Single-center Observational Cohort Study Research Articles

Short-term mortality and associated factors among older hospitalized patients: A narrative retrospective analysis of end-of-life care in an acute geriatric unit

ObjectivesTo explore short-term mortality and its predictors among older patients hospitalized in a acute geriatric ward (AGW) in Northwestern Italy. DesignRetrospective observational single-center cohort study. Material and methodsPatients consecutively admitted for any reason between June 2021 and May 2022 were included in the analysis. Along with sociodemographic, clinical, and functional variables, prognosis estimation (Palliative Prognostic Index; PPI) at the time of admission was registered. Short-term all-cause mortality (in-hospital and within 3 months of discharge) was the primary outcome. ResultsAbout one-third of the total sample died in the short-term (32.4 %). Along with PPI score (OR 1.115, 95 %CI 1.034–1.202), short-term mortality was independently associated with functional dependency (OR 1.278, 95 %CI 1.170–1.395). ConclusionsThe high short-term mortality in our sample should call for the inclusion of palliative prognostic tools within the in-hospital comprehensive geriatric assessment to better recognize and appropriately manage older patients at the end of life.

Clinical Course and Outcomes of Brain Tumor Patients Admitted to Medical Intensive Care Unit: A Descriptive Analysis

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU.Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined.Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors.Conclusion: Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

Comparison of 4.54% hypertonic saline and 20% mannitol for brain relaxation during auditory brainstem implantation in pediatric patients: a single-center retrospective observational cohort study

BackgroundMannitol is frequently utilized to achieve intracranial brain relaxation during the retrosigmoid approach for auditory brainstem implantation (ABI). Hypertonic saline (HS) is an alternative for reducing intracranial pressure; however, its application during ABI surgery remains under-investigated. We aimed to compare the efficacy and safety between HS and mannitol for maintaining brain relaxation.MethodsThis single-center retrospective cohort study included pediatric patients undergoing ABI surgery from September 2020 to January 2022 who received only 4.54% HS or 20% mannitol for brain relaxation. The analysis involved initial doses, subsequent doses, and dosing intervals of the two hyperosmolar solutions, as well as the time elapsed from meningeal opening to the first ABI electrode placement attempt. Additionally, the analysis encompassed electrolyte testing, hemodynamic variables, urine output, blood transfusion, second surgeries, adverse events, intensive care unit length of stay, and 30-day mortality.ResultsWe analyzed 68 consecutive pediatric patients; 26 and 42 in the HS and mannitol groups, respectively. The HS group exhibited a reduced rate of supplementary use (7.7% vs. 31%) and lower total urine volume. Perioperative outcomes, mortality, and length of intensive care unit stay did not exhibit significant between-group differences, despite transient increases in blood sodium and chloride observed within 2 h after HS infusion.ConclusionsIn pediatric ABI surgery, as an osmotherapy for cerebral relaxation, 4.54% HS demonstrated a lower likelihood of necessitating additional supplementation than 20% mannitol. Furthermore, the diuretic effect of HS was weak and the increase in electrolyte levels during surgery was temporary and slight.

Genotype predicts heart failure independent of left ventricular ejection fraction and NT-proBNP levels in hypertrophic cardiomyopathy

Abstract Background/Introduction Hypertrophic cardiomyopathy (HCM) is a myocardial disease associated with progression to heart failure. In around 40% of cases, the disease is caused by variants in genes encoding sarcomere proteins. Purpose To evaluate the role of genotype in predicting heart failure (HF) outcomes. Methods In this observational single-centre cohort study, consecutive patients with HCM were assessed for heart failure clinically stratified by genetic status into genotype-elusive which included those with no significant variants (G-) or variants of unknown significance (VUS) and genotype-positive (G+) with pathogenic/likely pathogenic (LP/P) variants. Heart failure endpoint was defined as left ventricular assist device implantation, heart transplantation or heart-failure-related death. The incidence of HF endpoint was compared between genotypes during follow-up using a time-to-event analysis. Results 474 patients (50.9 ±14.5 years, 67.3 males) with HCM (25% with left ventricular (LV) outflow obstruction) were followed for 10.9 years (IQR 5.1-13.5). G+ LP/P patients (201/474 (42.4%)) were younger (45.8. ±14.0 years) compared to G- (225/474 (47.5%), 55.2 ±13.4 years) and VUS (48/474 (10.1%), 52.0 ± 15 years); 29/474 (6.1%) reached the heart failure endpoint. The incidence of heart failure endpoints was 12.4% (25/201) in the G+ LP/P group compared to 1.5% (4/273) in the gene elusive group. A multivariate Cox proportional hazards model including NT-proBNP and LV ejection fraction (LVEF) and genetic status showed that G+ LP/P was associated with increased risk of heart failure outcomes (HR: 5.11, 95% CI: 1.43–18.25, p=0.012). Every 100-unit rise in NT-proBNP was associated with a 41% increase in risk (HR: 1.41, 95% CI: 1.20–1.66, p<0.0001). A one-unit (1%) reduction in LVEF correlated with a 10% increase in heart failure risk (HR: -0.90, 95% CI: 0.87–0.93, p<0.0001). Conclusion(s) Genetic status is a predictor of heart failure outcomes independent of LVEF and NT-proBNP levels in HCM. This underscores the importance of genetic testing in the clinical management of HCM.

