± 116.1 min; p < .001) and estimated blood loss (EBL) was 95 mL (range: 0-3500 mL; mean ± SD:142 ± 171.1 mL; p < .001). Both operative duration and EBL showed positive correlations with increasing IWATE scores. Median length of stay (LOS) of 3 days (range: 0-34; mean ± SD:4 ± 3.0 days; p < .001) significantly correlated with IWATE score. Total cost of $25 388 (range: $84-354 407; mean ± SD: 29752 ± 20106.8; p < .001) also significantly correlated with operative complexity, however hospital reimbursement did not. No correlation was found between IWATE score and postoperative complications or mortality. Clinical variables such as operative duration, EBL, and LOS correlate with IWATE difficulty scores in robotic hepatectomy. Financial metrics such as costs but not reimbursement received by the hospital correlate with IWATE scores.

Impact of neoadjuvant immunotherapy on postoperative complications after surgery for rectal cancer.

Despite the increasing use of immunotherapy in treating various cancer types, there is still limited understanding of its impact on surgical complications. We used a national database to examine the difference in surgical outcomes for rectal cancer patients who received standard neoadjuvant chemoradiation plus neoadjuvant immunotherapy and patients who received neoadjuvant chemoradiation only. This retrospective cohort study used the National Cancer Database (NCDB). We selected patients aged 18-90 with T1-3, N1-2, and M0 rectal cancer who underwent curative-intent surgery between 2010 and 2020. We performed a 1:1 propensity match to control for patient age, sex, Charlson-Deyo comorbidity index, surgical approach, and tumor site. Our primary outcome was difference in surgical outcomes (hospital length of stay, unplanned 30-day readmission, 30-day mortality) between the two groups. Secondary outcomes included days from diagnosis to surgery and pathologic outcomes. Our study included 26 229 patients, of which 126 received immunotherapy in addition to chemoradiation and 26 103 received only chemoradiation. In our matched population of 125 pairs of patients, patients who received immunotherapy and chemoradiation underwent surgery later compared to patients who only received chemoradiation (median 245 vs. 144 days, p < 0.001). There were no significant differences in median length of stay (5 vs. 5 days, p = 0.202), unplanned 30-day readmission (7 vs. 9, p = 0.617), and 30-day mortality (0 vs. 1, p = 1.000) between the two groups. Neoadjuvant immunotherapy for rectal cancer is not associated with adverse surgical outcomes. This work can help clinicians optimize treatment protocols and move closer toward strategies tailored to specific patient profiles.

All-cause and cause-specific mortality in US adults with periodontal diseases: A prospective cohort study.

This prospective cohort study investigated the association between periodontal diseases (PDs) and all-cause and cause-specific mortality. We utilized adult participants recruited from six National Health and Nutrition Examination Survey cycles (1999-2014) and linked mortality data from the National Death Index up to December 2019. Baseline clinical periodontal examinations were performed by trained and calibrated examiners. All-cause and cause-specific mortality was modelled through multivariable Cox proportional hazards and Fine-Gray models to account for competing risks. All models were adjusted for demographic and lifestyle variables, clinical measurements and comorbidities. Overall, 15,030 participants were included, with a median length of follow-up of 9 years. Risk of all-cause mortality was 22% greater in people with PD than the control group (adjusted hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.12-1.31). Risks of mortality by cardiovascular diseases (CVD), respiratory disease and diabetes were highest in participants with severe PD (CVD-sub-distribution HR [SHR]: 1.38, 95% CI: 1.16-1.64; respiratory-SHR: 1.62, 95% CI: 1.07-2.45; diabetes-SHR: 1.68, 95% CI: 1.12-2.53). Severe PD is associated with all-cause and cause-specific mortality among US adults after multivariable adjustment.

Microfiber emission from a municipal wastewater treatment plant in Hungary.

