National Database Research Articles

Findings from the 2019 nationally representative oral health survey for adults in Singapore.

The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). A multi-stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face-to-face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC-AAP classifications. Weighted analysis was performed to adjust for oversampling, non-response and post-stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. Six hundred and sixty-three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1-2-room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC-AAP classification, the prevalence of moderate-severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio-economic gradient in the distribution of tooth loss, untreated dental caries and moderate-to-severe periodontitis was observed.

AIDS but not asymptomatic HIV is associated with higher 2–10-year implant survivorship following total knee arthroplasty

IntroductionPrior studies have demonstrated HIV does not increase the risk of 2-year complications following TKA; however, the literature is sparse regarding the impact of HIV and AIDS on long-term implant survivorship. The purpose of this study was to compare the 10-year cumulative incidence and risk of revision TKA in patients with and without asymptomatic HIV, and with and without AIDS. MethodsPatients with HIV who underwent elective TKA were identified using a national database and divided into subgroups of asymptomatic HIV (AHIV) and acquired immunodeficiency syndrome (AIDS). These patients with HIV were propensity matched based on age, sex, and Charlson Comorbidity Index (CCI) to a control group of elective TKA patients without HIV in a 1:2 ratio. Patients were also compared to an unmatched control group. ResultsThe 10-year risk for all-cause revision TKA was higher in the HIV group compared to unmatched controls (HR 1.40, 95% CI 1.02–1.93, p = 0.038) but not matched controls (HR 1.13, 95% CI 0.77–1.63, p = 0.594). When compared to both control groups (unmatched; matched), the AIDS group had a higher risk of 10-year all-cause revision (HR 2.74, 95% CI 1.51–4.99, p < 0.001; HR 2.19, 95% CI 1.17–4.11, p = 0.014), dislocation/instability (HR 4.89, 95% CI 1.54–15.51, p = 0.007; HR 3.86, 95% CI 1.12–13.34, p = 0.033), and periprosthetic fracture [PPF] (HR 0.67, 95% CI 0.16–2.74, p = 0.002; HR 3.82, 95% CI 1.08–13.45, p = 0.037). However, patients with AIDS were not at increased risk of PJI or mechanical loosening compared to unmatched controls or matched controls. DiscussionThis study expands on current literature by following a nationwide cohort of HIV/AIDS patients for 10 years after TKA. Although a diagnosis of asymptomatic HIV was not associated with increased risk of 10-year revision rates following TKA, a diagnosis of AIDS was. Surgeons should ensure patients’ serum CD4 level is sufficient, ideally in the normal range of 500–1500 cells per mm3, before undergoing TKA.

Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty

BackgroundUrinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsA retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions. ResultsPatients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls. ConclusionsThis study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.

Infection and Pediatric Arterial Ischemic Stroke Presumably Related to Focal Cerebral Arteriopathy: Data From the COVID-19 Pandemic.

Infection may trigger pediatric arterial ischemic stroke (PAIS), notably when related to focal cerebral arteriopathy. Community- and individual-level nonpharmaceutical interventions during the COVID-19 pandemic resulted in a major decrease in pediatric viral infections. We explored the consequences on the incidence of PAIS. Using national public health databases, we identified children hospitalized between 2015 and 2022 with PAIS. Using an age proxy (29 days to 7 years) and excluding patients with cardiac and hematologic conditions, we focused on children with PAIS presumably related to focal cerebral arteriopathy or with no definite cause. Considering the delay between infection and PAIS occurrence, we compared a prepandemic reference period, a period with nonpharmaceutical interventions, and a post-nonpharmaceutical intervention period. Interrupted time-series analyses of the monthly incidence of PAIS in this group showed a significant decrease in the nonpharmaceutical intervention period compared with the prepandemic period: -33.5% (95% CI, -55.2%, -1.3%); P=0.043. These data support the association between infection and PAIS presumably related to focal cerebral arteriopathy.

