Tertiary Care Setting Research Articles

Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study

ObjectiveThrough predictable pharmacokinetics—including a convenient fixed-dose regimen, direct oral anticoagulants (DOACs) are preferred over previous treatments in anticoagulation for various indications. However, the association between higher body weight and the risk of adverse consequences is not well studied among DOAC users. We aim to explore the association of body weight and adverse clinical outcomes in DOAC users.MethodsA total of 97,413 anonymised DOAC users in a tertiary care setting were identified following structured queries on the electronic health records (EHRs) to extract the feature-rich anonymised dataset. The prepared dataset was analysed, and the features identified with machine learning (ML) informed the adjustments of covariates in the multivariate regression analysis to examine the association. Kaplan–Meier analysis was performed to evaluate the mortality benefits of DOACs.ResultsAmong DOAC users, the odds of adverse clinical outcomes, such as clinically relevant non-major bleeding (CRNMB), ischaemic stroke, all-cause mortality, and prolonged hospital stay, were lower in patients with overweight, obesity, or morbid obesity than in patients with normal body weight. The odds of ischaemic stroke (OR 0.42, 95% CI: 0.36–0.88, p = 0.001) and all-cause mortality (OR 0.87, 95% CI: 0.81–0.95, p = 0.001) were lower in patients with morbid obesity than in patients with normal body weight. In the Kaplan–Meier analysis, apixaban was associated with a significantly lower rate of mortality overall and in obesity and overweight subgroups than other DOACs (p < 0.001). However, rivaroxaban performed better than apixaban in the morbid obesity subgroup (p < 0.001).ConclusionThis study shows the positive effects of DOAC therapy on clinical outcomes, particularly in patients with high body weight. However, this still needs validation by further studies particularly among patients with morbid obesity.

Evaluation of the impact of hemotransfusion on hospitalization length and complications in patients with non-variceal upper gastrointestinal bleeding

Background: Upper gastrointestinal bleeding (UGB) is a common emergency associated with high morbidity and mortality. It can be caused by various factors, including peptic ulcers and vascular lesions. The decision to perform blood transfusion in stable UGB patients is still controversial, with more restrictive strategies showing better outcomes. Methods: A retrospective cohort study reviewed 1433 medical records of non-variceal UGB patients in a Brazilian tertiary care setting. Patients were divided into groups based on whether they received blood transfusion or not. Patient characteristics, laboratory values, procedures, and outcomes were analyzed. Logistic and linear regression models were used to assess the association of blood transfusion with complications and hospital stay. Results: Blood transfusion was associated with increased hospitalization length (p&lt;0.001), higher rebleeding rates (p&lt;0.001), and greater clinical severity. However, no association with worse renal outcomes was observed (p=0.203). Adjusting for clinical severity (Glasgow-Blatchford score) reduced the significance of the association with hospitalization length. Conclusion: Blood transfusion in stable UGB patients may serve as a marker of severity, associated with longer hospital stay and increased rebleeding rates. It does not appear to have a direct causal relationship with worse renal outcomes. The study suggests that clinical severity may play a pivotal role in outcomes, as indicated by the association with Glasgow-Blatchford score.

Effectiveness of Swallowing and Oral Care Interventions on Oral Intake and Salivary Flow of Patients Following Endotracheal Extubation at a Tertiary Care Center: A Randomized Controlled Trial.

