Retrospective Patient Record Review Research Articles

Clinical factors associated with increased length of stay and readmission in patients with medication-related hospital admissions: a retrospective study.

Adverse drug events (ADEs) remain a key contributor to hospitalisations, resulting in long hospital stays and readmissions. Information pertaining to the specific medications and clinical factors associated with these outcomes is limited. Hence, a better understanding of these factors and their relationship to ADEs is required. To investigate medications involved, clinical manifestations of ADE-related hospitalisations, and their association with length of stay and readmission. A retrospective medical record review of patients admitted to a major, tertiary referral hospital in NSW, Australia, from January 2019 to August 2020 was conducted. ADEs were identified using Australian Refined Diagnosis Related Group (AR-DRG) codes: X40, X61, X62 and X64. Medications were classified per the Anatomical Therapeutic Chemical (ATC) classification system and clinical symptoms were classified per the International Classification of Disease (ICD) 9-CM. Logistic regression was performed to assess the relationship between medication and presentation classes with length of stay (≥2 days vs<2 days) and readmission. There were 125 patients who met inclusion criteria (median age=64 [interquartile range, 45-75] years; 53.6% male). Anti-thrombotic agents, opioids, antidepressants, antipsychotics, insulins and NSAIDs were the most implicated pharmacological classes. Neurological medications and falls were associated with a length of stay ≥2 days (adjusted odds ratio [aOR] 3.92, 95% confidence interval [CI] 1.48-10.33 and aOR 3.24, 95% CI 1.05-10.06, respectively). Neurological medications and neurological and cognitive disorders were associated with an increased likelihood of 90-day readmission (aOR 2.63, 95% CI 1.05-6.57 and aOR 3.20, 95% CI 1.17-8.75, respectively). This study identified neurological medications as high-risk for increased length of stay and readmission in those hospitalised due to ADEs. This highlights the need for judicious prescribing and monitoring of these medications.

Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 InfectionDuring the First and Second Waves of the Pandemic.

ObjectivesTo compare the clinical profile and short-term outcome of children admitted with acute SARS-CoV-2 infection during the first and second waves of the Coronavirus Disease (COVID-19).MethodsThis retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confirmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay.ResultsOne thousand and twenty-four children were recruited, 592 of the first wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR = 3.38) and neurological manifestations (OR = 4.61). There was a higher requirement of intensive care (OR = 4.2) and invasive mechanical ventilation (OR = 4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the difference was not statistically significant. Children with neurological comorbidities (OR = 8.73), malnutrition (OR = 3.01), and preterm babies (OR = 6.8) were associated with severe COVID.ConclusionThe clinical profile of the second wave of COVID-19 in children was different from the first wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a significant increase in the incidence of severe infections requiring ICU care was observed.

EPID-06. Transfusion related iron overload in pediatric patients with CNS tumors

Abstract BACKGROUND: Patients receiving chemotherapy or autologous hematopoietic stem cell transplant (autoHSCT) routinely receive red cell transfusions as supportive care. Each unit of transfused red cells contains approximately 150mg of iron which the body has no natural mechanism for excreting. Transfusion-related iron overload (TRIO) is an under-recognized complication of therapy which left untreated may result in long-term damage to the liver, heart, or endocrine organs. We sought to identify the prevalence of TRIO in patients with pediatric CNS tumors and evaluate specific risk factors. METHODS: A retrospective record review of pediatric CNS tumor patients treated at Children’s Hospital Colorado was conducted including patients who completing therapy between 1/1/2014 – 12/1/2021. Patients at high risk for TRIO were defined as having a cumulative transfused blood volume of more than 150mL/kg or 4000mL total. The diagnosis of TRIO was confirmed if patients had a serum ferritin greater than 1000ng/mL or elevated liver iron content of 7mg/g dry weight or greater by MRI. RESULTS: There were 173 evaluable patients (40% embryonal tumors, 15% germ cell tumors, 10% ependymomas, 26% low grade gliomas, 5% high grade gliomas, and 3% other tumors). The mean age at completion of therapy was 8 years (range: 0.67 – 25 years). Patients receiving autoHSCT (24% of cohort) were at higher risk for TRIO based on transfused volumes (p&amp;lt;0.0001) than patients not treated with autoHSCT (72% vs 6%, RR 12.0) The prevalence of TRIO in autoHSCT patients was 7.5% (3/40) vs 0.8% (1/121) in patients not undergoing autoHSCT (RR 9.37). For autoHSCT patients at high risk by transfused volume the prevalence of TRIO was 10.3% (3/29). CONCLUSIONS: Pediatric CNS tumor patients who have received an autoHSCT are at higher risk for TRIO than those who have not. Routine screening for TRIO should be offered to patients receiving autoHSCT.