Advanced utilization of satellite and governmental data for determining the coverage and condition of green areas in Poland: An experimental statistics supporting the Statistics Poland

Statistics Poland utilizes Earth Observation and in-situ data to assess green areas, aiming to derive vital information on natural capital statistics and human well-being. This is essential for informed decision-making and sustainable development. Improving regional well-being statistics is a priority due to Poland's low rankings in environmental well-being indicators. To overcome challenges in obtaining comprehensive data at the commune level, the study introduces a new and innovative system for monitoring green areas. This system employs Sentinel-2 satellite data, combined with Copernicus vegetation and phenology products in order to determine extent and condition of green areas. In addition, the applied land cover product (Dynamic World) and national vector database of topographic features (BDOT10k) contributes to the quality and accuracy of the analyses carried out. The system yields two pivotal indicators: one delineating the proportional coverage of green areas within communes boundaries, and the other elucidating the state and health of these delineated areas. A key highlight of the system is its innovative use of local resources and the Google Earth Engine application to observe green areas at a 10-meter resolution at the commune level, particularly in major cities in Poland. These observations are crucial for the Polish Public Services Monitoring System (SMUP), providing comprehensive local-level evaluation services. The research outcome consists of a comparison between the extent of green areas delineated by public administration at the commune level and the extent of green areas determined using a newly proposed method, which relies on satellite imagery from the Copernicus program. The results indicate variability between these two datasets, depending on different forms of land cover within each administrative unit. The most consistent data is derived from large urban agglomerations in Poland.

Wake Up Safe in the USA & International Patient Safety.

Patient safety is the most important aspect of anesthetic care. For both healthcare professionals and patients, the ideal would be no significant morbidity or mortality under anesthesia. Lessons from harm during healthcare can be shared to reduce harm and to increase safety. Many nations and individual institutions have developed robust safety systems to improve the quality and safety of patient care. Large registries that collect rare events, analyze them, and share findings have been developed. The approach, the funding, the included population, support from institutions and government and the methods of each vary. Wake Up Safe (WUS) is a patient safety organization accredited by Agency for Healthcare Research and Quality. Wake Up Safe was established in the United States in 2008 by the Society for Pediatric Anesthesia. The initiative aims to gather data on adverse events, analyze these incidents to gain insights, and apply this knowledge to ultimately reduce their occurrence. The purpose of this review is to describe the patient safety approaches in the USA. Through a national patient safety database WUS. Similar approaches either through WUS international or independent safety approaches have been described in Australia-New Zealand, India, and Singapore. We examine the patient safety processes across the four countries, evaluating their incident review process and the distribution of acquired knowledge. Our focus is on assessing the potential benefits of a WUS collaboration, identifying existing barriers, and determining how such a collaboration would integrate with current incident review databases or systems.

Teacher verbal interaction as support for children’s oral language development: contributions from an integrative systematic review

Originating from an ongoing doctoral research, this article aims to analyze, through a systematic review, studies that investigated teachers’ verbal interaction as support for the development of children’s oral language. The purpose was to understand how the literature describes and interprets the role of teachers in verbal interaction with children. An integrative systematic review methodology was used, with searches conducted in national and international electronic databases for publications between 2012 and 2022. Access to the databases took place from October 13, 2021, to August 16, 2022. The PRISMA group’s recommended flowchart was used for the systematization of the findings. The search strategies resulted in thirty-eight scientific productions dedicated to children’s oral language, of which twelve investigated verbal interaction as support for the development of oral language in children. We conclude that teachers’ verbal interaction is fundamental to developing children’s orality. It is recommended that these conclusions guide future research and pedagogical innovations.

Source-specific nitrate intake and all-cause mortality in the Danish Diet, Cancer, and Health Study.

