Stable Patients Research Articles

Middle Meningeal Artery Embolization for "Trial-Ineligible" Chronic Subdural Hematomas.

The benefit of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) has been recently demonstrated in a series of clinical trials. Whether MMAE benefits "trial-ineligible" patients remains elusive. We thus sought to explore the potential benefit of MMAE in neurologically stable (modified Rankin Scale ≤3) patients with "trial-ineligible" CSDHs because of large size: Thickness >15 mm and/or midline shift ≥5 mm. A prospectively maintained database was reviewed to identify trial-ineligible CSDHs undergoing standalone MMAE. Surgical rescue rate, hematoma resolution, and neurological deterioration after hematoma progression were evaluated and compared with trial-eligible counterparts. Effect sizes were adjusted for demographic, clinical, and radiological features using multivariable regression. Of 150 standalone MMAE procedures, 92 (61%) were performed in "trial-ineligible" cases: 41% with CSDH thickness >15 mm, 21% with midline shift ≥5 mm, and 38% with both. The surgical rescue rate was 7.6% in the trial-ineligible cohort. Over a median follow-up of 62.5 days, 88.9% cases achieved satisfactory hematoma resolution (≥50% in thickness); 76% had satisfactory resolution at 90-day follow-up. Antithrombotic resumption was a risk factor for surgical rescue (adjusted odds ratio 9.64 [95% CI, 1.33-69.74]; P = .02). Surgical rescue and hematoma resolution did not significantly differ between trial-ineligible and trial-eligible cohorts (P = .87 for surgical rescue rate and P = .85 for hematoma resolution rate). This study emphasizes the considerable prevalence of potentially "trial-ineligible" patients with CSDHs because of large size that may still benefit from standalone MMAE.

Mind–body exercise for patients with stable COPD on lung function and exercise capacity: a systematic review and meta-analysis of RCTs

Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. Mind–body exercises like Tai Chi and Yoga are suggested as non-pharmacological interventions for COPD management. This meta-analysis evaluates mind–body exercises' impact on lung function and exercise capacity in stable COPD patients, aiming to assess their effectiveness in rehabilitation. A systematic search across various databases identified relevant randomized controlled trials until April 2024. Primary outcomes included lung function tests (FEV1, FVC, FEV1/FVC, FEV1%) and Six-Minute Walk Test (6MWT) results. The Standardized Mean Difference (SMD) measured intervention effects. Fifteen studies with 1047 participants were analyzed. Mind–body exercises significantly improved FEV1 (SMD = 0.87), FEV1/FVC (SMD = 0.19), FEV1% (SMD = 0.43), and 6MWT (SMD = 1.21) compared to standard care. Sensitivity and subgroup analyses confirmed result stability despite some heterogeneity.In conclusion, Mind–body exercises enhance lung function and exercise capacity in stable COPD patients. Integrating them into comprehensive rehabilitation programs is advisable. Further research should explore the specific impacts of different exercise types and intensities.

Effect of physical activity in lymphocytes senescence burden in COPD patients.

Chronic obstructive pulmonary disease (COPD) is regarded as an accelerated-age disease in which chronic inflammation, maladaptive immune responses and senescence cell burden coexist. Accordingly, cellular senescence has emerged as a potential mechanism involved in COPD pathophysiology. In this study, 25 stable COPD patients underwent a daily physical activity promotion program for six months. We reported that increase of physical activity was related to a reduction of the senescent cell burden in COPD patients' circulating lymphocytes. Senescent T-lymphocytes population, characterized by absence of surface expression of CD28, was reduced after physical activity intervention and the reduction was associated to the increase of physical activity level. In addition, the mRNA expression of cyclin-dependent kinases inhibitors, a hallmark of cell senescence, was reduced and, in accordance, the proliferative capacity of lymphocytes was improved post-intervention. Moreover, we observed an increase in functionality in T-cells from patients after intervention, including improved markers of activation, enhanced cytotoxicity and altered cytokines secretions in response to viral challenge. Lastly, physical activity intervention reduced the potential of lymphocytes' secretome to induce senescence in human primary fibroblasts. In conclusion, our study provides, for the first time, evidence of the potential of physical activity intervention in COPD patients to reduce the senescent burden in circulating immune cells.