Management of Steroid-Refractory Gastrointestinal Immune-Related Adverse Events.

Immune checkpoint inhibitors (ICIs) cause inflammatory immune-related adverse events (irAEs), which are often effectively managed with steroids. Less is known about the best management of irAEs refractory to steroid treatment. We aimed to assess the efficacy of second-line medications used to treat gastrointestinal (GI) irAEs. This study was a single-center, retrospective medical record review of patients who received steroids for an ICI GI irAE and at least one dose of infliximab, vedolizumab, or adalimumab for irAE treatment from March 25, 2011 to September 20, 2019, approved by Yale University's Institutional Review Board. Our primary objective was to assess the efficacy of second-line treatment, measured by the change in the Common Terminology Criteria for Adverse Events Version 5.0 grading system. A total of 39 patients met inclusion criteria. Treatment for steroid-refractory GI irAEs demonstrated a high response rate, with irAE resolution seen in 89.7% of patients. Patients who were specifically initiated on infliximab within 14 days of starting steroids had a higher percent resolution seen in 94.4% of patients. The average time to response, defined as the average days from second-line therapy to reported symptom resolution, was 17 days. Steroid-refractory GI irAEs can be managed effectively in most patients with immunosuppressive therapy, such as infliximab. Furthermore, initiating second-line immunosuppressive therapy within 14 days of steroid failure resulted in a higher rate of symptom resolution.

A retrospective study of the association of pre-autologous stem cell transplantation disease status with outcomes in patients with multiple myeloma: A single-center study.

e20013 Background: Autologous stem cell transplantation (ASCT) has improved long-term survival for many patients with multiple myeloma (MM), but not all patients respond to ASCT favorably, and many experience disease relapse. Our goal was to explore various disease parameters in patients with MM that might be associated with adverse outcomes after receiving ASCT. Methods: We performed a retrospective medical record review of adult patients with MM who underwent ASCT at Henry Ford Hospital between January 1, 2010 and November 1, 2020. Age, sex, international staging system stage, type of induction therapy, bone marrow cytogenetics and/or fluorescence in situ hybridization, International Myeloma Working Group (IMWG) treatment response criteria categories before ASCT, and the use of maintenance therapy were collected. Outcomes analyzed were time to relapse (TTR) and overall survival (OS). Cox regression analysis was performed. Results: A total of 321 patient records were analyzed: 194 (60.4%) patients were &lt; 65 years old; 185 (57.6%) were men; 162 (50.5%) were Black, and 140 (43.6%) were White. IMWG treatment response categories before ASCT included 250 (78.2%) patients with partial response (PR) and very good partial response (VGPR) combined, and 40 (12.5%) with complete response (CR). There were 69 (21.4 %) patients classified with high-risk cytogenetics. Commonly used induction therapies included 96 (29.9%) patients receiving bortezomib/lenalidomide/dexamethasone, 21 patients (9%) receiving lenalidomide/dexamethasone, 80 patients (24.9%) receiving bortezomib/dexamethasone, and 30 patients (9.3%) receiving cyclophosphamide/bortezomib/dexamethasone, while other patients received a combination of other induction therapies. Mean time from ASCT and last follow-up date was 3.94 years. The overall mean TTR was 29.4 months and OS was 44.8 months. Univariate analysis showed that pre-ASCT treatment response status of combined PR/VGPR was associated with higher hazard of dying than CR (hazard ratio 3.03; 95% CI, 1.23-7.46); however, multivariate analysis showed that PR/VGPR status before ASCT was not significantly associated with increased TTR compared to CR (hazard ratio 1.29; CI, 0.65-2.59). Patients with pre ASCT CR status had longer OS than those with PR/VGPR status (hazard ratio 2.75; CI, 0.995-7.61; p &lt; 0.05). No other variables, including cytogenetic risk were associated with a difference in OS or TTR. Conclusions: Being at CR status before receiving ASCT may indicate a reduced risk of death in MM patients compared to PR and VGPR status, regardless of upfront therapies. Since multiple factors, including treatment type, impact CR status in patients with MM, we believe that studying evolving risk-adapted front-line therapies will help guide optimized treatment strategies to improve overall survival.