Nitrate and nitrite are naturally occurring in both plant- and animal-sourced foods, are used as additives in the processing of meat, and are found in water. There is growing evidence that they exhibit a spectrum of health effects, depending on the dietary source. The aim of the study was to examine source-dependent associations between dietary intakes of nitrate/nitrite and both all-cause and cause-specific mortality. In 52,247 participants of the Danish Diet, Cancer and Health Study, associations between source-dependent nitrate and nitrite intakes--calculated using comprehensive food composition and national drinking water quality monitoring databases--and all-cause, cardiovascular disease (CVD)-related, and cancer-related mortality over 27 years were examined using restricted cubic splines within Cox proportional hazards models adjusting for demographic, lifestyle, and dietary confounders. Analyses were stratified by factors hypothesised to influence the formation of carcinogenic N-nitroso compounds (namely, smoking and dietary intakes of vitamin C, vitamin E, folate, and polyphenols). Plant-sourced nitrate intake was inversely associated with all-cause mortality [HRQ5vsQ1: 0.83 (0.80, 0.87)] while higher risks of all-cause mortality were seen for higher intakes of naturally occurring animal-sourced nitrate [1.09 (1.04, 1.14)], additive permitted meat-sourced nitrate [1.19 (1.14, 1.25)], and tap water-sourced nitrate [1.19 (1.14, 1.25)]. Similar source-dependent associations were seen for nitrite and for CVD-related and cancer-related mortality except that naturally occurring animal-sourced nitrate and tap water-sourced nitrate were not associated with cancer-related mortality and additive permitted meat-sourced nitrate was not associated with CVD-related mortality. No clear patterns emerged in stratified analyses. Nitrate/nitrite from plant sources are inversely associated while those from naturally occurring animal-sources, additive-permitted meat sources, and tap water-sources are positively associated with mortality.

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.

Burden of cardiovascular disease on coronavirus disease 2019 hospitalizations in the USA.

Patients with cardiovascular disease (CVD) and risk factors have increased rates of adverse events and mortality after hospitalization for coronavirus disease 2019 (COVID-19). In this study, we attempted to identify and assess the effects of CVD on COVID-19 hospitalizations in the USA using a large national database. The current study was a retrospective analysis of data from the US National (Nationwide) Inpatient Sample from 2020. All adult patients 18 years of age and older who were admitted with the primary diagnosis of COVID-19 were included. The primary outcome was in-hospital mortality, while secondary outcomes included prolonged hospital length of stay, mechanical ventilation, and disposition other than home. Prolonged hospital length of stay was defined as a length of stay greater than the 75th percentile for the full sample. The diagnoses were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. A total of 1 050 040 patients were included in the study, of which 454 650 (43.3%) had prior CVD. Patients with CVD had higher mortality during COVID-19 hospitalization (19.3 vs. 5.0%, P < 0.001). Similarly, these patients had a higher rate of prolonged hospital length of stay (34.5 vs. 21.0%, P < 0.001), required mechanical ventilation (15.4 vs. 5.6%, P < 0.001), and were more likely to be discharged to a disposition other than home (62.5 vs. 32.3%, P < 0.001). Mean hospitalization cost was also higher in patients with CVD during hospitalization ($24 023 vs. $15 320, P < 0.001). Conditional logistic regression analysis showed that the odds of in-hospital mortality [odds ratio (OR), 3.23; 95% confidence interval (CI), 2.91-3.45] were significantly higher for COVID-19 hospitalizations with CVD, compared with those without CVD. Similarly, prolonged hospital length (OR, 1.82; 95% CI, 1.43-2.23), mechanical ventilation (OR, 3.31; 95% CI, 3.06-3.67), and disposition other than home (OR, 2.01; 95% CI, 1.87-2.21) were also significantly higher for COVID-19 hospitalizations with coronary artery disease. Our study showed that the presence of CVD has a significant negative impact on the prognosis of patients hospitalized for COVID-19. There was an associated increase in mortality, length of stay, ventilator use, and adverse discharge dispositions among COVID-19 patients with CVD. Adjustment in treatment for CVD should be considered when providing care to patients hospitalized for COVID-19 to mitigate some of the adverse hospital outcomes.