Since the ingestion of both natural and anthropogenic microfibers produces a deleterious effect on aquatic organisms, it is crucial to explore the emission of these pollutants by WWTPs into the receiving water bodies, such as rivers. Cellulose- and petroleum-based microfibers, as well as microplastic particles, were collected from the effluent of a municipal WWTP operating with activated sludge technology in Budapest, Hungary. During two sampling campaigns organized in February and April of 2023 on different working days and at different times of the day, 123-145 L of effluent was sieved and filtered. The organic matter was removed by hydrogen-peroxide treatment. All fibers and particles larger than 10µm were counted, and using a fluorescence microscope, the fibers were geometrically characterized in terms of length and diameter. Each fiber was individually identified by transflection-FT-IR method. The fiber concentration varied in the range of 1.88-2.84 and 4.25-6.79 items/L during the 7th and the 16th week of 2023, respectively. In February and April, the proportion of microfibers in the solid particles was 78.3 and 94.7%, respectively. In the effluent the cellulose-based microfibers were dominant (53-91%), while among the petroleum-based microfibers, polyester occurred most often. The median length of cellulose-based fibers was considerably higher in April than in February (650 vs. 1250µm), and simultaneously the median diameter also increased from 21 to 29µm. This behaviour was also seen, albeit to a lesser extent, in connection to microfibers derived from petroleum. The treated wastewater's daily microfiber transport to the Danube River varied between 0.44 -0.69 and 0.94-1.53 billion in February and April 2023, respectively.

P.141 Endoscopic transorbital approach to the skull base: a single centre experience

Background: Minimally invasive endoscopic techniques via the transorbital approach (ETOA) have emerged as a promising alternative for addressing skull base tumours. This study aims to showcase our institution’s extensive experience with ETOA, detailing the surgical technique employed and presenting comprehensive patient outcomes. Methods: A retrospective analysis was conducted on data from patients who underwent ETOA within the past five years. Results: Over the study period, 24 ETOA procedures were performed on 21 patients, with an average age of 48.92, 13 of whom were women. The superior orbital corridor was utilized in 95.83% of cases, and in 79.17%, ETOA was complemented by a transnasal approach. Spheno-orbital meningioma accounted for the most common surgical indication (33.33%, n=8), all resulting in vision improvement, followed by lateral frontal sinus mucocele (25%, n=6). The median length of stay was one day, and ETOA achieved the procedure goal in 19 patients. Transient V1 numbness was the primary complication (29.17%, n=7), and 20.83% (n=5) necessitated another surgery. Notably, no mortality was associated with this procedure. Conclusions: Our institution’s experience underscores the notable safety and efficacy potential of ETOA, with 19 out of 21 patients exhibiting positive outcomes, obviating the need for revision surgery in most cases.

Hidden Dangers of Frailty: Higher Mortality, Complications and Costs in Acute Pancreatitis.