Effectiveness and safety of olokizumab and levilimab in patients with COVID-19 in 2022: a cohort study

A single-center observational cohort study of the use of levilimab and olokizumab in patients with COVID-19 was conducted. Purpose was to evaluate the effectiveness and safety of olokizumab and levilimab in the infectious diseases hospital of the Volgograd region in 2022. Materials and methods: We analyzed 182 medical records of patients who were prescribed genetically engineered biological drugs in 2022. Long-term results of the use of drugs and disease outcomes after discharge or transfer to another medical fascility were assessed using the federal register of people with COVID-19. Results: There were no significant differences in the effectiveness of levilimab and olokizumab. The chance of detecting signs of bacterial infection/sepsis was significantly higher by 2.7 times in patients receiving levilimab compared with olokizumab (OR=2.7, 95 % CI 1.43-5.17).

Failure of an expandable lumbar interbody spacer - a critical analysis of secondary collapse, pseudoarthrosis and revision rates after thoracolumbar fusion.

To report on the failure rates of an expandable interbody spacer, used for spinal instrumented transforaminal lumbar interbody fusion (TLIF) or posterior thoracolumbar interbody fusion (PLIF). In this retrospective, single-center observational cohort study we reviewed consecutive PLIF/TLIF patients using the Catalyft™ PL and PL40 expandable titanium interbody implant (Medtronic, Minneapolis (USA)) between 07/2022 and 11/2023. We recorded patient demographics, surgical parameters, adverse events, radiological parameters and clinical outcomes according to the MacNab criteria. We identified 53 patients (mean age 68.6 ± 11.5 years; 49.1% female; mean BMI 25.7 ± 4.4kg/m2), in which 92 Catalyft™ spacers were implanted, mostly at L4/5 (n = 35; 38.0%) and L5/S1 (n = 31; 33.7%) for degenerative (n = 44; 83.0%), deformity (n = 7; 13.2%) or other indications (n = 2; 3.8%). We noticed secondary collapse of 20 (21.7%) spacers in 11 patients (20.7%) occurring after a mean time of 4.0 ± 4.1 months postoperatively. Age < 70 years was identified as risk factor for secondary collapse (OR 3.71, 95% CI 1.31-10.5, p = 0.014), but no association was found regarding other patient-specific or surgery-related variables. Pseudarthrosis was evident in seven patients (13.2%), of which four (7.6%) required revision surgery. Clinical outcome at last follow-up (mean 6.4 ± 4.2 months) was excellent/good in 29 (54.7%), fair in 14 (26.4%) and poor in six patients (11.3%). We provide a critical analysis of our series of patients with use of a specific type of expandable interbody spacer. We noticed failure and secondary collapse in an unacceptably high number of implants, some of which required revision surgery.

Risk Factors for Increased Opioid Use During Postoperative Intensive Care.