Transarterial embolization to treat hemodynamically unstable trauma patients with splenic injuries: A retrospective multicenter observational study

PurposeWe described clinical outcomes for patients with blunt splenic injuries treated with transarterial embolization (TAE) based on their hemodynamic status. Materials and MethodsThis is a retrospective two-center study of adult patients with splenic injuries who underwent emergency TAE between January 2011 and December 2022. Patients were divided into two groups; hemodynamically unstable (HDU) and hemodynamically stable (HDS) patients. HDU patients were defined as transient- or non-responders to fluid resuscitation and HDS as responders. When immediate laparotomy was not possible for HDU patients, angiography and embolization were performed. The primary outcome was the survival discharge rate. Rebleeding and splenectomy rate was also investigated. ResultsOf 38 patients underwent emergency TAE for splenic trauma, 17 were HDU patients and 21 were HDS patients. The survival discharge rate was 88.2 % (15/17) in the HDU- and 100 % in HDS patients (p = 0.193). Rebleeding rate was 23.5 % (4/17) in HDU- and 5.0 % (1/21) in HDS patients (p = 0.15). Splenectomy was required for one HDU patient (5.9 %) for rebleeding. ConclusionThe survival discharge rate of TAE for splenic trauma in HDU patients was acceptable with a low rate of splenectomy. Further comparative studies of TAE versus operative management in HDU patients are needed to prove the usefulness of TAE.

Relationship between Respiratory Microbiome and Systemic Inflammatory Markers in COPD: A Pilot Study

The respiratory microbiome may influence the development and progression of COPD by modulating local immune and inflammatory events. We aimed to investigate whether relative changes in respiratory bacterial abundance are also associated with systemic inflammation, and explore their relationship with the main clinical COPD phenotypes. Multiplex analysis of inflammatory markers and transcript eosinophil-related markers were analyzed on peripheral blood in a cohort of stable COPD patients (n = 72). Respiratory microbiome composition was analyzed by 16S rRNA microbial sequencing on spontaneous sputum. Spearman correlations were applied to test the relationship between the microbiome composition and systemic inflammation. The concentration of the plasma IL-8 showed an inverted correlation with the relative abundance of 17 bacterial genera in the whole COPD cohort. COPD patients categorized as eosinophilic showed positive relationships with blood eosinophil markers and inversely correlated with the degree of airway obstruction and the number of exacerbations during the previous year. COPD patients categorized as frequent exacerbators were enriched with the bacterial genera Pseudomonas which, in turn, was positively associated with the severity of airflow limitation and the prior year’s exacerbation history. The associative relationships of the sputum microbiome with the severity of the disease emphasize the relevance of the interaction between the respiratory microbiota and systemic inflammation.

Evaluation of the Variability of AIZE Rapid Tests on the "imo" Perimeter In Stable Glaucoma Patients.

Analysis of AIZE Rapid test variability in stable glaucoma patients showed that the 95% prediction interval of the MD value, potentially an index for judging progression, was ±1.63 to ±1.78dB in early-to-moderate-stage patients. To explore the 95% prediction interval of the mean deviation (MD) value using the AIZE Rapid test strategy for glaucoma observation. This study included seventy-two patients with stable or suspected glaucoma who underwent the imo AIZE Rapid test three times or more within two years. Both eyes from each patient were classified as better or worse eyes. They were divided based on baseline MD values into the following four groups: MD > -3dB, -6dB < MD ≤ -3dB, -12dB < MD ≤ -6dB, and MD ≤ -12dB. The variability of MD during the observation period and the 95% prediction intervals were analyzed. Pointwise variability of limits at each test locations were also calculated. The numbers of better and worse eyes included in the study were forty-six and thirty-three. The median follow-up period was 1.3 years (range: 0.5 to 1.9 years). The 95% prediction intervals for MD values were ±1.41dB for better eyes (n = 46) and ±1.47dB for worse eyes (n = 33). The 95% prediction intervals in the MD > -3dB, -6dB < MD ≤ -3dB, -12dB < MD ≤ -6dB, and MD ≤ -12dB groups were ±1.63dB, ±1.34dB, ±1.78dB, and ±1.33dB, respectively. Pointwise variability of worse eyes was larger than better eyes especially in between 10 to 15dB. In the case of a difference in MD greater than the 95% prediction intervals when compared with the previous visual field result, we should pay much attention to the possibility of progression of the glaucomatous visual field in stable glaucoma patients.