Frailty is a clinically recognizable state of increased vulnerability due to age-related decline in reserve and function across multiple physiologic systems that compromises the ability to cope with acute stress. As frailty is being identified as an important risk factor in outcomes of gastrointestinal pathologies, we aimed to assess outcomes in patients with acute pancreatitis within this cohort. We conducted a retrospective study using the Nationwide Inpatient Sample (NIS) database. ICD-10 codes were used to inquire for patients admitted with acute pancreatitis between September 2015 through 2017. ICD-10 codes corresponding to the Hospital Frailty Risk Score (HFRS) were used to divide the study sample into 2 cohorts: low risk (< 5 points) and intermediate or high risk (> 5 points). To calculate the points, we fitted a logistic regression model that included membership of the frail group as the binary dependent variable (frail vs. non-frail) and the set of ICD-10 codes as binary predictor variables (1 = present, 0 = absent for each code). To simplify the calculation and interpretation, we multiplied regression coefficients by five to create a points system, so that a certain number of points are awarded for each ICD-10 code and added together to create the final frailty risk score. Multivariate regression analysis was performed to find adjusted mortality. Out of a total of 1,267,744 patients admitted with acute pancreatitis, 728,953 (57.5%) were identified as intermediate and high risk (> 5 points) (study cohort) and 538,781 (42.5%) as low risk (< 5 points). The mean age in the study cohort was 64.8 ± 12.6 and that in the low-risk group was 58.6 ± 9.5. Most of the patients in both groups were males and Caucasians; Medicare was the predominant insurance provider. A majority of the admissions in both groups were in an urban teaching hospital and were emergency. (Table1). The primary outcome was in-hospital mortality which was significantly higher in the study cohort as compared to the low-risk group (4.3% vs. 2.5%, p < 0.0001). The age-adjusted Odds ratio of mortality was 1.72(95% CI (Confidence Interval) 1.65-1.80, p < 0.05). When compared between the two groups; median length of stay (6 vs. 4); hospitalization cost ($14,412 vs. $10,193), disposition to a skilled nursing facility (SNF) (17.1% vs. 8.6%) and need for home health care (HHC) was significantly higher in the study cohort. Complications like septicemia, septic shock, and acute kidney injury were also higher in the study group (Table2). Table1 Baseline demographics of the cohort Characteristics Acute pancreatitis with High HES Frailty score (> 5, intermediate + high) Acute pancreatitis with low HES Frailty score (< 5) P-value N = 1,267,744 N = 728,953 (57.5%) N = 538,781 (42.5%) Age Mean years (Mean ± SD) 64.8 ± 12.6 58.6 ± 9.5 < 0.001 Gender < 0.001 Male 59.1% 52.3% Female 40.9% 47.7% *Missing-475 Age groups < 0.001 18-44 3.7% 14.3% 45-64 48% 52.9% 65-84 32.2% 28.7% ≥ 85 16.1% 4.1% Race < 0.001 Caucasians 67.4% 61.9% African Americans 9.6% 16.8% Others 23% 21.3% *Missing-10 Insurance type < 0.001 Medicare 40.9% 36.3% Medicaid 17.2% 24.3% Private 31.8% 27.9% Other 9.9% 11.4% *Missing-75 Active smoking 32.7% 37.9% 0.005 Biliary Stone 36.2% 16.7% < 0.001 Admission Type < 0.001 Emergent 93.7% 94.3% Elective 6.3% 5.7% *Missing-2880 Hospital ownership/control < 0.001 Rural 7.8% 10% Urban nonteaching 26.3% 26.6% Urban teaching 65.9% 63.4% Table2 Outcomes Outcomes Acute pancreatitis with High HES Frailty score (> 5, intermediate + high) Acute pancreatitis with low HES Frailty score (< 5) P-value In-hospital mortality *Missing-920 4.3% 2.5% < .0001 1.72(1.65-1.80) < .0001 Length of stay, days (Median,IQR) 6(3-8) 4(2-6) < .0001 Total hospitalization cost, $ (Median,IQR) 14,412(8843-20,216) 10,193(6840-13,842) < .0001 In-Hospital Complications ARDS 0.4% 0.3% 0.08 Ventilator dependence respiratory failure 0.23% 0.29% 0.25 Septicemia 15.2% 9.6% < .0001 Septic Shock 6.1% 2.9% < .0001 AKI 24.8% 14.9% < .0001 Disposition < .0001 Discharge to home 58.9% 74.9% Transfer other: includes Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), and another type of facility 17.1% 8.6% Home health care 11.5% 8.1% Against medical advice (AMA) 1.6% 3.4% *Missing-920 CONCLUSION: Using frailty as a construct to identify those who are at greater risk for adverse outcomes, can help formulate interventions to target individualized reversible factors to improve outcomes in patients with acute pancreatitis. Future large-scale prospective studies are warranted to understand the dynamic and longitudinal relationship between pancreatitis and frailty.