Racial and Ethnic Disparities in Menopausal Hormone Therapy Acceptance [A134

INTRODUCTION: There is a paucity of data on race and ethnicity in hormone therapy (HT) acceptance in previous menopause treatment studies. Our primary objective was to examine differences in HT acceptance between self-reported race and ethnic groups. Our secondary objective was to assess patient comorbidities and trends in reported symptom frequency at presentation in a menopause-focused care clinic. METHODS: Retrospective medical record review of patients presenting to a single menopause clinic from July 2018 to July 2021 at a tertiary level, urban, academic center in the Midsouth. Statistical tests included t test and odds ratios, with P values &lt;.05 considered significant. RESULTS: A total of 113 patients presented with menopausal symptoms and were included; 58 (52%) were Black, 47 (42%) were White, and 8 (6%) declined to answer. Of 42 women with vasomotor symptoms, 23 (55%) accepted lifestyle modification therapy and 19 (45%) accepted HT. Of 34 women with vaginal dryness, only 5 (15%) accepted vaginal HT, while 29 (85%) accepted moisturizers/lubricants. A total of 20 patients were excluded from eligibility for systemic HT due to medical comorbidities. Of 37 women eligible for systemic HT, 18 (49%) of White women accepted HT, compared to only 9 (24%) of Black women. This difference was statistically significant (P=.01). Black women were 24% less likely to accept HT for menopausal symptom management (OR, 0.24; 95% CI, 0.09–0.64). CONCLUSION: Our pilot study suggests racial disparity in acceptance of HT among perimenopausal and postmenopausal women. This can inform clinicians about patient factors affecting treatment choice for menopausal symptoms and opportunities to explore racial differences in quality of care.

Risk of Ipsilateral Deep Vein Thrombosis After Kidney Transplantation: A Retrospective Study.

Objective: To investigate the incidence and characteristics of deep vein thrombosis (DVT) in kidney transplantation recipients and analyze whether the anatomical side of DVT was associated with the side of the transplanted organ.Methods: A single-center retrospective medical record review of patients who received a kidney transplant between January 2004 and July 2019 and who subsequently developed DVT. Only patients who received unilateral kidney transplants were included in the study. Patients who underwent concomitant pancreatic transplants, bilateral kidney transplants, or repeat procedures were excluded.Results: Of the 2449 kidney transplants performed during the study period, 1482 were included in the analysis (948 men [64%]; mean age 61 years). Of 606 duplex ultrasound tests, 115 results confirmed the presence of DVT. The incidence of symptomatic DVT was 4.7%. The most common time of DVT diagnosis was within four weeks after transplantation. Type 2 diabetes, heart failure, acute myocardial infarction, sepsis, chronic obstructive pulmonary disease/abnormal pulmonary function, and being confined to bed were associated with DVT after kidney transplant (all P < 0.05). Patients with ultrasound-confirmed DVT had higher mean Caprini scores than patients with negative duplex ultrasounds (P < 0.5). Approximately 53% of transplant patients with ultrasound-confirmed DVT had a 1:1 correlation of transplant side to the side of DVT. Cohen kappa statistic 0.03 indicated no correlation between the side of DVT and the side of transplant.Conclusions: The incidence of DVT after kidney transplant was lower than the incidence reported in the literature. Being confined to a bed may be a risk factor for DVT after transplant surgery. Kidney transplant recipients who had a positive duplex ultrasound had higher Caprini risk assessment scores than transplant recipients who had negative duplex ultrasounds. There was no correlation between the side of the DVT and the side of the transplant.

Ten years of riluzole use in a tertiary ALS clinic.

Riluzole is a glutamate inhibitor approved for the treatment of amyotrophic lateral sclerosis (ALS). There are scant data on factors associated with riluzole initiation and adherence. The goal of this study was to describe the use of riluzole at the Penn State Hershey Medical Center (PSHMC) ALS clinic. A retrospective medical record review of ALS patients seen at the PSHMC from January 2007 to December 2016. A timeline of riluzole use was established for each patient. Factors contributing to dose changes or discontinuations were recorded. Riluzole adherence was assessed using the proportion of days covered (PDC) calculated by the patient-reported length of riluzole use divided by total time from prescription to death/censor. Multivariable analysis was performed to evaluate the association of demography and clinical course with adherence. Seven hundred twenty-three records were screened, with 508 (307 men, 201 women) meeting the criteria for inclusion. The median duration of riluzole use was 435 (range, 0-3773) days. The median PDC for the group was 64%. Those with higher initial overall function and slower rate of decline were more likely to have a larger PDC. No trends in patients' demographics, riluzole use, and tracheostomy-free survival were found over time. A high rate of riluzole initiation and adherence was found in this sample. The most common reasons for dose modification were related to adverse effects, yet social-, economic-, and patient-related factors were also common. The characteristics of riluzole prescription and use have remained relatively unchanged in a single tertiary ALS center over the past 10 years.