Effects of Baduanjin Exercise on lung function and 6 min walk in COPD patients: a systematic review and meta-analysis

COPD is a public health problem of global concern, which seriously affects the quality of life of patients and is also the third leading cause of death from non-communicable diseases. To investigate the effect of Ba duan jin exercise on lung function and the results of a 6-min walking trial in patients with stable COPD. Literature databases such as Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Literature (CBM), CNKI, Wanfang Data and VIP were searched by computer, the search period is up to January 2024. Literature screening, quality evaluation and data extraction were carried out independently by two researchers. And use RevMan 5.3 software and StataMP 18 (64-bit) software to process the relevant outcome indicators. A total of 16 RCT studies with 1184 patients were included. The meta-analysis results showed that compared with the control group, Ba Duan Jin exercise could improve FEV1 (MD = 0.29, 95% CI (0.20, 0.37), P < 0.0001), FEV1/FVC (%) (MD = 3.86, 95% CI (2.24, 5.47), P < 0.00001), and 6-min walking distance (MD = 45.41, 95% CI (33.93, 56.89), P < 0.00001) in stable COPD patients. The results of subgroup analysis based on the duration of the intervention cycle, research quality, and intervention frequency showed that periodic Ba Duan Jin exercise can significantly improve the relevant lung function levels to varying degrees. At the same time, the intervention effect of Ba Duan Jin exercise during the implementation process is also affected by the duration of the exercise cycle, exercise frequency, and the completion of the exercise plan. Ba Duan Jin exercise has a positive improvement effect on lung function and 6-min walking distance in stable COPD patients. In the process of exercise implementation, attention should be paid to cultivating exercise habits, stabilizing and improving attendance rates, and strictly implementing training techniques to achieve the best clinical outcomes for these patients.

Analysis of individual alpha frequency in a large cohort from a tertiary memory center.

Precise and timely diagnosis is crucial for the optimal use of emerging disease-modifying treatments for Alzheimer disease (AD). Electroencephalography (EEG), which is noninvasive and cost-effective, can capture neural abnormalities linked to various dementias. This study explores the use of individual alpha frequency (IAF) derived from EEG as a diagnostic and prognostic tool in cognitively impaired patients. This retrospective study included 375 patients from the tertiary Memory Clinic of IRCCS San Raffaele Hospital, Milan, Italy. Participants underwent clinical and neuropsychological assessments, brain imaging, cerebrospinal fluid biomarker analysis, and resting-state EEG. Patients were categorized by amyloid status, the AT(N) classification system, clinical diagnosis, and mild cognitive impairment (MCI) progression to AD dementia. IAF was calculated and compared among study groups. Receiver operating characteristic (ROC) analysis was used to calculate its discriminative performance. IAF was higher in amyloid-negative subjects and varied significantly across AT(N) groups. ROC analysis confirmed IAF's ability to distinguish A-T-N- from the A+T+N+ and A+T-N+ groups. IAF was lower in AD and Lewy body dementia patients compared to MCI and other dementia types, with moderate discriminatory capability. Among A+ MCI patients, IAF was significantly lower in those who converted to AD within 2 years compared to stable MCI patients and predicted time to conversion (p < 0.001, R = 0.38). IAF is a valuable tool for dementia diagnosis and prognosis, correlating with amyloid status and neurodegeneration. It effectively predicts MCI progression to AD, supporting its use in early, targeted interventions in the context of disease-modifying treatments.

Immediate vs. Multistage Revascularization of Non-Culprit Coronary Arteries in Hemodynamically Stable Patients With Multivessel Disease Acute Myocardial Infraction: A Systematic Review and Meta-Analysis

Immediate vs. Multistage Revascularization of Non-Culprit Coronary Arteries in Hemodynamically Stable Patients With Multivessel Disease Acute Myocardial Infraction: A Systematic Review and Meta-Analysis

Comparative Analysis of Combined Topography-Guided Photorefractive Keratectomy and Corneal Crosslinking in Progressive Versus Stable Keratoconus.