Endotracheal intubation and mechanical ventilation are the most frequently used life-sustaining interventions in critical care. Prolonged intubation can lead to post-extubation dysphagia, affecting the individual's nutritional level and communication ability. Thereupon, this study aims to assess the effectiveness of swallowing and oral care interventions in resuming oral intake and increasing salivary flow in post-extubation patients. A randomized controlled trial was conducted in critical care units of a tertiary care setting, where 92 post-extubation patients who had undergone intubation for≥48 hours were enrolled. The intervention group received swallowing and oral interventions, including safe swallowing education (SSE), toothbrushing, salivary gland massage, oral cavity, and swallowing exercises. In contrast, the control group received standard oral care every 8th hour. Oral intake was assessed daily with the Functional Oral Intake Scale, and the salivary flow measurement was assessed with oral Schirmer's test on the 1st, 3rd, and 7th day after extubation. The baseline demographic and clinical characteristics showed that the groups were homogenous. The intervention group achieved total oral intake two days earlier than the control group. Findings also showed that the participants in the intervention group had a significant increase in salivary flow than in the control group on the 3rd and 7th days of the intervention. Swallowing and oral care interventions help post-extubation patients resume early oral intake and increase salivary flow after prolonged intubation. Hence, it improves the patient's outcome toward a healthy life.

Molecular detection of antimalarial resistance in Plasmodium vivax isolates from a tertiary care setting in Puducherry

PurposeThe study was aimed at detecting the mutation patterns in the drug targets in Plasmodium vivax that confer resistance to the common antimalarial agents used in India. MethodsA total of 27 Plasmodium vivax isolates collected from whole blood samples over a three year period were subjected to PCR amplification followed by sequencing of the genes pvmdr1, pvdhfr, pvdhps and pvk12, which serve as the molecular targets to detect resistance to chloroquine, pyrimethamine, sulfadoxine and artemisinin respectively. ResultsThe study found T958 M F1076L double mutants of pvmdr1 in 52 %(14/27) isolates, S58R S117 N double mutants of pvdhfr in 67 % (18/27) isolates, A383G A553G double mutant pvdhps in 59 % (16/27) isolates and wild type of pvk12 gene in all the isolates. ConclusionsThere was a rise in the proportion of double mutants of pvmdr1 and pvdhfr over time. Those cases with double mutant pvmdr1 gene in their isolates were found to have a prolonged hospital stay compared to those without, indicating reduced clinical response to chloroquine.

Long term stability of lactate in uncentrifuged sodium fluoride/potassium oxalate blood collection tubes.

Delayed time from collection to centrifugation may cause erroneously high lactate levels in vitro (from continued blood cell metabolism under anaerobic conditions in the collection tube) if not collected in appropriate collection devices, consequently increasing the risk for inappropriate patient care or harm. We undertook a study to determine the turnaround time for lactate testing in a tertiary care setting and also performed short- and long-term lactate stability studies in blood collected in sodium fluoride/potassium oxalate (NaF/KOx) collection tubes. The hospital lab information system was mined for 6 months to determine patient samples that may have exceeded the time from collection-to-receival in lab of 15-min. Lactate stability was evaluated in unspun NaF/KOx collection tubes at 15min intervals for to 2h; and separately at 2, 6, 12, 24, and 48-h post-collection. A total of 8,929 plasma samples were collected in 6 months, and 1/3 were not received in the lab within 15min from collection. In NaF/KOx additive, lactate levels had minor increases over 2h, and incremental increases at an average rate of 0.0035mmol/L/h over 48h with maximum increase of 9.8% at 48h. However, the average change across all time points were within local allowable performance goals (at ≤4mmol/L ± 0.5mmol/L; at >4mmol/L ± 12%). A small proportion of lactate specimens may experience delay in processing. Although lactate levels may incrementally increase over 48-h at room temperature in unspun NaF/KOx collection tubes, the changes may not be clinically impactful.

Acute respiratory distress syndrome in patients with COVID-19 vs. Non-COVID-19: clinical characteristics and outcomes in a tertiary care setting in Mexico City

BackgroundAcute Respiratory Distress Syndrome (ARDS) due tocoronavirus disease (COVID-19) infection has a unique phenotype generating a growing need to determine the existing differences that can alter existing evidence-based management strategies for ARDS. Research Question: What differences does the clinical profile of patients with ARDS due to COVID 19 and Non-COVID 19 have?Study Design and methodsWe conducted a comparative, observational, retrospective study in the Intensive Care Unit (ICU)of a third-level hospital in Mexico City, from March 2020 through March 2022. Clinical, echocardiographic, and laboratory variables were compared between patients with ARDS due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and those due to other etiologies.ResultsWe enrolled 140 patients with a diagnosis of ARDS. The study group of COVID-19 etiology were younger males, higher body mass index, progressed to organ dysfunction, required more frequently renal replacement therapy, and higher SOFA score. There was no difference in rates of right ventricular dysfunction.InterpretationCOVID-19 ARDS exhibit much greater severity that led to higher admission and mortality rates, whilst being younger and less comorbid.