#2814 Characterization of cardiological manifestations in patients with sodium-wasting tubulopathies

Abstract Background and Aims Bartter (BS) and Gitelman (GS) syndromes are rare tubulopathies caused by mutations affecting renal NaCl transporters, resulting in similar symptoms like muscle weakness, cramps, and electrolyte imbalances, with GS also presenting with hypomagnesemia. Treatment focuses on electrolyte and fluid balance, using supplements and drugs to inhibit prostaglandin production and RAAS activation. Electrolyte deficits in these conditions can extend the QT interval and increase the risk of potentially fatal cardiac arrhythmias. This study aims to profile BS and GS patients followed at our hospital, focusing on cardiological phenotyping. We assessed diagnostic, clinical, and lab data, particularly examining the link between electrolyte imbalances (like hypokalemia or hypomagnesemia) and electrocardiographic changes or cardiac symptoms during follow-up. Method We screened all BS and GS patients for study inclusion, requiring a genetic diagnosis with disease-causing mutations and comprehensive clinical and electrocardiographic data. We excluded cases lacking sufficient data. We gathered demographic and health information retrospectively, categorizing patients based on electrocardiographic results into groups: 1) persistent long QT interval, 2) transient long QT interval, and 3) no long QT interval. Data were summarized with medians, interquartile ranges, and frequencies. Results A total of 27 patients were enrolled in the study, 16 with Bartter Syndrome (BS) and 11 with Gitelman Syndrome (GS); median length of follow-up was 6 years (range 3-19). Only one patient was classified in group 1, with a constant QTc prolongation (446.3 ms); 8 patients (34.8%) fell into group 2 with median QTc values of 420 ms, all exhibiting hypokalemia and hypomagnesemia. The majority (14/23, 61%) were in group 3, with a median QTc of 399.2 ms and 79% displaying hypokalemia and hypomagnesemia. All 9 patients who experienced cardiac-related symptoms were adults, with 8 presenting these symptoms during intercurrent episodes. The study also compared clinical differences between BS and GS patients, noting a higher frequency of hypokalemia and hypomagnesemia in GS, whereas BS patients had more electrocardiographic alterations, although not statistically significant. No echocardiographic abnormalities were detected from the available data, and there were no recorded incidents of malignant arrhythmias or sudden death. Conclusion Electrocardiographic abnormalities in BS and GS patients fluctuate, often related to episodic events, with QT prolongation in one-third of cases but no severe cardiac complications, indicating a generally positive prognosis.

#2857 Home hemodialysis training time: associated factors and impact on technique survival

Abstract Background and Aims The optimal training time for Home Hemodialysis (HHD), its related factors and its impact in the technique survival are not well established. Our objective was to analyze the risk factors associated with longer duration of HD training and to assess the impact of training time on the survival of the technique. Method Single-center observational study in which all patients seen in our HHD program from January 2013 to November 2023 were included. Training time was defined as the total number of dialysis treatments undertaken for instructional purposes, regardless of prior experience. Patients were divided into two groups, according to standard (≤31 days) or prolonged (&amp;gt;31 days) training duration. Sociodemographic and clinical variables were compared between the two groups, and the factors associated with prolonged training were analyzed using binary logistic regression. HDD failure was the composite of technique failure (defined as transfer to in-center HD for ≥ 30 consecutive days) and death. Results We analyzed 50 patients (women: 18, 36%) with a mean age of 55.1 ± 12.6 years and a median length of time on dialysis of 33 (IQR 3-369) months. The median training time was 31 (IQR 24-45) days. 14 (28%) patients were single, 22 (44%) were actively working and the percentage of primary, middle and university education was 20%, 56% and 24%, respectively. In the univariate analysis, a younger age, and the presence of a care partner were associated with a shorter HHD training time, whereas the type of vascular access, the educational level, the marital status, the gender, and the need for a care partner were similar in both standard and prolonged training duration groups. After a multivariate logistic regression analysis, the only factor independently associated to a longer training time was the age (OR: 1.08, 95% CI: 1.02-1.14; p = 0.01). After a median follow-up of 27 (IQR: 15-50) months, HDD failure was observed in 12 (27%) of patients. Although in the crude analysis the technique survival tended to be lower in the prolonged training duration group (Fig. 1), this finding was not confirmed after adjusting for age. Conclusion In our experience, the older age was the only factor independently associated with longer HDD training time, whereas a longer training time did not impact in the HDD survival. These data suggest that HHD training should be especially careful in elderly patients, whose learning may require greater use of time and resources.