To perform a comparative analysis of visual, refractive, and tomographic outcomes of combined topography-guided photorefractive keratectomy (TG-PRK) and corneal crosslinking (CXL) in patients with progressive versus stable keratoconus. Longitudinal retrospective case-control study. Patients with keratoconus submitted to simultaneous TG-PRK and CXL were included, with a minimum follow-up of 12 months up to 3 years. According to predefined disease progression criteria, patients were considered as progressive or stable. A total of 101 eyes from 93 patients were included, 62 considered progressive and 39 stable keratoconus. All baseline characteristics were similar between groups, except for age at surgery (progressive: 23.40 ± 4.22 years; stable: 35.97 ± 9.09; P < 0.001). Logarithm of the minimum angle of resolution CDVA improved significantly in progressive (baseline: 0.48 ± 0.24; 12 months: 0.33 ± 0.29; P < 0.001) and stable (baseline: 0.51 ± 0.24; 12 months: 0.28 ± 0.21; P < 0.001) patients, with no differences between groups. Maximum keratometry decreased significantly in progressive (baseline: 59.18 ± 5.63 diopters; 12 months: 54.73 ± 5.95; P < 0.001) and stable (baseline: 57.77 ± 5.02; 12 months: 53.59 ± 4.20; P < 0.001) patients, with no differences between groups. Index of surface variance significantly improved in progressive (baseline: 109.18 ± 31.74 diopters; 12 months: 94.11 ± 34.11; P < 0.001) and stable (baseline: 102.87 ± 29.52; 12 months: 86.95 ± 27.21; P < 0.001) patients, with no differences between groups. Other tomographic outcomes were also similar between groups. Pachymetry significantly decreased after surgery but remained stable throughout the follow-up. Combined TG-PRK and CXL is a safe and effective procedure for improving CDVA and regularizing the cornea, with comparable visual, refractive, and tomographic outcomes in both progressive and stable keratoconus. Combined TG-PRK and CXL may be added to the armamentarium of therapeutic tools for visual rehabilitation in patients with stable keratoconus.

Role of Laparoscopy in Evaluation of Various Blunt Abdominal Trauma

Introduction with Objective: The aim of the present study was to assess the role of laparoscopy in evaluation of various Blunt abdominal trauma (BTA) in tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted from 21st June 2016 to 21st December 2017 among 50 abdominal blunt trauma patients attending at Casualty Block, Dhaka Medical College Hospital, Dhaka, after obtaining requisite consent from the patients attendant. Data were collected through the assessment and investigation report of abdominal blunt trauma patients in the Casualty Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the role of laparoscopy in evaluation of various blunt abdominal trauma. Results: Most of the patients were from 21-30 years (36%) of age group followed by 11-20 years (32%). The median age of this study population is 27 years. Of the study population, 84% (n=42) were male and 16% (n=8) were female. Male-female ratio was 84:16. In this study, 62% (n=31) of patients underwent only laparoscopy and 38% of patients (n=19%) underwent laparoscopy followed by laparotomy. Perforation of gas containing hollow viscus (94.73%) is responsible for conversion of laparoscopy into laparotomy in patients with blunt abdominal trauma. Among 50 patients 14 patients (28%) developed post operative complications. Rate of wound infection was higher laparoscopy followed by laparotomy (n=11). One patient developed post operative collection following laparoscopy. The accuracy rate is 100% in laparoscopic evaluation of BTA in this study. Conclusion: laparoscopy is a useful modality for evaluating and managing hemodynamically stable blunt abdominal trauma patients. Medicine Today 2024, Vol.36 (2): 95-98

Short- and Long-Term Prognosis in Hemodynamically Stable Pulmonary Embolism With Unresectable or Metastatic Malignancies: The Role of Performance Status.