In the ICU, opioids treat pain and improve ventilator tolerance as part of an analgosedation approach. Identifying predictors of opioid consumption during the ICU course might highlight actionable items to reduce opioid consumption. To identify risk factors for opioid use during a postoperative ICU course. Patients enrolled in the Michigan Genomics Initiative single-center prospective observational cohort study completed baseline preoperative sociodemographic and mental/physical health questionnaires and provided blood samples for genetic analysis. Included patients were 18 years old and older, admitted to ICU postoperatively, and received opioids postoperatively. The primary outcome was ICU mean daily oral morphine equivalent (OME) use. The association between OME and phenotypic risk factors and genetic variants previously associated with pain were analyzed through univariable and multivariable linear regression models. The cohort consisted of 1865 mixed-surgical patients with mean age of 56 years (sd, 15 yr). Preoperative opioid users were more likely to continue to receive opioids throughout their ICU stay than opioid-naive patients. OME (log10 scale) was most strongly associated with ICU mechanical ventilation (β = 0.27; 95% CI, 0.15-0.38; p < 0.0001; effect size 1.85 for receiving > 24 hours of mechanical ventilation), preoperative opioid use (β = 0.22; 95% CI, 0.16-0.29; p < 0.0001; effect size 1.67 for receiving preoperative opioids), major surgery (β = 0.21; 95% CI, 0.12-0.30; p < 0.0001; effect size 1.62 compared with minor surgery), and current/former illicit drug use (β = 0.12; 95% CI, 0.01-0.23; p = 0.04; effect size 1.30 for drug use). Younger age, centralized pain, and longer anesthetic duration were also significantly associated with OME but with smaller effect sizes. Selected genetic variants (FKBP5, COMT, and OPRM1) were not associated with OME use. Mechanical ventilation and preoperative opioids were the strongest risk factors for postoperative ICU opioid consumption, whereas psychologic factors and genetic variants were not associated.

A novel scoring system proposal to guide surgical treatment indications for high grade gliomas in elderly patients: DAK-75.

High-grade gliomas are the most prevalent neurooncological desease in adults, their incidence increases with age, peaking in the seventh decade. This paper aims to address how to select patients for surgical resection by identifying pre-surgical predictors of 12-month mortality in newly diagnosed HGG patients aged ≥ 75years. A prognostic score will be proposed to guide surgical decisions based on expected survival. Retrospective observational single-center cohort study was carried out at the "Città della Salute e della Scienza-Molinette" University Hospital in Turin, Italy. All consecutive patients aged ≥ 75years newly diagnosed with HGG were included, regardless of whether they underwent surgical resection. Clinical, radiological, histological and molecular data were collected.Variables potentially available at the time of diagnosis were considered to develop a multivariable logistic regression predictive model, with 12-months overall survival as the dependent variable. 102 patients aged 75years or older received a new diagnosis of high-grade glioma, of whom 68 underwent surgical resection. Patients undergoing surgery were slightly younger (76.9 vs 79.0years, p = 0.007) and had better performance status (median KPS 80 vs 70). Most tumors undergoing surgery were localized in cortical or subcortical non-motor areas (p < 0.001) and less frequently deep-seated (p = 0.023) or multifocal (p < 0.001). A predictive model, the DAK-75 score, was developed: the AUROC of the final model was 0.822 (95% CI 0.741-0.902). The score includes clinical presentation, tumor location, and KPS, ranging from 0 to 20, categorizing risk scores into low-risk and high-risk groups (< or > 8). Higher scores corresponded to fewer surgical patients and higher one-year mortality rates (92.2% vs 47.1%, p < 0.001). DAK-75 score may represent a valuable tool in the decision-making process for neurosurgical intervention in elderly patients diagnosed with HGG. Further studies are needed to externally and prospectively validate the scoring system.

Inter-atrial Septum Stenting in Congenital Heart Disease Patient: A Case Series in Indonesia.

Inter-atrial septum (IAS) stenting in duct-dependent congenital heart disease patient has shown to be an effective way to maintain inter-atrial blood flow, however it is still considered a high risk procedure and inter-atrial septum stenting remains a low-frequency procedure. A single-center observational cohort study was carried out at the National Cardiovascular Center Harapan Kita (NCCHK) between April 2019 and April 2023. This study included duct-dependent congenital heart disease patients. The extracted data were baseline characteristics, clinical findings, complications, and outcomes of the patients. Eleven patients with duct-dependent physiology were intervened with inter-atrial septum stenting. The patients were 4 females and 7 males with the median age of implantation being 150 days (range 11-703 days) and the median weight being 3.9 (range 2.8-9) kg, with 2 patients weighing less than 3 kg. The average stent diameter was 8.50 (2.03) mm with an average length of 24.45 (7.94) mm. Non-restrictive atrial flow was successfully achieved in 90.90% of the procedures, corresponding to 10 patients. Inter-atrial septum stenting in duct-dependent congenital heart disease patients produces reliable patency with a very good intra-procedural success rate.