Paediatric Intracranial Aneurysms: Long-term Angiographic and Clinical Outcomes in a Contemporary Series.

ObjectivePaediatric aneurysms are rare and difficult to treat. Studies on the long-term angiographic and clinical outcomes conducted within the past decade are lacking. We aimed to investigate the clinical and radiographic outcomes of paediatric aneurysms treated with different strategies in a contemporary series.MethodsWe performed a retrospective medical record review of paediatric patients examined at our institution between 2011 and 2018. Patient charts were retrospectively reviewed for age, presentation, type and location of the aneurysm, modalities of treatment, complications, and clinical and angiographic outcomes. The rates of aneurysm recurrence and de novo formation were determined.ResultsWe evaluated 61 patients (mean age, 11.6 years; 23 females, 38 males) with 69 intracranial aneurysms. Their presentations included headache, neurological deficits, aneurysmal subarachnoid haemorrhage, incidental aneurysm, and traumatic subarachnoid haemorrhage. Of the aneurysms, 30 (49.2%) were giant. Forty-five (73.8%) patients underwent treatment for their aneurysms, and 16 (26.2%) patients were managed conservatively. The perioperative morbidity rate was 17.8%. There were no deaths. The long-term morbidity rate was 4.6%. The clinical outcomes were favourable in 82.2 and 95.3% at discharge and follow-up, respectively (mean, 41.5 months; range, 1.5–9 years). For treated aneurysms, 2/43 (4.6%) risk of aneurysm recurrence, 1/43 (2.3%) risk of aneurysm bleeding, 1/43 (2.3%) risk of de novo aneurysm formation. The annual bleeding, recurrence, and de novo formation or growth risk were 0.7, 1.4, and 0.7%, respectively.ConclusionsIn neurovascular centres where microsurgical and endovascular options are available, most children with intracranial aneurysms can be successfully treated with low morbidity and mortality. However, they have higher rates of recurrence and a greater risk of de novo formation or growth than their adult counterparts, which mandates lifelong follow-up.

COMPARISON OF LIVE BIRTH RATE IN IVF PATIENTS WITH SEVERE OATS AND NORMOZOOSPERMIC IN MALE FACTOR INFERTILITY

Introduction: Infertility is defined as the inability of couples to have a baby after one year of regular unprotected intercourse, affecting 10-15 percent of couples. Aims &amp; objective: The present study aimed to compare of live birth rate in IVF patients with severe OATS and Normozoospermic in male factor infertility. Methods: It is retrospective case record review of patients undergoing ICSI from 2018-2020 in a specialty fertility center. Infertile patients presenting at the Radha Hospital, CANDOR IVF Center, Surat were diagnosed for the study. Sample of male partner was diagnosed for different sperm parameters and select Normozoospermic and severe OATS patients. Results: Total 100 infertile patients were considered for study, out of which 50 were or Normozoospermic and 50 patients with Severe OATS. The Fertilization Rate ( 95% and 87.5%) , Blastocyte Rate(67.5% and 58.8%) , Implantation Rate (39.9% and 28.9%), Pregnancy Rate (64% and 58%), Missed Abortion Rate (16% and 8%), Live Birth Rate (32.9% and 21.9%) in Normozoospermic and in severe OATS patients. Conclusion: This study concludes, Fertilization Rate, Blastocyst rate, Pregnancy Rate, implantation Rate &amp; Live Birth Rate are Slightly or mild higher in Normozoospermic compare to Severe OATS. While Missed Abortion Rate is higher in severe OATS. Overall, a negative relationship is observed between semen quality (Severe OATS) and Fertlization Rate, Blastocyst Rate, Pregnancy rate, Implantation Rate, Missed Abortion Rate and Live Birth rate.

Neuropsychiatric Manifestations of Autoimmune Encephalitis in a Tertiary Hospital: A Case Series and Current Perspectives.