The simplified Pulmonary Embolism Severity Index (sPESI) has limitations when evaluating acute pulmonary embolism (PE) in patients with concurrent malignancy. Despite its utility in predicting outcomes among cancer patients, the role of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) in acute PE remains underexplored. This study aims to assess the prognostic significance of ECOG PS ≥ 3 on short- and long-term mortality in acute PE with malignancy, correlating it with the sPESI. We retrospectively analyzed 44 hemodynamically stable acute PE patients with unresectable or metastatic malignancies ineligible for curative treatment at Kameda Medical Center, a tertiary medical facility in Japan, from April 1, 2019, to March 2, 2023. Of these patients, 16 (36.4%) had ECOG PS ≥ 3. No 30-day mortality occurred in patients with ECOG PS ≤ 2, compared to 18.8% in those with ECOG PS ≥ 3 (p = 0.04). Groups were similar in the sPESI scores, hospital-onset PE proportion, and initial treatments. Post PE diagnosis, 92.9% of ECOG PS ≤ 2 patients and 50% of ECOG PS ≥ 3 patients received chemotherapy (p = 0.002). Cox regression analysis revealed ECOG PS ≥ 3 was independently associated with increased overall survival hazard (adjusted HR = 4.0; P = 0.002). ECOG PS ≥ 3 suggests a poorer short-term prognosis and independently predicts a worse long-term prognosis in hemodynamically stable acute PE patients with advanced malignancies.

Psychometric Evaluation of the Facial and Total Vitiligo Area Scoring Index Instruments in the TRuE-V Phase 3 Studies.

This study reports psychometric testing of the facial and total Vitiligo Area Scoring Index quantitative clinical instruments (F-VASI [range: 0-3], T-VASI [range: 0-100], respectively) using data from two phase 3 randomized, vehicle-controlled studies of ruxolitinib cream (TRuE-V1/TRuE-V2), the largest vitiligo trials conducted to date. Because VASI assessment is required by regulatory authorities, we evaluated the psychometric properties of the VASI instruments and confirmed thresholds for clinically meaningful change. The TRuE-V1/TRuE-V2 full analysis set population included 652 patients (≥ 12years old with nonsegmental vitiligo affecting ≤ 10% total body surface area, F-VASI ≥ 0.5, and T-VASI ≥ 3 at baseline). Data collected using the facial and total Patient Global Impression of Change-Vitiligo (PaGIC-V) and Physician's Global Vitiligo Assessment (PhGVA) scales were used as anchors to assess F-VASI and T-VASI for reliability, validity, sensitivity to change, and clinically meaningful change. Median F-VASI and T-VASI scores were 0.70 and 6.76, respectively, at baseline, decreasing to 0.48 and 4.80 at week 24. Test-retest reliability was excellent between screening and baseline for F-VASI (intraclass correlation coefficient [ICC]: 0.943) and T-VASI (ICC: 0.945). Among stable patients per PaGIC-V and PhGVA, reliability was moderate to good for both F-VASI (ICC: 0.891 and 0.739, respectively) and T-VASI (ICC: 0.768 and 0.686). F-VASI and T-VASI differentiated well among PhGVA categories mild/moderate/severe at baseline and week 24. Both VASI instruments detected changes assessed by correlations with PaGIC-V scores at week 24 (F-VASI, r = 0.610; T-VASI, r = 0.512) and changes in PhGVA scores from baseline to week 24 (F-VASI, r = 0.501; T-VASI, r = 0.344). Thresholds for clinically meaningful improvement per PaGIC-V and PhGVA were 0.38-0.60 for F-VASI and 1.69-3.88 for T-VASI. Data from the TRuE-V1/TRuE-V2 studies confirmed that F-VASI and T-VASI are reliable, valid, and responsive to change, with defined clinically meaningful change from baseline in patients with nonsegmental vitiligo. The original studies were registered at ClinicalTrials.gov: NCT04052425/NCT04057573.