Challenges to Alzheimer Care in Pakistan

Madam, Alzheimer's, the prime culprit behind Dementia, is a neurodegenerative disorder that gradually erases memory and cognition, affecting daily tasks 1. Symptoms often emerge in later years, and in Pakistan, where a rising aging population and middle-income status prevail, the risk amplifies. By 2030, global dementia cases can soar to 1.3 million from 850,000 in 2015, surging to 3.6 million by 2050 without preventive action 2. Urgent attention beckons. Yet, challenges abound. With Pakistan’s depleting literacy rate currently of 58.9% in 2023, misconceptions are likely 3. Stigma, cultural norms, and language barriers shroud the path to treatment. Moreover, mental health issues like depression, an Alzheimer’s symptom, are seen as taboo, deterring help-seeking. Till date, the lack of national databases stifles research progress, and a shortage of neurologists-just less than 150 for millions of people-worsens with scarce training programs4. Private caretakers in this developing country may be limited. As this chronic Alzheimer's has no cure, high drug costs hinder adherence, while the affordability of the new "Leqembi" drug, if approved, raises concerns. Additionally, access to MRI and CT scanning equipment in Pakistan is not widespread and their procurement along with testing entail significant costs. Furthermore, government policies and funding for Alzheimer's treatment and research might be insufficient with the rising aging population. NGOs in Pakistan related to Alzheimers are very limited- “Alzheimers Pakistan” the one and only centered in just three regions across this vast country. Solutions for these challenges emerge as vibrant threads. How can we aid patients and families in Alzheimer education? Imagine engaging workshops and media partnerships with prominent figures like the UNICEF Goodwill ambassadors thereby igniting a good community-healthcare bond, and envision ‘Alzheimer homes’ for patients lacking caregivers. Besides, a national database involving stakeholders, from NGOs to healthcare providers, can not only pave the way for easy data accessibility but also to proper treatment plans and protocols. Engaging these stakeholders could also lead to initiatives for more affordable medicines. For the shortage of neurologists, medical tourism initiatives that attract foreign neurologists to work temporarily in the country, sharing their expertise and contributing to healthcare delivery can be deployed. Targeted training for healthcare professionals and collaborating with international organizations for increased research, clinical trial participation and even in machinery purchase hold a promise to resolving this issue. Conclusively, emphasizing these concerns holds utmost significance in the pursuit of discovering effective interventions for this incurable ailment.

Heart failure events prediction algorithm for patients implanted with multi-brand CIED

Abstract Background Heart failure (HF) hospitalizations are associated with poor patient outcomes and generate a large burden on healthcare systems. Mitigation is a priority. Among HF patients with CIEDs, existing HF algorithm-based management solutions are manufacturer and device-specific, which imposes limitations. The SignalHF universal algorithm was developed to democratize access to HF management solutions by enabling prediction of HF decompensation based on CIED sensors data agnostic to manufacturer. Objective FORESEE-HF study aims to validate the SignalHF machine learning score and alerting system by matching alerts generated by SignalHF from CIED-related stored data in a universal platform (Implicity™) with HF events available in the French national health database containing medico-administrative data on patients’ characteristics, hospitalizations and deaths across 10 years. Methods The study cohort consisted of 19,013 patients (pacemaker (PM) 7,711, ICD 6,022, CRT-D 4,367 and CRT-P 913; age 70.0 ± 13.3, male 70.7%). Co-primary endpoints were sensitivity of HF hospitalizations detection with HF as primary diagnosis, the unexplained alert rate per patient-year defined as alert states not followed within 30 days by a hospitalization with HF as primary or secondary diagnosis (UAR PPY), and the lower quartile on alerting time defined as the lower bound on the time-to-event of 75% of true alert states (see Table 1). Results SignalHF for ICD/CRT-Ds demonstrated a sensitivity of 60%, a UAR PPY of 0.66 and a lower quartile on alerting time of 35 days. For PM/CRT-Ps, SignalHF demonstrated a sensitivity of 46%, a UAR PPY of 0.47 and a lower quartile on alerting time of 37 days. Conclusion FORESEE-HF demonstrates that SignalHF is an improvement over existing HF monitors for ICD/CRT-Ds, while also providing the same capability for PM/CRT-Ps. Being an algorithm that can be easily activated through a universal CIED remote monitoring platform, SignalHF widens the pool of patients that can benefit from HF monitoring solutions.Table 1:Study coprimary endpointsTable 2:Study results per device type