Quality of life, social support, and pathways of care among persons with psychiatric disorders—A cross-sectional study

Background: Patients with psychiatric disorders have varied psychosocial realities embedded in the community context. Help-seeking behavior is extremely crucial in determining the prognosis and outcome of interventions. Objectives: (1) To assess the levels of quality of life, perceived social support, and decision to first seek help. (2) To assess the association of socio-demographic variables with these domains. Materials and Methods: A cross-sectional descriptive survey with 100 psychiatric patients in a tertiary care setting employed three scales, namely WHOQOL-BREF, PSSS, and WHO Pathways Encounter form. Results: Patients had higher levels of quality of life and perceived social support. The majority of patients chose health professionals over faith healers at the onset of symptoms, had higher reliance on family members, and continued with hospital visits till the third follow-up. Sex, occupation, and marital status were associated with perceived social support, and duration of illness was associated with help-seeking behavior. Conclusions: Community-based interventions must include holistic services and reduce the gap between onset and first contact, leading to higher quality of life and perceived social support.

Naturalistic Evaluation of ERAS Bundle Implementation Feasibility in Elective Cesarean Deliveries of Tertiary Care Hospital in a Low-Middle-Income Country

The present study assessed whether applying enhanced recovery after surgery (ERAS) guidelines for cesarean delivery is feasible in the tertiary care setting with an add-on objective to identify barriers to successful implementation. The cross-sectional study included women undergoing elective CS and willing to participate. The study attempted to understand barriers to ERAS implementation through timely interviewing study participants. Sixty-two patients participated in the study. Antenatal and fetal complications were observed in 39(63%) and 32(51%) participants. The study observed that at least 80% of the proposed components could be applied to 71% of the study population. All 15 components could be applied to 7(11.2%) patients, and at least 50% could be applied to 58(94%) patients. The least applied component was minimizing starvation by taking clear liquids until 2 hrs before surgery in 26(42%) patients due to waiting hours outside the operation-theater (OT). When fitness-for-discharge was assessed against the percent components of ERAS implemented, the area under the curve (AUC) value was 0.75, with a specificity value of 95.65% and a positive predictive value of 94.12%. In the postoperative ERAS bundle, fitness-for-discharge on day-two was statistically associated with early and frequent breastfeeding (p = 0.000) and prevention of intra-op hypotension (p = 0.03). In conclusion, the primary barriers to implementing ERAS were resource limitations in the form of single functional OT and limited doctors.

Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review.

Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the "Active Implementation Framework stages": exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs.

Craniopagus: a proposed nursing care protocol.

Craniopagus is a rare condition in which the skulls of conjoined twins, and the neurovascular structures in their skulls, are incompletely separated. Separation surgery is complex and requires a range of skills and expertise, including from all the nursing teams involved. A multidisciplinary group of professionals in a tertiary paediatric care setting in Italy developed a comprehensive protocol for the nursing care of craniopagus twins in hospital, informed by the findings of a literature review and the expertise of its members. The protocol was applied to the management of a pair of craniopagus twins who successfully underwent separation surgery at the authors' hospital. The protocol describes the crucial role of nurses in the care of craniopagus twins and their families before, during and after separation surgery.