#2430 Comparison of the efficacy of gentamicin-citrate and gentamicin-citrate/Taurolock-urokinase locks for non-tunneled catheters in hemodialysis patients

Abstract Background and Aims Catheter-related complications, such as dysfunction, thrombosis and infection, are associated with significant morbidity and mortality in patients on hemodialysis (HD) receiving dialysis through temporary non-tunneled double-lumen central venous catheters (CVC). Catheter lock solutions containing antibiotics and antitrombolytics are commonly used to prevent such complications. The aim of the present study was to compare impact of a different prophylactic catheter lock solutions on the incidence of catheter-related complications (catheter-related bloodstream infection (CRBSI) and catheter thrombosis) and mortality compared with heparin catheter locks. Method We performed a single-centre prospective, randomized, single-blinded controlled trial of 96 adult patients undergoing HD in our institution from Jun 2018 to Jun 2023. Patients were randomized 1:1:1 to receive either a lock solution combining gentamicin-citrate twice a week with taurolidine-citrate (Taurolock)/urokinase at the end of the third hemodialysis session before the end of the week (TAURO group) or gentamicin-citrate at the end of all hemodialysis sessions (GENTAM group) or unfractionated heparin 5000 U/mL thrice weekly as control (HEPARIN group). Catheter lock solutions were administered for 3 months after insertion of CVC and patients were followed for at least 6 months after insertion of CVC. Demographic, clinical and laboratory parameters, as well as used medications, were analyzed. Episodes of acute catheter thrombosis and incidence of CRBSI were recorded, along with dialysis adequacy (Kt/V) and adverse events. Results The study population (96 patients, 32 in each group) had a median age of 60 years (range 19–85 years), 56.3% man. In the majority of patients (88.5%) the indication for placement of the CVC was the initiation of dialysis, while in the remaining patients indication was thrombosis of the existing vascular access. The most important baseline clinical and laboratory values are presented in Table 1. The catheter median length of stay was of 125.94 ± 87.48 (from 50 to 535) days in TAURO group, 113.44 ± 35.68 (from 54 to 233) days in GENTAM group and 108.59 ± 37.84 (from 42 to 212) days in HEPARIN group (p = 0.831). There was no difference between groups with regard to catheter thrombosis (3.3 events/1000 catheter-days in all groups). The CRBSI rate of 3.2 episodes/1000 catheter-days in TAURO group was slightly lower than the rate of 5.3 episodes/1000 catheter-days in GENTAM group (p = 0.479) and 4.3 episodes/1000 catheter-days in control HEPARIN group (p = 0.705). The CRBSI-free survival time in TAURO group was 197 ± 220 (from 28 to 447) days, longer than in the GENTAM group (38 ± 33 days, from 8 to 86) and HEPARIN group (37 ± 35 days, from 4 to 86), p = 0.21. Impact of catheter lock solution on dialysis adequacy as measured by Kt/V in time is presented in Fig. 1. No significant differences were found between study groups in survival after 6 months (p = 0.810) and at the end study period (p = 0.096)-presented in Fig. 1. Conclusion We observed no difference in the incidence of catheter thrombosis and mortality rate in groups with prophylactic catheter lock solutions and control group. The use of Gentamicin-citrate/Taurolock-urokinase as a dialysis catheter lock solution, as compared with gentamicin-citrate or heparin administered three times a week, led to a nonsignificant reduction of CRBSI incidence and longer CRBSI-free survival time in patients on HD receiving dialysis through temporary non-tunneled double-lumen CVC.

#1708 Mortality and kidney function recovery in patients with sepsis-associated vs non-septic acute kidney injury treated with CRRT