Does abdominal protrusion in pregnant women affect abdominal injury severity in motor vehicle collisions? A nationwide database study.

Some pregnant women avoid vehicle driving owing to the risk of contact between their protruding abdomen and steering wheel. This study was performed to determine whether abdominal protrusion in late-term pregnant car users affects the occurrence and severity of abdominal injuries in motor vehicle collisions using a national crash database. The National Automotive Sampling System/Crashworthiness Data System was used to analyse maternal background, collision characteristics, outcome and Abbreviated Injury Scale (AIS) scores for the body regions of all persons involved in the collision. Comparison of pregnant and non-pregnant women in the driver's seat showed no significant differences in the rate of AIS scores of ≥2 (2+) for abdominal injuries and female outcomes. Comparison of use of the driver's seat and front passenger's seat by pregnant women showed no significant difference in rate of AIS 2+ injuries or in maternal and fetal outcomes. Comparison of pregnant women with a gestational age of ≤27 and >27 weeks in the driver's seat showed no significant differences in rate of AIS 2+ injuries or in maternal and fetal outcomes. Based on the data from relatively low-speed frontal collisions, obstetrician/gynaecologists should advise pregnant women that they do not need to change their preferred car seat from the driver's seat to another seat because of fear of contact between their protruding abdomen and the vehicle interior.

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Analysis of the Russian Database of Spontaneous Reports

(1) Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are extremely severe cutaneous adverse drug reactions which are relatively rare in routine clinical practice. An analysis of a national pharmacovigilance database may be the most effective method of obtaining information on SJS and TEN. (2) Methods: Design—a retrospective descriptive pharmacoepidemiologic study of spontaneous reports (SRs) with data on SJS and TEN retrieved from the Russian National Pharmacovigilance database for the period from 1 April 2019 to 31 December 2023. Descriptive statistics was used to assess the demographic data of patients and the structure of suspected drugs. (3) Results: A total of 170 SRs on SJS and TEN were identified, of which 32.9% were SJS and 67.1%—TEN. In total, 30% were pediatric SRs, 21.2%—SRs of the elderly. There were 12 lethal cases, and all cases were TEN. The leading culprit drugs were anti-infectives for systemic use and nervous system agents. The top 10 involved drugs are as follows: lamotrigine (23.5%), ibuprofen (12.9%), ceftriaxone (8.8%), amoxicillin and amoxicillin with beta-lactam inhibitors (8.8%), paracetamol (7.6%), carbamazepine (5.9%), azithromycin (4.1%), valproic acid (4.1%), omeprazole (3.5%), and levetiracetam (3.5%). (4) Conclusions: Our study was the first study in Russia aimed at the assessment of the structure of the drugs involved in SJS and TEN on the national level.

Spatial Distribution Patterns of Phytoplankton and Their Relationship with Environmental Factors in the Jinjiang River, China

Our study aims to investigate the water quality and distribution patterns of phytoplankton communities in the Jinjiang River Basin in Quanzhou, as well as their relationship with environmental factors. We integrated data from the national water quality databases of the two main tributaries of the West and East Jinjiang Rivers between 2020 and 2023, supplemented by field surveys. Redundancy analysis was used to explore the effect of environmental factors on phytoplankton communities. Our findings revealed that the West Jinjiang River experienced a significant influence from excessive fertilizer use in tea cultivation, leading to an increase in TN concentrations compared to the East Jinjiang River. The abundance of phytoplankton in the Jinjiang River Basin was 105 cells·L−1, with phytoplankton being dominated by Chlorophyta, Cyanphyta, and diatoms, accounting for an average of 50%, 20%, and 19% of the total phytoplankton abundance, respectively. Redundancy analysis indicated that temperature, pH, and nutrient concentrations were important factors influencing the phytoplankton communities. With increasing temperature and nutrients concentrations, the abundance of Chlorophyta and Dinophyta significantly increased. This study provides a solid foundation for the regular “health diagnosis” of crucial rivers and lakes in Quanzhou and supports the establishment of a health guarantee system for rivers and lakes.