Longitudinal frailty assessment in the prediction of survival among patients with advanced chronic kidney disease: a prospective observational single-centre cohort study

ObjectivesThis study aims to describe the prevalence, characteristics and longitudinal changes in frailty among outpatient chronic kidney disease (CKD) and haemodialysis (HD) populations and their impact on survival.DesignProspective observational cohort...

Hepatic artery stenosis after pediatric liver transplantation: The potential role of conservative management

AimThis study aimed to investigate the outcomes and effectiveness of various treatment strategies in patients with hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT). MethodsThis is a single center observational cohort study between January 1st, 2004 and August 1st, 2023, including pLT recipients aged <18 years. The primary outcome was graft and patient survival. The secondary outcomes included incidence of biliary complications, technical success of surgery or endovascular therapy (EVT), and changes in liver function. The cut-off for early and late HAS was 14 days after pLT. ResultsAmong a total of 327 pLT patients, 4 % (n = 13) developed HAS (n = 3 early; n = 10 late). Treatments included surgical revascularization for one early HAS, conservative management with anticoagulation for one early and four late HAS, and EVT for one early and six late HAS. Over a median follow-up of 28.2 months after the diagnosis of HAS, graft survival was 100 % and 83 % in early and late HAS groups, and patient survival reached 100 % in both groups. One graft loss occurred in the conservative group. Conversely, graft survival in the EVT group was 100 %. ConclusionThe long-term outcomes of HAS after pLT are excellent. Both EVT and conservative management exhibited high graft survival rates for late HAS, with EVT achieving high technical success.

Adnexal Masses in Pregnancy: A Single-Centre Prospective Observational Cohort Study

Objective: To prospectively determine the nature of adnexal masses diagnosed during pregnancy and investigate whether ultrasound was a reliable means of assessing these. Methods: A single-centre prospective observational cohort study was conducted in a large tertiary referral hospital in London. Pregnant women with an adnexal mass detected at or prior to the 12-week routine ultrasound received a detailed ultrasound by a level II ultrasound practitioner at the time of detection; at 12 weeks; 20 weeks; and 6 weeks postpartum. The following outcomes were recorded: subjective impression of the mass; International Ovarian Tumor Analysis simple rules classification; resolution and intervention rate; and the incidence of complications related to the mass. Results: A total of 28,683 pregnant patients were scanned and an adnexal masses was detected in 277 patients, yielding an incidence of 1%. 274 participants were included in the analysis. Subjective impression was as follows: simple 75.9%; dermoid 29.1%; endometrioma 6.6%; haemorrhagic 3.3%; para-ovarian 2.6%; torted simple 0.7%; decidualized endometrioma 0.4%; fibroma 0.4%; theca luteal 0.4%; and borderline ovarian tumour: 0.7%. There was a significant reduction in the volume at each scan (p &lt; 0.0001). Approximately 74.2% of the masses resolved spontaneously. Surgery was performed in 14/274: 2 antenatally, 6 at caesarean section, and 6 postpartum. In 5/247 (2%), there were complications due to the mass. Using IOTA simple rules, 272/274 (99.3%) (p &lt; 0.0001) were classifiable. Only 1/274 (0.4%) had malignant features as per IOTA (p = 0.05). As there were no confirmed malignancies, the accuracy of IOTA simple rules could not be calculated. Conclusions: Adnexal masses in pregnancy are uncommon and the majority spontaneously resolve. Malignancy is rare, as are complications. In the absence of concerns regarding malignancy or cyst accident, there is no need for additional monitoring of these masses during pregnancy.