GDF-15 and the risk of bleeding in patients with stable CAD receiving multicomponent antithrombotic therapy: the results of the prospective REGATA register

To evaluate the prognostic value of GDF-15 in relation the development of bleeding and events in stable CAD patients, receiving combined antithrombotic therapy. The data was obtained from the prospective registry REGATA, 343 CAD patients (249 males), median age 68 [IQR 62; 75] years) were enrolled. Patients with sinus rhythm and concomitant PAD received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid (31.8%) or clopidogrel (24.8%). Other 43.4% with concomitant atrial fibrillation (AF) received direct oral anticoagulants in combination with antiplatelet therapy after elective percutaneous coronary interventions. Median follow-up was 12 months [IQR 9.0; 18.0]. The safety end point was major and clinically relevant bleedings (type 2-5) according to the BARC classification. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA assay. Frequency of BARC 2-5 bleedings was 16% (BARC 2 - 46; BARC 3 - 9; BARC 4-5 - 0), median GDF-15 level was 1185.0 pg/ml [850.0; 1680.0]. In patients with AF and concomitant MFA, the level of GDF-15 was significantly higher than in the subgroups of patients with only AF or MFA (p=0.0022). According to the quintile analysis, GDF-15 values in the top three quintiles of distribution (cut-off value >943 pg/ml) were associated with higher frequency of bleeding events: 23.2% versus 5.1%; p=0.0001. The multivariable logistic regression model demonstrated that bleeding events were independently associated with GDF-15 level>943 pg/ml (OR 2.65, 95% CI 1.11-6.30; p=0.0275), AF (OR 2.61, 95% CI 1.41-4.83; p=0.0023) and chronic kidney disease (OR 1.92, 95% CI 1.03-3.60; p=0.0401). Clinical factors determining the risk of bleeding events also determined a GDF-15 elevation. Assessment of GDF-15 level may improve bleeding risk stratification in CAD patients with concomitant AF and/or PAD receiving combined antithrombotic therapy.

Clinical Outcomes of Patients with AmpC-Beta-Lactamase-Producing Enterobacterales Bacteremia Treated with Carbapenems versus Non-Carbapenem Regimens: A Single-Center Study

Introduction: Bloodstream infections caused by AmpC-producing Enterobacterales pose treatment challenges due to the risk of AmpC overproduction and treatment failure. Current guidelines recommend carbapenems or cefepime as optimal therapy. We aimed to evaluate empiric and definitive non-carbapenem regimens for these infections. Methods: In a retrospective study from June 2014 to March 2023, adult bacteremic patients with Enterobacter cloacae complex strains and Morganella morganii were evaluated. Demographic, clinical and lab data and outcomes were assessed. Results: The cohort comprised 120 bacteremic patients, 17 receiving empiric carbapenem and 103 non-carbapenem regimens. Both groups had similar Charlson and Norton scores and previous antimicrobial exposure. The most common sources of bacteremia were urinary, abdominal and central-line-associated sources. Empiric non-carbapenem regimens (primarily piperacillin–tazobactam and cephalosporins) were not associated with recurrent bacteremia or 30-day mortality. Definitive regimens included mainly carbapenems (n = 41) and ciprofloxacin (n = 46). Beta-lactams were administered to 25 patients. Recurrent bacteremia and 30-day mortality rates were similar among treatment groups. Ciprofloxacin showed comparable outcomes to carbapenems, however, severity of illness among these patients was lower. Conclusions: Empiric and definitive non-carbapenem regimens for bacteremia with AmpC-producing organisms were not associated with treatment failure or increased 30-day mortality. Ciprofloxacin appears promising for selected, stable patients, potentially enabling early discharge.

Evaluating antibiotic de-escalation for autologous stem cell transplant patients with febrile neutropenia in a real-world clinical setting