The incidence of thrombosis with co-occurring thrombocytopenia prior to the SARS-CoV2 pandemic: A population-based study.

Thrombosis with thrombocytopenia syndrome (TTS) is a very rare prothrombotic disorder that is a safety concern for some COVID-19 vaccines. We aimed to devise a case definition to estimate the incidence of thrombosis with thrombocytopenia as a proxy for TTS in a national insurance claims database. We conducted a retrospective observational study using the National Health Insurance Research Database (NHIRD) in Taiwan over the three-year period prior to the SARS-COV-2 pandemic (2017-2019). Our case definition was all patients with newly diagnosed thrombosis co-occurring with a diagnosis of thrombocytopenia within seven days before or after the thrombosis diagnosis. Cases were identified using International Classification of Disease-10 codes. We identified 2010 patients with newly diagnosed thrombosis co-occurring with thrombocytopenia during the study period. The mean age was 64.71 years; female:male ratio 1:1.45. The most frequent thrombotic events were coronary artery disease (18.81%), cerebral infarction (16.87%), and disseminated intravascular coagulation (13.13%). Cerebral venous sinus thrombosis was rare (<0.1%). The average annual incidence rate of co-occurring new diagnoses of thrombosis and thrombocytopenia was 2.84 per 100 000 population. Incidence rates were higher in men than women, except in 20-39 year-olds (higher in females). 20.6% of patients died within the first month after diagnosis. We observed that the demographic and clinical characteristics of thrombosis with co-occurring thrombocytopenia using our case definition is different from that of TTS. Further research is needed to refine the case definition of TTS in the post-COVID-19 vaccination period.

Impact of Sulfonamide Allergy Label on Clinical Outcomes in Patients with Pneumocystis jirovecii Pneumonia.

The presence of antibiotic allergy labels can have harmful impacts on clinical outcomes, particularly among immunosuppressed patients, in whom there have been associations with increased complications, readmission rates, and mortality. We explore the effects of a sulfonamide allergy label (SAL) on clinical outcomes in adult patients with Pneumocystis jirovecii pneumonia (PJP). In this retrospective matched cohort study, we utilized TriNetX, a multicenter national database, to match 535 adult patients with PJP and SAL to an equal number of controls. We identified cases indexed between 01/01/2010 and 01/01/2023 utilizing ICD-10 codes for PJP and allergy status to sulfonamides and through detection of P. jirovecii antigen with immunofluorescence or PCR. Propensity score matching was performed in a 1:1 fashion for demographics and comorbidities, and our analysis included clinical outcomes that occurred within 30days after the occurrence of the index event. While hospitalization risk tended to be lower among patients with SAL as compared to controls (RR: 0.90; 95% CI 0.81-1.01), there were no major differences in the risk of respiratory failure (RR: 0.94; 95% CI 0.84-1.05), prednisone use (RR: 1; 95% CI 0.91-1.10), intensive level of care requirement (RR: 0.85; 95% CI 0.69-1.06), intubation (RR: 0.85; 95% CI 0.61-1.19), or mortality (RR: 0.98; 95% CI 0.68-1.42). The presence of SAL did however impact antibiotic prescription patterns, with an underutilization of trimethoprim (RR: 0.50; 95% CI 0.43-0.59) and sulfamethoxazole (RR, 0.47; 95% CI 0.40-0.56) and overuse of alternative agents by patients with SAL as compared to controls. Yet, there was no difference in the occurrence of adverse outcomes such as hepatotoxicity (RR: 1.09; 95% CI 0.49-2.45) or acute kidney injury (RR: 0.94; 95% CI 0.78-1.14) between patients with SAL and controls. The presence of SAL alters antibiotic prescription patterns among adults with Pneumocystis infection but has no clinically significant impact on outcomes.