Importance:Autoimmune encephalitis (AE) refers to a group of neuropsychiatric conditions associated with specific circulating autoantibodies directed against synaptic receptors, neuronal cell surface proteins, and intracellular targets. Increased recognition of these disorders is of value, as affected patients prominently display cognitive impairment, behavioral disturbances, and seizures requiring multidisciplinary teams, with early recognition often impacting prognosis.Observations: This case series is based on a retrospective record review of adult patients diagnosed with AE between January 1, 2010- January 1, 2020. Cases 1 and 2, demonstrating anti- N-methyl-d-aspartate receptor (NMDAR) encephalitis with initial manifestations of neurologic and psychiatric symptoms, correlate with the literature describing a higher prevalence of this condition in young women. Case 3, despite being seronegative, exhibited classic features of anti-NMDAR encephalitis. Case 4 demonstrates a classic presentation of anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis: a middle-aged male with psychosis, altered mentation, and epilepsy. Case 5 had a more indolent neuropsychiatric presentation with mild elevation of N-type voltage-gated potassium channel (VGKC) antibody. Case 6, with glutamic acid decarboxylase 65 (GAD65) antibody, was an elderly female with speech dysfunction and altered mentation, and case 7 was an elderly male with GAD65 antibody who had stiff-person syndrome, ataxia, cognitive decline, and thymoma.Conclusions: This retrospective case series describes the clinical details of 7 individuals with AE and overlapping neuropsychiatric symptoms. This series is limited in scope, with a small number of cases and observational findings, which prevents specific conclusions from being drawn. Despite this limitation, the present article explores the nuances of variable presentations of this disease to inform better interdisciplinary management and emphasize the gap areas that need rigorous research.

Abstract P1-18-18: Real-world natural history data among patients with PIK3CA-mutant and PIK3CA-wild-type advanced breast cancer

Abstract Background: Oncogenic mutations involving PIK3CA gene (PI3Kα) are observed in over 40% of patients with hormone receptor-positive (HR+) advanced breast cancer (ABC). Clinical efficacy of PI3K inhibition was demonstrated in a recent trial, but data on the natural history of disease by PIK3CA status are limited in ABC. We assessed patient and disease characteristics, treatment patterns, and clinical outcomes among patients with ABC treated at the Memorial Sloan Kettering Cancer Center in the United States, prior to the clinical availability of alpelisib (a PI3Kα inhibitor). Methods: A retrospective medical record review of adult patients diagnosed with HR+ and human epidermal growth factor receptor 2-negative (HER2-) ABC between January 2014 and December 2018 was conducted. Data collection is ongoing and updated results will be presented. Cohorts were determined by eligible patients’ PIK3CA gene status (i.e., mutant or wild-type [WT]), and were frequency matched to have an equal distribution of the year of ABC diagnosis between cohorts. Study measures were descriptively summarized, and the Kaplan-Meier method was used to estimate progression-free survival (PFS) and left truncation-adjusted overall survival (OS), in months. To assess the association of PIK3CA mutation status on OS, a multivariate Cox proportional hazard model adjusted for age, race, stage at diagnosis, menopausal status, visceral disease, bone only disease, and Charlson Comorbidity Index score was computed. Additional adjustment on treatment modalities is planned. Results: Data for 249 PIK3CA-mutant and 143 PIK3CA-WT patients was analyzed. For the mutant cohort, the mean (SD) age was 59.0 (11.2) years, 80.7% were White, 30.9% were diagnosed with de novo ABC, and 54.6% were postmenopausal at initial BC diagnosis. Visceral- and bone only-disease were observed among 41.4% and 21.7% of patients, respectively. Among patients with a single PIK3CA mutation (n=220, 88.4%), the most common mutations were H1047R (37.3%), E545K (20.5%), and E542K (12.7%). Multiple PIK3CA mutations were observed in 29 (11.6%) patients. For the WT cohort, the mean (SD) age was 56.3 (12.1) years, 77.6% were White, 39.9% were diagnosed with de novo ABC, and 45.5% were postmenopausal at initial BC diagnosis. Visceral- and bone-only disease were observed among 51.8% and 16.8% of patients, respectively. Most common 1st-line treatments for ABC were cyclin-dependent kinase 4 and 6 inhibitor (CDK4/6i) + aromatase inhibitor (AI) (mutant: 38.6%; WT: 40.6%), AI only (mutant: 21.3%; WT:22.4%), CDK4/6i + fulvestrant (mutant: 15.7%; WT: 7.7%), and chemotherapy-based regimens (mutant: 9.6%; WT: 11.2%). Chemotherapy-based regimens were the most common 2nd- (mutant: 25.6%; WT: 21.3%) and 3rd-line (mutant: 41.4%; WT: 33.9%) therapies for both cohorts. Results for PFS and OS are presented in Table 1, and the survival risk was similar for both cohorts (adjusted HR: 1.18, 95% CI: 0.88-1.60). Conclusion: In this preliminary analysis of HR+/HER2- ABC, CDK4/6i-based regimens were the most common 1st-line therapy, and PFS to 1st-3rd line therapies and OS were not statistically significantly different. The recent availability of PI3K inhibitor therapy may improve clinical outcomes among patients with PIK3CA-mutant tumors. Table 1.Progression-free Survival and Overall Survival Among Patients with HR+/HER2- ABC.PIK3CA MutantPIK3CA Wild-typeProgression-free Survival (months)1st line – all patients (n)249143Median (95% CI)12.4 (10.4-15.2)13.5 (10.3-16.0)1st line – CDK4/6i + AI (n)9658Median (95% CI)21.0 (17.0-27.9)19.1 (9.4-28.6)2nd line – all patients (n)211127Median (95% CI)7.3 (6.3-10.4)6.8 (5.4-8.8)2nd line – chemotherapy-based regimens (n)5427Median (95% CI)5.1 (3.7-6.3)5.2 (3.3-6.3)3rd line – all patients (n)186115Median (95% CI)4.5 (3.7-5.4)5.7 (4.7-8.9)3rd line – chemotherapy-based regimens (n)7739Median (95% CI)4.3 (3.0-5.1)4.7 (3.0-7.7)Overall Survival (months)Median (95% CI)47.4 (42.8-52.4)55.5 (44.9-61.9) Citation Format: Pedram Razavi, Rohan C Parikh, Barbara Acevedo, Abigail Hitchens, Mehnaj Ahmed, Anton Safonov, Emanuela Ferraro, Komal Jhaveri, Michelle Sidel, Stacey Simmons, Mark Robson, Sarat Chandarlapaty, Sanjeev Balu. Real-world natural history data among patients with PIK3CA-mutant and PIK3CA-wild-type advanced breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-18.