Febrile neutropenia (FN) is a complication in approximately 90% of autologous stem cell transplant (SCT) patients. Guidelines support early broad-spectrum antibiotics (BSA) to prevent morbidity and mortality. However, in patients who are clinically stable and deemed to have a fever of unknown origin, the optimal duration of BSA is unknown. Accumulating evidence suggests that de-escalation of BSA in select patients may decrease duration of BSA exposure without compromising clinical outcomes such as infection, recurrent fever, and readmission. With this, a de-escalation protocol was implemented at Vanderbilt University Medical Center (VUMC) to identify autologous SCT patients who may benefit from early de-escalation of BSA. The objectives of this study were to analyze the impact of early empiric antibiotic de-escalation on the duration of BSA as well as its impact on the incidence of recurrent fever and documented infection in autologous SCT patients. This was a single-center, retrospective study evaluating patients older than 18 years of age who underwent autologous SCT and experienced an episode of FN from January 2018 to December 2022 at VUMC (N = 195). The protocol was initiated on January 1, 2020, to de-escalate BSA back to prophylaxis in stable neutropenic patients determined to have a fever of unknown origin. The primary outcome was the number of BSA days within 30 days. Secondary clinical outcomes included recurrent fever, documented infection, readmission, 30-day mortality, and 90-day non-relapsed mortality (NRM). Outcomes were compared across pre- and post-protocol groups with a Wilcoxon rank sum test, Pearson chi-square test, or regression analysis as appropriate. The median BSA duration was 4.7 and 2.7 days in the pre- and post-protocol groups, respectively (p <0.001). Recurrent fever (14.2% vs. 16.0%, p = 0.726), documented infection (1.7% vs. 6.7%, p = 0.068), and readmission (13.3% vs. 22.7%, p = 0.091) within 30 days were not significantly different between the two groups. Neither 30-day mortality (0.8% vs. 1.3%, p = 0.736) nor 90-day NRM (0.8% vs. 1.3%, p = 0.736) differed. The implementation of an early de-escalation protocol for autologous SCT patients who develop FN was associated with a reduction in duration of BSA compared to the pre-protocol group without a significant difference in readmission, recurrent fevers, and documented infections. This study adds to existing evidence that early de-escalation of BSA in FN patients with a fever of unknown origin who are afebrile and clinically stable is safe and reduces unnecessary antibiotic use.

Is It Safe to Treat Stable Patients with Bacteremic Urinary Tract Infections with High-Resistant-Rate Antibiotics?

Background and Objectives: In most areas of the world, urine bacteria have high resistance rates to third-generation cephalosporins, and it is unclear if it is safe to treat stable patients with bacteremic urinary tract infections (UTI) with those antibiotics. There are recommendations that empiric therapy for a suspected UTI should include only antibiotics with resistance rates less than 10%. Materials and Methods: In this historical observational single center study, we selected 180 stable internal medicine patients hospitalized between January 2019 and December 2021, with identical bacteria isolated from blood and urine cultures. Charts were reviewed to determine if deaths and readmissions up to 30 days after discharge were due to bacterial resistance to initial antibiotic therapy (BRIAT). Results: The patient’s median age was 82 years (1st–3rd quartiles, 73–87 years). A total of 54.4% were female. There were 125 patients treated with ceftriaxone. A total of 38 (30.3%) had BRIAT. Four patients died, but none were because of a delay in appropriate treatment. The median days of hospitalization for all patients was 7 days, and 9 days versus 6 days in those with and without BRIAT. There were no re-hospitalizations for a UTI in patients with BRIAT. Conclusions: We conclude that, despite high resistance rates, empiric ceftriaxone in stable hospitalized patients with a bacteremic UTI is safe. There was no urosepsis-related mortality during the hospitalization or on follow-up. The treatment of all patients with wider-spectrum antibiotics might have decreased the median hospital stay by only one day. The potential effect would be even lower if all patients with a suspected systemic UTI were treated with wide-spectrum antibiotics, because some patients do not have an infection of the urinary tract. A reassessment of the recommendation that empiric therapy for a suspected systemic urinary tract infection should include only wider-spectrum antibiotics is warranted.

Post-capillary pulmonary hypertension in heart failure: impact of current definition in the PH-HF multicentre study.