Abstract Background and Aims It was recently suggested that sepsis-associated acute kidney injury (SA-AKI) is characterized by different pathogenesis and outcomes compared to non-Septic AKI (NS-AKI). However, limited data are available focusing on the clinical outcomes of SA-AKI versus NS-AKI. The aim of this study is to examine risk factors and outcomes of SA-AKI vs NS-AKI among critically ill patients who developed AKI requiring renal replacement therapy (RRT). Methods We performed a single-center retrospective analysis, examining all patients admitted to ICU who developed AKI requiring RRT at Policlinico of Bari, from January 2021 to July 2023. We classified patients in two groups based on the leading cause of AKI: NS-AKI and SA-AKI. We collected clinical and laboratory data, including maximum AKI stage reached during hospitalization, RRT indications, modality and duration. The primary outcome was to assess mortality rate between SA-AKI and NS-AKI groups. The cumulative 28-day survival probability was calculated using the Kaplan–Meier method. The analysis of the risk factors associated with in-hospital mortality was performed using Cox's proportional hazard regression models. Kidney Functional Recovery (KFR) from, RRT discontinuation and length of ICU and hospital stay were also analyzed. Results 320 patients were included in the study; 131 patients developed SA-AKI (40.9%), while the remaining 189 were classified as NS-AKI (59.1%). Median age was 67 years (IQR 57-73) with a predominance of male gender (67.8%), without significant differences between groups. A significant percentage of patients had an history of cardiovascular disease in NS-AKI group compared to SA-AKI group (54.5% vs 29%, p &amp;lt; 0.001). Conversely, the proportion of patients with a history of chronic respiratory disease was significantly higher in the SA-AKI group (23.7% vs 9.5%, p = 0.001). 268 patients (83.8%) developed AKI Stage 3 and 40 patients AKI stage 2 (12.5%) at RRT initiation. All patients were treated with continuous modalities (CRRT). There was no significant difference in CRRT duration between groups (median days 5, IQR 2-12) (Table 1). The timing of CRRT initiation from ICU admission was significant different and we reported a late CRRT initiation in the SA-AKI group (3 vs 1 days, p = 0.002). The median length of ICU stay was 12 days (IQR 4-25) and did not differ between groups. 184 patients (57.5%) died at 28 days, with a higher percentage in the SA-AKI (70.2 vs 48.6%, p &amp;lt; 0.001). Similarly, in-hospital mortality was reported in 221 patients (69%), with impressive percentages in the SA-AKI group (82.45 vs 69.3%, p &amp;lt; 0.001) (Fig. 1). KFR at 28 days from CRRT initiation was significantly higher in the NS-AKI (28.5%) compared to the SA-AKI group (13.7%, p = 0.002). Median time of KFR was similar between groups (p = 0.833). Multivariate Cox Regression analysis showed that only SA-AKI (HR 1.442, 95% CI 1.052-1.978, p = 0.023) was independently associated with increased risk of mortality. Conclusions Sepsis-associated AKI was associated with high mortality rate and lower likelihood of renal recovery compared to non-septic AKI in critically ill patients requiring RRT. These findings emphasize the importance of identifying specific AKI phenotypes characterized by different pathophysiology and clinical outcomes.

#509 Idiopathic nephrotic syndrome in children in Chad

Abstract Background and Aims The objective of our study was to describe the characteristics and outcomes of Nephrotic Syndrome (SN) in children from three major hospitals in one of the world's poorest countries, Chad. Method This observational, cross-sectional, descriptive, and multicenter study took place over a period of 36 months (1 January 2019–31 December 2021) and was carried out in three hospitals in N'Djamena, Chad. Children aged 1–15 years presenting with NS were included in the study. Results Out of 16,776 children hospitalized or followed up with in outpatient clinics, 24 cases of NS were identified, yielding a prevalence of 0.14%. The median age at presentation was 6.16 years (1–10). Nineteen children were male (sex ratio 3.8). Eight cases were classified as impure NS (33.3%). Edema was present in all patients, while oliguria was present in 29.16% (n = 7), and arterial hypertension was present in 20.83% (n = 5) of cases. Mean proteinuria, albuminemia, and total proteins were 2.86 g/L, 19.13 g/L and 30.41 g/L, respectively. The median serum creatinine was 87.3 µmol/L (75–1375 µmol/L). Three patients experienced acute renal failure upon admission. Four patients had secondary NS. All idiopathic NS patients (n = 20) who had received corticosteroid therapy had a 90% response rate to steroids. Non-responsive or relapsed patients underwent kidney biopsy (n = 7), revealing focal segmental glomerulosclerosis (FSGS; n = 4) as the most common histological lesion, followed by minimal change disease (n = 2) and membranoproliferative glomerulonephritis (n = 1). The median length of hospitalization stay was 10.67 (5–27) days. None of the patients with idiopathic NS died. At the last follow-up, sixteen patients (80%) achieved long-term complete remission with normal renal function; however, four of those had subsequent relapses. One patient with secondary NS died. Conclusion In Chad, childhood idiopathic nephrotic syndrome predominantly affects young males; steroid sensitivity is as high as 95%, and in the long-term, 80% of patients achieve remission with normal renal function.