Factors Associated with Retention and Adherence in a Comprehensive, Diverse HIV Pre-Exposure Prophylaxis Clinic.

Retention in HIV pre-exposure prophylaxis (PrEP) care and adherence to PrEP have been suboptimal in some populations, despite evidence that high adherence dramatically enhances PrEP efficacy. A comprehensive PrEP Clinic with a retention specialist and clinical pharmacist could impact patient's retention and adherence in PrEP care. A retrospective electronic medical record review of patients attending an academic PrEP Clinic was conducted between June 2018 and June 2019 (at least one visit attended for PrEP was required). Retention was defined as a medical or laboratory visit every 3 months ±30 days, as recommended by CDC guidelines, but was analyzed using the number of visits and time between visits via multivariate regression analyses. PrEP adherence was calculated using a Medication-Possession Ratio (MPR) and compared between patient characteristics using Kruskal-Wallis tests. One hundred twenty-two patients were identified by chart review, 96 had sufficient data for follow-up and were included in at least one analysis. The population was primarily cisgender men who have sex with men and over half were African American or Hispanic. Overall, patient retention was 43%. The retention analysis demonstrated that individuals who self-identified as gay were more likely to be retained than those who identified as heterosexual (53% vs. 18%, hazard ratio = 1.75, 95% confidence interval = [1.01-3.03], p = .045). Although not statistically significant, African Americans and cisgender women were less likely to be retained in care. The adherence analysis identified higher median MPRs among patients not reporting previous incarceration (80% vs. 35%, p < .01). Although not statistically significant, there was lower adherence among youth 18-24 (11% vs. 54% MPR >80, p = .058). Despite comprehensive PrEP clinical care, heterosexual individuals were less likely to be retained in PrEP care than those who self-identified as gay and previously incarcerated individuals were less likely to be adherent to PrEP.

The use of a single-piece bone flap for cranial reshaping in anterior craniosynostosis patients: clinical experience and a description of a novel technique

BackgroundCraniosynostosis is known as premature closure of one or more of the cranial sutures. Anterior craniosynostosis involves anterior plagiocephaly and trigonocephaly. One of the issues in anterior craniosynostosis skull reshaping is maintaining an aesthetically pleasing forehead curve. Therefore, in this article, we demonstrate our novel technique to use a single-piece bone flap for cranial reshaping of the anterior mold in patients diagnosed with anterior craniosynostosis. A retrospective record review of patients who underwent single piece bone flap cranial reshaping for correction of unicoronal synostosis (UCS) and metopic synostosis (MS) at an Academic Institute in Riyadh, Saudi Arabia, between 2018 and 2020, was conducted.ResultsSix non-syndromic consecutive patients were included. Three of the patients had MS. The mean age at surgery was 11.16 months (range, 6–19 months). The average OR time was 315 min (range, 263–368 min). The average intraoperative blood loss was 225 ml (range, 100–400 ml). All patients had achieved acceptable functional and aesthetic results.ConclusionOur novel technique is an innovative and efficient reconstructive technique to simultaneously address MS and UCS and minimize intraoperative bleeding and surgery time. However, more studies with more cases are required.