Based on retrospective studies, the 2022 European guidelines changed the definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF) by lowering the level of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). However, the impact of this definition and its prognostic value has never been evaluated prospectively. Stable left HF patients with the need for right heart catheterization were enrolled from 2010 to 2018 and prospectively followed up in this multicentre study. The impact of the successive pcPH definitions on pcPH prevalence and subgroup [i.e. isolated (IpcPH) vs. combined pcPH (CpcPH)] was evaluated. Multivariable Cox regression analysis was used to assess the prognostic value of mPAP and PVR on all-cause death or hospitalization for HF (primary outcome). Included were 662 HF patients were (median age 63 years, 60% male). Lowering mPAP from 25 to 20 mmHg resulted in +10% increase in pcPH prevalence, whereas lowering PVR from 3 to 2 resulted in +60% increase in CpcPH prevalence (with significant net reclassification improvement for the primary outcome). In multivariable analysis, both mPAP and PVR remained associated with the primary outcome [hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.00-1.03, P = .01; HR 1.07, 95% CI 1.00-1.14, P = .03]. The best PVR threshold associated with the primary outcome was around 2.2 WU. Using the 2022 definition, pcPH patients had worse survival compared with HF patients without pcPH (log-rank, P = .02) as well as CpcPH compared with IpcPH (log-rank, P = .003). This study is the first emphasizing the impact of the new pcPH definition on CpcPH prevalence and validating the prognostic value of mPAP > 20 mmHg and PVR > 2 WU among HF patients.

Risk of new-onset diabetes and efficacy of pharmacological weight loss therapy.

To develop a clinical risk model to identify individuals at higher risk of developing new-onset diabetes and who might benefit more from weight loss pharmacotherapy. A total of 21 143 patients without type 2 diabetes at baseline from two TIMI clinical trials of stable cardiovascular patients were divided into a derivation (~2/3) and validation (~1/3) cohort. The primary outcome was new-onset diabetes. Twenty-seven candidate risk variables were considered, and variable selection was performed using multivariable Cox regression. The final model was evaluated for discrimination and calibration, and for its ability to identify patients who experienced a larger benefit from the weight loss medication lorcaserin in terms of risk of new-onset diabetes. During a median (interquartile range) follow-up of 2.3 (1.8-2.7) years, new-onset diabetes occurred in 1013 patients (7.7%). The final model included five independent predictors (glycated haemoglobin, fasting glucose, age, body mass index, and triglycerides/high-density lipoprotein). The clinical risk model showed good discrimination (Harrell's C-indices 0.802, 95% confidence interval [CI] 0.788-0.817 and 0.807, 95% CI 0.788-0.826) in the derivation and validation cohorts. The calibration plot demonstrated adequate calibration (2.5-year area under the curve was 81.2 [79.1-83.5]). While hazard ratios for new-onset diabetes with a weight-loss therapy were comparable across risk groups (annual risks of <1%, 1%-5%, and >5%), there was a sixfold gradient in absolute risk reduction from lowest to highest risk group (p = 0.027). The developed clinical risk model effectively predicts new-onset diabetes, with potential implications for personalized patient care and therapeutic decision making.

Proportion of sleep-related breathing disorders and their association with echocardiographic parameters in stable patients with chronic obstructive pulmonary disease: a cross-sectional observational exploratory study

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. The coexistence of COPD and obstructive sleep apnea (OSA) (i.e., overlap syndrome) has been reported in several studies. Both disorders independently increase the risk of cardiovascular complications. Hence, there is a theoretical possibility that cardiovascular parameters may be worse in patients with overlap syndrome compared to those with only COPD. However, this has been sparsely assessed in the literature. This study aimed to compare the clinical characteristics, echocardiography, and sleep parameters amongst COPD patients with and without sleep-related breathing disorders (SRBD). This observational, cross-sectional study included 30 patients with stable COPD. All participants underwent a detailed clinical evaluation, followed by level 1 polysomnography (PSG). Each participant underwent echocardiographic evaluation to estimate mean pulmonary artery pressure from right ventricular systolic pressure (RVSP). Based on their PSG findings, participants were classified into non-SRBD and SRBD groups. Both groups were further compared with respect to clinical characteristics, echocardiographic, and PSG parameters. We found that most of the participants (93.3%) were male, and the mean age of the study population was 56±8.2 years. The only SRBD identified in this study was OSA, which was observed in 80% of participants. In this group, OSA was not associated with obesity. Systemic hypertension (50%) was the most common comorbidity, followed by diabetes mellitus (26.67%), but both were not significantly different between the groups. The mean RVSP was significantly higher amongst OSA patients than non-OSA patients (41.25±14.98 versus 30.83±5.84, respectively; p=0.01). OSA was seen in 80% of participants with stable COPD, even in the absence of obesity. The presence of OSA was associated with a higher RVSP in this patient group.