Anticoagulation strategies in patients with coexisting traumatic intracranial hematomas and cerebral venous sinus thrombosis: an observational cohort study

PurposePost-traumatic cerebral venous sinus thrombosis (ptCVT) is a rare but serious complication of traumatic brain injury (TBI). Managing ptCVT is challenging due to the concurrent risk of traumatic intracranial hematoma (ICH) expansion. Limited data exists on the safety and efficacy of anticoagulation therapy (ACT) in these cases.MethodsThis single-center observational cohort study included adult TBI patients with concurrent ICH and ptCVT. Low-molecular-weight heparin (LMWH) or heparin infusion was used to treat all ptCVTs based on institutional protocols. The outcomes of interest were hemorrhagic and thrombotic complications.ResultsOut of 1,039 TBI-patients admitted between 2006 and 2020, 32 met the inclusion criteria. The median time from injury to ptCVT diagnosis was 24 h. ACT was initiated at a median of 9 h after ptCVT diagnosis. Patients were administered either heparin infusion (n = 8) or LMWH at dosages ranging from 28 to 72% of the therapeutic level (n = 24). There were no hemorrhagic complications, even in patients receiving LMWH at ≥ 50% of the therapeutic dose. Thrombotic complications occurred in 3 patients (9.4%) – two cases of thrombus progression and one venous infarct. The patients who developed thrombotic complications differed from those who did not by having a 17-h delay in ACT initiation after diagnosis or by receiving an initial LMWH dose at 28% of the therapeutic level.ConclusionLMWH at approximately 50% of the therapeutic level was effective for managing ptCVT associated with TBI in our retrospective dataset, with no risk of hematoma expansion. Prospective trials are warranted to confirm these results.

Utility of Early Postoperative DWI to Assess the Extent of Resection of Adult-Type World Health Organization Grade 2 and 3 Diffuse Gliomas.

World Health Organization (WHO) grade 2 and 3 diffuse gliomas account for approximately 5% of primary brain tumors. They are invasive and infiltrative tumors and have considerable morbidity, causing progressive neurologic deterioration. The mean survival time is <10 years from diagnosis. Surgical debulking represents first-line management. The extent of resection is associated with progression-free and overall survival. Radiologic assessment of the extent of resection is challenging. This can be underestimated on early postoperative MRI, meaning that accurate assessment may be achieved only on delayed follow-up imaging. We hypothesized that DWI may help facilitate more reliable estimates of the extent of resection on early postoperative MRI. This study aimed to assess the utility of DWI in early postoperative MRI to evaluate the extent of resection. A single-center observational cohort study was performed. All patients with histologically confirmed WHO grade 2 and 3 gliomas managed with surgical debulking between January 2015 and December 2020 were identified. Preoperative, early postoperative, and follow-up imaging were reviewed independently by 2 consultant neuroradiologists. The extent of resection was estimated with and without DWI sequences for each case. Two hundred twenty-four patients with WHO grade 2 and 3 gliomas were managed with surgical debulking between 2015 and 2020. DWI was not performed on early postoperative MRI in 2 patients. With the use of DWI, the extent of resection was upgraded in 30% of cases (n = 66/222) and classified as "complete" or "supramaximal" in 58% of these patients (n = 38/66). In cases in which the extent of resection was upgraded with the use of DWI, signal abnormality was stable or reduced at follow-up in 78% (n = 49/63). In cases with worsening signal abnormality, 64% were deemed to be secondary to adjuvant radiation therapy (n = 9/14). Eight percent (n = 5/63) of patients with an increased estimated extent of resection using DWI demonstrated signal progression attributed to true disease progression at follow-up. DWI is a helpful and reliable adjunct in differentiating residual tumor from marginal ischemia in early postoperative MRI in WHO grade 2 and 3 diffuse gliomas and increases the accuracy in assessing the extent of resection. It should be used routinely in these cases.

Sleep quality after autologous breast reconstruction

BackgroundSleep is a fundamental aspect of human health and well-being, but is often interrupted in a hospital setting. Especially after surgery, poor sleep quality can negatively affect postoperative recovery and quality of life. Therefore the aim of this study is to gain insight in the quality of sleep in patients after autologous breast reconstruction and evaluate factors associated with quality of sleep. Materials and methodsIn this single-center observational cohort study, participants completed a sleep diary, including the Pittsburgh Sleep Quality Index (PSQI) and the EQ-5D-5L quality of life questionnaire, before surgery, during hospital admission and two weeks and three months postoperative. Additional variables such as pain, and anesthesia time were collected. ResultsTwenty-nine patients were included. Before surgery, 58% of them experienced poor quality of sleep, with a median PSQI score of 5.0. During hospital admission, 83% of the patients had a poor quality of sleep, with a PSQI score of 6.0. The PSQI score two weeks postoperative increased to 7.0 and was decreased three months postoperative to 5.0. Patients with a pain score >4 (‘pain’ group), had a higher median PSQI score than patients with a pain score ≤4 (‘no pain’ group) at all postoperative time points previously mentioned. No correlation was observed between anesthesia time or quality of life. ConclusionPoor sleep quality is experienced by most women after autologous breast reconstruction, especially in those with higher postoperative pain scores. This knowledge offers an opportunity to improve the postoperative care for these patients.