Predictive Nomogram and Propensity Score Matching in Neuroendocrine Carcinoma of the Tubular Gastrointestinal Tract: A US Population-Based Clinical Outcome Study

Background: Neuroendocrine carcinomas (NECs) of the tubular gastrointestinal tract (GI-NECs) are rare and associated with worse clinical outcomes. This population-based study aims to highlight key demographics, clinicopathological factors, and survival outcomes in the US population. Methods: Data from 10,387 patients with GI-NECs were extracted from the Surveillance, Epidemiology, and End Result (SEER) database from 2000 to 2020. Results: Most patients were &gt;40 years old at the time of presentation with a median age of 63 years old, with almost equal ethnic distribution per US population data. The most common primary tumor site was the small intestine (33.6%). The metastatic spread was localized in 34.8%, regional in 27.8%, and distant in 37.3% of cases, and the liver was the most common site of metastasis (19.9%) in known cases of metastases. Most NEC patients underwent surgery, presenting the highest 5-year overall survival of 73.2% with a 95% confidence interval (CI) (95% CI 72.0–74.4%), while chemotherapy alone had the lowest 5-year survival of 8.0% (95% CI 6.4–10.0%). Compared to men, women had a superior 5-year survival rate of 59.0% (95% CI 57.6–60.5%). On multivariate analysis, age &gt; 65 (HR 2.49, 95% CI 2.36–2.54%, p ≤ 0.001), distant metastasis (HR 2.57, 95% CI 2.52–2.62%, p ≤ 0.001), tumor size &gt; 4 mm (HR 1.98, 95%, CI 1.70–2.31%, p ≤ 0.001), esophageal (HR 1.49, 95% CI 0.86–2.58%, p ≤ 0.001), transverse colon (HR 1.95, 95% CI 1.15–3.33%, p ≤ 0.01), descending colon (HR 2.12, 95% CI 1.12, 3.97%, p = 0.02) anorectal sites, and liver or lung metastases were associated with worse survival. Surgical intervention and tumors located in the small intestine or appendix showed a better prognosis. Conclusion: GI-NECs are a group of rare malignancies associated with a poor prognosis. Therefore, epidemiological studies analyzing national databases may be the best alternative to have a more comprehensive understanding of this condition, assess the impact of current practices, and generate prognosis tools.

Elevated Cardiac Troponin I Level associated to Cardiac Dysfunction in Burned Patients.

Severely burned patients often developed cardiac dysfunction and heart failure. The purpose of this retrospective study is to evaluate the role of Cardiac Troponin I (cTI) and its association to patients with burns. Patients deidentified data were collected from a national database in May 2023. Adult burn patients who had cTnI lab counted were enrolled in this study. Patients were grouped by the cTnI mean level within 72 hours including patients with elevated cTnI levels at >0.3ng/mL (n= 2188 patients), and patients with non-elevated cTnI level (< 0.04ng/mL) (n= 3200). The cohorts were further stratified by less than 20% TBSA mild burn population and >20% TBSA severe burn population to replicate the severity of burns. The 30-days incidences of acute myocardial infarction (MI), sepsis, and mortality were investigated after the cohorts were propensity matching balanced. The odds ratios (ORs) with 95%CI for MI were (9.829/7.081-13.645), sepsis (1.527/1.269-1.959) and mortality (2.586/2.110- 3.170) respectively (p<0.05). The groups that were further stratified into mild burn and severe burn had the following results: The mild burn ORs and 95% CI for MI was (6.237/3.986-9.785), sepsis (1.603/1.132-2.270), and mortality was (2.298/1.629-3.242). The severe burn cohort had ORs and 95% CI for MI (3.145/1.469-6.732), sepsis (0.993/0.555-1.777), mortality (2.934/1.924-4.475). In conclusion, the patients with earlier elevated cTnI level had worse outcomes of MI and mortality in both severe and mild burns.