Lobar Lung Transplantation: A Single-Center 10-Year Experience

IntroductionThe shortage of donors for lung transplant is the main limitation to the preceding. Lobar transplantation is an alternative especially useful in patients with short statute and small thoracic cavities. The aim of this study was to perform a descriptive analysis of Portuguese patients who underwent lobar lung transplantation. MethodsA retrospective study was conducted, and patients submitted to lobar lung transplantation from January 2012 to December 2023 were evaluated. A descriptive analysis was made, including demographic data, lung diseases, waiting list dynamics, pre-transplant evaluations and post-transplant outcomes. ResultsSixteen lobar transplants were performed with a predominance of female patients and median age of 47 years. Most patients had interstitial lung disease or bronchiectasis either due to cystic fibrosis or non-cystic fibrosis. Median pTLC ratio was 0.73. Median waiting list time was 6 months with 9 urgent transplants and 1 emergent lobar retransplant. ECMO was used in pre, intra and postoperative periods. Most transplanted lobes were ML + RUL and LUL. The median length of stay was 58 days with complications such as PDG grade 3, bronchial tree ischemia and concentrical stenosis of bronchial anastomosis. Six patients died in this period, one in the immediate postoperative period and five during the post-transplant hospitalization, with a median survival of 20.7 months and 1-year and 5-year survival rate of 60%. Conclusionour results show a population with increased waiting list converging in many urgent cases, with an early mortality and high PGD rate. Nevertheless, mid-, and long-term survival is promising.

Upper gastrointestinal endoscopic submucosal dissection using an ultrathin endoscope: a retrospective, single-center evaluation.

Recent studies have reported the therapeutic use of endoscopic submucosal dissection (ESD) using an ultrathin endoscope for targeting pharyngeal and distal side lesions in the stenosis or as a less invasive treatment via the nasal route. However, the effectiveness and safety of these treatments remain undetermined. Therefore, this study aimed to review treatment outcomes and discuss the advantages and precautions of the treatments based on our experience. This study included 13 patients with 14 lesions who underwent 14 sessions of upper gastrointestinal ESD using an ultrathin endoscope between December 2021 and August 2023. The outcome measures included lesion background, en bloc resection rate, en bloc complete resection rates, and incidence of adverse events (including post-operative bleeding, intraoperative perforation, and delayed perforation). The lesions in the esophagus, stomach, and duodenum were eight, three, and three, respectively, and the median length (range) of each located lesion was 16.5 (6-26), 17 (9-36), and 10 (4-16) mm, respectively. En bloc resection and en bloc complete resection rates were 100 and 92.9%, respectively. The only adverse event was an intraoperative perforation observed during duodenal ESD, resulting from the assistant's inadvertent expansion of the SOUTEN at the final dissection stage. Our results demonstrate that ESD with an ultrathin endoscope effectively reaches lesions in difficult locations and enables treatment within a small working space. Therefore, ESD using an ultrathin endoscope is a treatment option for lesions located distally to gastrointestinal stenosis, highly fibrotic lesions, and duodenal tumors.