Measles-Clinical and Biological Manifestations in Adult Patients, Including a Focus on the Hepatic Involvement: Results from a Single-Center Observational Cohort Study from Romania.

Background: Hepatic involvement in measles, particularly among adolescents and adults, has been recognized since 1960. This involvement typically manifests during the eruptive phase of the disease and is primarily characterized by hepatocellular dysfunction, with jaundice being a less common occurrence. Studies have reported hepatic involvement in 80-86% of measles cases among young adults associated with severe forms of the disease with intra-infectious hepatitis. Recent data from Romania indicated 20,035 confirmed measles cases between January and June 2024, including 17 fatalities and significant hepatic alterations. These findings underscore the need for the further investigation of the hepatic manifestations of measles. The primary objective of our study was to evaluate the clinical and baseline characteristics of the enrolled patients with a brief assessment of liver impairment. Methods: In light of these observations, we conducted a retrospective analysis between 1 November 2023 and 15 June 2024 in patients aged >16 years who were confirmed, by the detection of measles IgM in serum samples, to have acute measles infection and hospitalization. Results: During the study period, 71 hospitalized patients were diagnosed with measles, of whom 37 were female (52.1%), with ages ranging from 16 to 64 years (mean age 34.21 years). Most cases (77.5%) exhibited moderate clinical forms of measles, while 22.5% had severe forms. Respiratory failure requiring oxygen therapy was uncommon (25.4% of severe pneumonia cases). Although a Pearson chi-square test indicated no significant association between the presence of pneumonia and clinical form (p = 0.066), the likelihood ratio test suggested a potential link (p = 0.018). Hepatic involvement was common with elevated AST (87.3%) and ALT (76%) levels. Jaundice was observed in 12.7% of patients. GGT changes were noted in 35.2% of cases, with significant correlations between GGT levels and disease severity (p = 0.001). Analysis of various symptoms revealed significant associations between nausea, dyspnea, and severe clinical forms. Anorexia, diarrhea, and nausea were the most frequently reported symptoms. Thrombocytopenia was observed in 11 patients, with no significant correlation with disease severity. Comorbidities, such as COPD, were significantly associated with disease severity (p = 0.010). Conclusions: Our findings highlight that, while cytolytic hepatic damage is a typical response to measles infection, cholestatic involvement may serve as an indicator of more severe disease progression.

Strategies for Coping With Complicated Grief in Relatives of Patients Who Are Critically Ill: An Observational Single-Center Cohort Study

Relatives of deceased critically ill patients are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives' coping strategies, are not well understood. How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms? In this observational single-center cohort study, relatives of deceased critically ill patients were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief-COPE questionnaire to assess CG symptoms and coping strategies, respectively. Patients' and relatives' characteristics were obtained. The primary outcome was the ICG sum score. Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ICG sum score (SD) was 41.6+10.9. Eighty-four relatives (94.4%) had an ICG score of >25. Multivariable analysis revealed that being a partner affected the ICG sum score significantly (coefficient 4.9, 95% confidence interval [1.8; 8.0], p=0.003), as did the coping strategies self-distraction (coefficient 4.4, 95% CI [2.5; 6.3], p<0.001), acceptance (coefficient -4.4, 95% CI [-6.3; -2.5], p<0.001), and self-blame (coefficient 3.8, 95% CI [1.4; 6.3], p=0.002). Almost all relatives of deceased critically ill patients show symptoms of CG. Relatives' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

Functional outcomes and clinical characteristics of children discharged from pediatric intensive care unit of a low- and middle-income countries: A single-center prospective observational cohort study from Rwand