#2560 Intradialytic serum phosphate variations are associated with low PTH levels

Abstract Background and Aims Secondary hyperparathyroidism (SHPT) is one of the most common complications in patients with chronic kidney disease (CKD). The prevalence of SHPT progressively increases with the severity of CKD, affecting approximately 50-70% of patients on hemodialysis (HD). SHPT significantly impacts morbidity, mortality, hospitalization risks, healthcare costs, and the quality of life of CKD patients, making its management of paramount importance in this population. A positive serum phosphorus (P) balance is one of the critical determinants of SHPT, and the management of P levels in HD patients revolves around nutritional therapy, medications, and optimal kidney replacement therapy (KRT). Numerous studies have explored the role of KRT in P control among prevalent HD patients. However, whether the reduction of P achieved during KRT affects parathyroid hormone (PTH) levels is still a matter of debate. Currently, a direct evaluation of the relationship between intra-HD P reduction and PTH levels is lacking. Method We conducted a retrospective observational study on the prevalent HD population at the Division of Nephrology, University Hospital of Verona, from January to December 2022. We Included clinically stable adult patients undergoing HD for over 6 months, with multiple recorded visits during the follow-up. Demographic, clinical, laboratory, and medication data were collected. Time-varying variables were updated at each study visit. Food intake was assessed through a 3-day food record (HD day, non-HD day, and weekend day). Patients were instructed to maintain their usual ideally low-phosphate diet and to meticulously record and weigh all foods and preparations consumed. This assessment was conducted every 4 months during the observation period. From the 3-day food records, the dietary phosphorus intake was calculated using a national database and reported as mg of P per day. A dietitian evaluated dietary questionnaires. The primary outcome of interest was PTH levels. The absolute intra-HD change in P (intra-HD ∆P), defined as the difference between pre- and post-HD P levels, served as the main exposure. Multivariable adjusted linear mixed models were used to investigate the relationship between intra-HD ∆P and PTH levels. Potential confounders were included in the following three models of hierarchical adjustment: (i) Model 1, unadjusted; (ii) Model 2, adjusted for age and sex; (iii) Model 3, adjusted for all covariates in Model 2 plus URR, HD modality, active vitamin D, phosphate binders, calcimimetics, comorbidities. Since the relationship between intra-HD ∆P and PTH is influenced by the pre-HD P, all models were adjusted for pre-HD P. The association between PTH and intra-HD ∆P was also assessed in a subgroup of patients who provided a valid dietary diary. A multivariable linear mixed model adjusted for all covariates in Model 3 plus dietary phosphorus intake was used to assess this association. Results A total of 211 patients contributed to 904 study visits. A significant and positive relationship was observed between intra-HD ∆P and pre-HD P (β = 0.76, 95% CI 0.75, 0.78, p &amp;lt; 0.001) and urea reduction ratio (β = 0.38, 95% CI 0.35, 0.41; p &amp;lt; 0.001) (Figure). An increase in intra-HD ∆P was significantly and independently associated with low PTH levels (β = −0.17, 95% CI −0.30, −0.03; p = 0.016; Table). Overall, 86 out of 211 patients provided valid dietary data. The relationship between intra-HD ∆P and PTH levels was confirmed after additional adjustment for dietary P intake (p = 0.041). Conclusion The extent of intra-HD P reduction significantly correlates with low PTH levels. Strategies focused on optimizing or enhancing depurative efficiency in KRT can exert a substantial impact on managing positive phosphorus balance and secondary hyperparathyroidism (SHPT). The assessment of intra-HD P reduction may play a pivotal role in the management and follow-up of SHPT in HD patients.