A comprehensive evaluation of bronchoscopy at a large urban public hospital in South Africa

ABSTRACT Background: A definitive diagnosis of respiratory pathology is often elusive without tissue biopsy. Bronchoscopy is indispensable to visualise and sample endobronchial lesions and lung parenchyma. Objectives: To describe the practise of fibreoptic bronchoscopy at Chris Hani Baragwanath Academic Hospital (CHBAH). Outcomes include patient demographics, as well as indications and findings of fibreoptic bronchoscopy. To define possible associations between demographic characteristics and final diagnosis. Methods: Retrospective record review of patients who had undergone fibreoptic bronchoscopy at CHBAH over a 8-year period (2011–2018). Results: Bronchoscopy records were retrieved for 830 patients. Two thirds of patients were male; the mean age of patients was 56.1 (+/−13.3) years. Human Immunodeficiency virus (HIV) status was reported in 74%. Twenty-two percent of this population was seropositive for HIV (median CD4 count 233 cells/mm3, IQR: 85–434 cells/mm3). Most were performed for suspected endobronchial lesions (52%), and 12% for pulmonary infiltrates. The most common final diagnosis was lung malignancy in 39% of patients. Squamous cell carcinoma was identified in 43%, followed by adenocarcinoma (31%). Women and HIV positive patients were less likely to be diagnosed with malignancy compared to men and HIV negative patients. The complication rate for bronchoscopy was 2%. Conclusion: Suspected endobronchial lesions were the most common indication for bronchoscopy, and the most common diagnosis was primary lung cancer. Bronchoscopy is a useful tool in the diagnosis of respiratory disease with a low complication rate.

Pre-operative lipid profile of cardiac surgery patients: Implications of incidental findings

Background: Dyslipidemia is an established risk factor for cardiovascular disease (CVD). Different schools of thought hold different opinions regarding the use of statins in the perioperative period for cardiac surgery patients. There seems not to be a consensus yet on when to commence statin therapy for cardiac surgery patients not yet on treatment for dyslipidemia, but the beneficial effects of dyslipidemia management are not in doubt. Objectives: The objective was to characterize the pattern of dyslipidemia and atherogenic indices present in cardiac surgery patients. Materials and Methods: The study was a retrospective record review of patients who presented for open heart surgery between 2013 and 2017. Results of pre-operative lipid profile of patients were extracted and analyzed using SPSS version 22. Atherogenic risk was determined using three different risk ratios: atherogenic plasma index and Castelli’s risk indices-I and II. Results: The study included a total of 51 adult patients with the age range 18–75 years and male: female ratio of 1:1.4. Dyslipidemia observed in participants was majorly in the form of low high-density lipoprotein 24 (49.0%) and elevated low-density lipoprotein 11 (22.5%). Using atherogenic plasma index, more than one-quarter of participants 15 (30.6%) were found to be in the high- and medium-risk groups. Conclusion: Incidental findings of dyslipidemia made in this group of patients have its associated health implications. Hence, it buttresses the importance of assessing for and adequate management of the medical condition, particularly in a group of patients already burdened with CVD.

Early outcomes of patients after on-pump coronary artery bypass grafting at Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Bahrain Defence Force Hospital in the Kingdom of Bahrain