Abstract Background: The development of pediatric intensive care units (PICUs) has contributed to the improvement in the survival of critically ill children; however, the long-term functional outcome of these children is often unknown in many low-/middle-income countries including Rwanda. This study aimed to describe incidence and type of long-term functional outcomes and associated clinical characteristics among PICU survivors during a 5 years’ period (2015–2019). Subjects and Methods: This was a single-center, prospective observational cohort study conducted in the PICU of University Teaching Hospital in Rwanda. A Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scales were used to screen for long-term functional outcomes. The results were evaluated by telephone interview and statistically analyzed using logistic regression. Results: Out of 158 children, 53.2% had overall disability while 33.6% had some level of cognitive disability after PICU discharge. Out of 41 (2`5.9%) deaths during study period, three (7.3%) occurred during the hospital stay, while 8 (19.6%) occurred after the first year of hospital discharge. Disability screened by two scales, PCPC and PCOC, was comparable for mild (13.3% vs. 23.4%), moderate (11.4% vs. 20.3%), and severe (5.1% vs. 5.7%) categories. PICU admission for patient with at least one preadmission comorbidity had significantly greater disability at discharge (P &lt; 0.05). Conclusions: Despite a high survival rate, residual functional disability is prevalent among children after discharge from the PICU in Rwanda. The presence of at least one preadmission comorbidity was independently associated with greater disability at discharge.

Frequency and outcome of cerebral venous thrombosis attributed to oral contraceptive pills

Background: Oral contraceptive (OCP) use is a significant risk factor for cerebral venous thrombosis (CVT). There is limited research on its association with CVT development in Islamic countries. Therefore, our study aimed to assess the risk of different OCPs in developing CVT and their prognosis. Methods: This is an observational retrospective single-center cohort study that included CVT patients between March 2018 and March 2021. All CVT participants were registered in the organized registry system (CVT registry code: 9001013381) at the Neurology Research Center of Shiraz University of Medical Science. Univariate analysis and multivariable binary logistic regression modeling were applied to determine the associated factors leading to poor outcome. Results: A total of 204 patients (139 women, 65 men) were enrolled in the study. Seventy-four females (53.25% of total female patients) used OCPs, with second-generation OCPs being the most commonly used type (70%). OCP consumption was associated with a lower mortality rate (P=0.004, aOR=11.732) and a better 3-month follow-up outcome (p=0.001, aOR=9.882) than their female counterparts who did not use OCPs. The duration and generation of OCPs did not affect the follow-up outcome (P=0.148, P=0.428, respectively) or mortality (P=0.555, P=0.569, respectively). In multivariable analysis, the use of OCPs was a predictor of a favorable 3-month follow-up outcome in females (aOR =4.423, 95% CI: 0.423-46.248). Conclusion: These results suggest that OCPs may have a positive impact on the prognosis of CVT in women. However, further research is required to understand the underlying mechanisms and validate these findings.

Does patient activation matter? An examination of the relationships between patient activation and healthcare use in older adults with mild frailty after discharge from an emergency department.

ObjectivePatient engagement, as measured by the Patient Activation Measure (PAM®), has been used to assess patients' ability to manage their own care. This study aimed to determine whether the PAM® could predict healthcare use in older adults aged >70years, living independently in the community with mild frailty, within 30days after emergency department (ED) discharge.MethodsA prospective single-centre observational cohort study was completed including older adults who presented to an ED. The 13-item PAM® and selected International Consortium for Health Outcomes Measures were completed prior to ED discharge.ResultsTwo hundred patients were recruited with a mean age of 84.8years (s.d. 6.9). The mean PAM® score was 58.6 (s.d. 13.3), with 12.5% at Level 1 (n=25), 40% at Level 2 (n=80), 34.5% at Level 3 (n=69) and 13.0% at Level 4 (n=26). The PAM® level was significantly associated with ED presentations in the past 6months (P=0.030). The PAM® level did not predict healthcare use within 30days of discharge consisting of time until ED representation (P=0.557), number of ED representations (P=0.560), number of hospital admissions (P=0.499), length of stay in hospital (P=0.254) and number of post-discharge contacts (P=0.667).ConclusionsOverall, the PAM® did not predict prospective short-term healthcare use. However, the PAM® was significantly associated with 6-month previous ED use. With more than 50% of patients at Level 1 or 2, indicating lower capacity for self-management, tailored interventions are required to assist mildly frail patients to manage discharge care plans and engage in preventative strategies.