COVID-19 Associated Mucormycosis and Risk Factors: A Case-Control Study from Turkey

Background: Mucormycosis, a fatal fungal infection, has increased during the COVID-19 pandemic and posed significant challenges for clinicians. Objectives: Our research focused on identifying the clinical traits of patients with COVID-19-associated mucormycosis (CAM), comparing them with a control group, and identifying risk factors for the development of CAM. Methods: Our study was conducted on 39 CAM patients and 78 control patients from September 2020 to October 2022 at a tertiary education center and regional hospital. The control group was selected blindly in a 1:2 ratio among patients who did not develop mucormycosis, were hospitalized due to COVID-19, and were either discharged or deceased. The control group was matched to the case group regarding age and hospitalization date. To test potential risk factors for CAM, we performed a binary logistic regression analysis. The variables included in the multivariate binary logistic regression model were gender, diabetes, cumulative steroid dose (dexamethasone equivalent), duration of steroid treatment, and tocilizumab/anakinra treatment. Results: In our study, 39 patients were diagnosed with CAM. The average age of the patients was 66 ± 11.5 years. Of the patients, 54.7% (n = 64) were male, with a statistically significantly higher proportion of men in the CAM group (74.4% vs. 44.9%, P = 0.003). The diabetes rate was 51.3% (n = 60) among all patients, and it was higher in the CAM group (69.2% vs. 42.3%, P = 0.006). Regarding in-hospital mortality, the rate was higher in the CAM group (56.4% vs. 14.1%, P &lt; 0.001). The median length of stay in the hospital was 37 days for the CAM group and 10 days for the control group (P &lt; 0.001). The cumulative steroid dose was elevated in the CAM group compared to the control group (191 ± 61.4 mg vs. 117 ± 69.8 mg, P &lt; 0.001). The duration of steroid treatment was 16.5 ± 6.2 days in the CAM group, compared to 9.8 ± 4.7 days in the control group (P &lt; 0.001). Among CAM cases, paranasal involvement was the most common (56.4%), followed by rhino-orbital involvement (33.3%). In binary logistic regression analysis, male gender (OR, 3.9; 95% CI, 1.4 – 11.3), diabetes mellitus (OR, 4.4; 95% CI, 1.5 – 12.4), more than ten days of steroid use (OR, 5.5; 95% CI, 1.3 – 22.4), and tocilizumab/anakinra use (OR, 0.23; 95% CI, 0.06 – 0.8) were identified as risk factors for the development of CAM (p values 0.011, 0.005, 0.019, and 0.020, respectively). Conclusions: Male gender, diabetes mellitus, and steroid use for more than ten days were identified as positive risk factors, while tocilizumab/anakinra use was identified as a negative risk factor for the development of CAM.

Azithromycin for Pediatric Critical Asthma: A Multicenter Retrospective Cohort Study.

To characterize the prescribing trends and clinical outcomes related to azithromycin (AZI) among children hospitalized for critical asthma (CA). We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry of children 3 to 17 years of age hospitalized in a PICU for CA from January 2011 to December 2022. We excluded for alternative indications for AZI (eg, atypical pneumonia, B. pertussis infection, acute otitis media, acute sinusitis, pharyngitis/tonsillitis, and urethritis). The primary outcome was AZI prescribing rate by hospital and calendar year (trends assessed by Joinpoint regression). Cohorts with and without AZI exposure were further characterized by demographics, CA treatments, and inpatient outcomes using descriptive and comparative (ie, χ2 and Wilcoxon rank tests) statistics. Of the 47 797 children studied, 9901 (20.7%) were prescribed AZI with a downward annual trend noted from 34.7% in 2011% to 12.4% in 2022 (-1.7% per year, R2 = 0.91). Median institutional AZI prescribing rate was 19.2% (interquartile range [IQR] 11.7%-28%; total range 5.6%-60%). Compared with children not prescribed AZI, those prescribed AZI were older (median 8.3 [IQR 5.7-11.6] vs 7.3 [4.9-10.8] years, P < .001) and experienced a more severe clinical trajectory with greater rates of bilevel positive airway pressure ventilation (19.7% vs 12.6%, P < .001), invasive ventilation (22.1% vs 13.5%, P < .001), extracorporeal life support (0.8% vs 0.1%, P < .001), and median length of stay (4 [IQR 3-6] vs 3 [IQR 2-4] days, P < .001). Between 2011 and 2022, 20.7% of children hospitalized for CA were prescribed AZI notwithstanding the absence of trial-derived efficacy or safety data for this indication and population.