Background: Coronary artery bypass grafting (CABG) is increasingly performed on patients with acute coronary syndrome in Bahrain. Recognition of early outcomes associated with the procedure can provide members of the healthcare team with a better awareness of their occurrence, hence can impact on important decisions with respect to provision of monitoring, diagnosis, and further treatment. Objective: The objective of this study is to determine the early outcomes of patients who have undergone on-pump CABG at Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Bahrain Defence Force Hospital (BDF) in the Kingdom of Bahrain. Method: This is a retrospective medical record review of patients who have undergone on-pump CABG at BDF Hospital from January 1, 2010 to December 31, 2010. Data extraction was carried out by one investigator and cross checked. Results: 150 patients were included in this study, 85.3% were between 40 and 59 years of age and 70% were male. 43.3% of patients stayed in the Intensive Care Unit (ICU) for 5 days. One patient had congestive heart failure and another one had stroke. Two patients had acute renal failure. Post-op ejection fraction at 30-40% was seen in 35% of patients. Blood loss in 25% of patients was estimated at 150cc. Post-operative wound complication occurred in 3 patients, and in one this necessitated sternal debridement. Conclusion: On-pump coronary artery bypass grafting (CABG) is increasingly being undertaken for Bahraini men aged 40-59 years, with ejection fraction lower than normal levels who have multi-vessel disease. The relative safety of CABG was illustrated by the comparatively low mortality rate.

Mortality disparities among patients with HIV-associated Kaposi's sarcoma in the southern United States.

To describe risk factors for mortality in HIV-associated Kaposi's sarcoma in an urban population in Dallas, Texas. Retrospective electronic medical record review of patients with HIV-associated Kaposi's sarcoma. Electronic medical records were reviewed from 1 January 2009 to 31 December 2018 for patients with a diagnosis of HIV and Kaposi's sarcoma by ICD-9 or ICD-10 codes. Demographics, HIV history, Kaposi's sarcoma history, treatment, and mortality data were collected. Mortality data was supplemented by an inquiry from the National Death Index (NDI). Survival analyses were performed using Cox proportional hazards analysis to determine independent predictors of mortality. Black patients had higher mortality than white or Hispanic patients (hazard ratio 2.07, 95% confidence interval 1.12-3.82), even after adjusting for covariates. This mortality difference correlates with higher rates of advanced Kaposi's sarcoma disease and KS-IRIS in black patients compared with other groups and is not explained by differences in CD4+ cell count, HIV viral load, engagement in care, or ART adherence at the time of cancer diagnosis. Despite nationwide trends showing decreased incidence and decreased mortality in Kaposi's sarcoma in the ART era, a high number of Kaposi's sarcoma cases and disparities in Kaposi's sarcoma outcomes persist in certain populations in the United States.

Effect of urine-specific gravity on performance of bacteriuria in predicting urine culture results.

To determine the effect of urine-specific gravity (USG) on using microscopic evaluation of bacteriuria to predict urine culture results in dogs and cats. We performed a retrospective medical record review of canine and feline patients that had a urinalysis and urine culture performed simultaneously. The sensitivity, specificity, positive predictive value and negative predictive value of microscopic bacteriuria for predicting urine culture results were calculated, stratified by USG. Multivariable regression was performed to test the effect of USG, pyuria, haematuria and species on the agreement between microscopic bacteriuria and culture results. A total of 481 dogs and 291 cats with paired urinalysis and urine culture results were included in the study. Microscopic bacteriuria had moderate sensitivity (76% in dogs, 64% in cats) and high specificity (97% in dogs, 96% in cats) for predicting urine culture bacterial growth. Samples with rod bacteria were more likely to have bacterial growth than those with cocci (OR=Infinity, 95% CI 4.8 - Infinity). As compared to isosthenuric+hyposthenuric samples (USG ≤1.012), agreement was lower in moderately concentrated (OR=0.44, 95% CI 0.19 to 0.91) samples. Absence of bacteriuria, pyuria and haematuria had a high negative predictive value for no bacterial growth (96%). Microscopic bacteriuria has a high specificity in predicting urine culture results, regardless of USG. The finding that microscopic bacteriuria has better agreement with urine culture results in isosthenuric+hyposthenuric urine argues against reflex culture in these samples, especially if pyuria and haematuria are also absent. Urine microscopy can aid clinicians in determining the likelihood of urine culture growth.

Bronchoscopy Decreases Ventilator-Associated Pneumonia in Trauma Patients.

Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for all patients who have been intubated pre-hospital providing no contraindications were present. Our aim was to ascertain any influence of the protocol change on the rate of VAP. We conducted a retrospective medical record review of trauma patients who were intubated in the field or ED and seen at our institution (an accredited Level 1 trauma center) from 2012 to 2018. Applying the current definition of VAP from the Centers for Disease Control and Prevention (CDC) to data collected from the CMMC trauma registry, we observed a 13% lower VAP rate in the bronchoscopy group (YB) as compared to the group that did not receive bronchoscopy (NB) (P < .025). Based on our results, we determined that bronchoscopy performed in this setting does support a statistically significant decrease in the rate of ventilator-associated pneumonia.