Adverse Fetal Outcomes in Patients with Low Amniotic Fluid Index: Presenting Care Hospital Setting

Background: Pregnancy is a critical period where various physiological parameters are monitored to ensure the well-being of both mother and fetus. Amniotic fluid index (AFI) is one such measure, with deviations from the norm, particularly low AFI, being associated with adverse fetal outcomes. This study delves into the correlation between low AFI and fetal well-being in a tertiary care setting. Objective: The aim of this study was to investigate the association between low AFI and adverse fetal outcomes and to quantify the impact of low AFI on fetal health during delivery in a tertiary care hospital. Methods: A prospective study was conducted on 100 pregnant women attending the Obstetrics and Gynecology Department of Khyber Teaching Hospital, Peshawar, from June 28 to September 27, 2023. AFI was measured using ultrasonography, with a particular focus on participants with an AFI of less than 5 cm. The study also included a systematic sample of patients across various gestational ages and recorded outcomes such as intrauterine growth restriction (IUGR), oligohydramnios-associated deformations, cord compression, variable decelerations in fetal heart rate, and the presence of meconium-stained amniotic fluid. Statistical analysis was performed using chi-square and t-tests, with a significance level set at p&lt;0.05. Results: The mean AFI was 8.7 cm (SD = 1.5). Low AFI (&lt;5 cm) was observed in 15% of the participants. Adverse outcomes included 6 cases of IUGR (6%), 4 cases of oligohydramnios-associated deformations (4%), 3 cases of cord compression (3%), 5 cases of variable decelerations in fetal heart rate (5%), and 8 cases of meconium-stained amniotic fluid (8%). A significant association was found between low AFI and adverse fetal outcomes (χ² = 8.43, p &lt; 0.01). Conclusion: The study confirmed a significant correlation between low AFI and the presence of adverse fetal outcomes, emphasizing the importance of vigilant fetal monitoring and management in pregnancies with low AFI.

Analysis of Treatment Outcome in Large Granular Lymphocytic Leukemia: A Retrospective Study from India

Large granular lymphocytic (LGL) leukemia is a rare and indolent lymphoproliferative disorder that belongs to mature T and natural killer (NK) cell neoplasms, as per the World Health Organization classification. This article assesses the response to immunosuppressive therapy. In this retrospective study, various cases of chronic lymphoproliferative disorders (CLPDs) evaluated and treated in two tertiary care settings were screened and taken for subanalyses. After fulfilling the criteria for LGL leukemia, cases were further assessed for presenting features and response to treatment. Statistical analysis was performed using the Statistical Package for the Social Sciences, version 23. Out of 384 cases of CLPDs analyzed, 14 cases of LGL leukemia were identified (3.64%) and subjected to further analysis. There were six males (42.85%) and eight females (57.14%) (M: F = 1:1.33) with an age group ranging from 42 to 82 years. Thirteen cases (92.85%) were T-LGL type, and one case belonged to NK-LGL type (7.14%). Anemia was the most common presentation (92.85% of cases), followed by lymphocytosis (85.71% of cases) and neutropenia (78.57% of cases). Four patients (28.57%) presented with thrombocytopenia, and two patients presented with pancytopenia (14.28%). Splenomegaly was seen in two patients (14.28%), and lymphadenopathy in one patient (7.14%). One patient (7.14%) had rheumatoid arthritis, and one (7.14%) had recurrent chest infections. Out of the 14 cases, 5 (35.71%) attained complete remission, 5 (35.71%) attained partial remission, 2 patients were resistant to first-line treatment, and 2 patients were closely followed with observation only. The overall treatment response rate was 83.33%. This study highlights the excellent response rates with immunosuppressive therapy in a rare lymphoproliferative disorder.

Safety and clinical impact of adenosine stress perfusion cardiac magnetic resonance in Asian patients with known or suspected coronary artery disease.

Adenosine stress cardiac magnetic resonance (CMR) imaging is increasingly utilized for evaluating patients with known or suspected coronary artery disease (CAD). This study aims to assess the safety and clinical impact of adenosine stress CMR in a tertiary care setting in Thailand. A total of 3,768 consecutive patients aged 18 years and above who underwent adenosine stress CMR between 2017 and 2020 were included in the study. Patient records were reviewed to collect data on clinical characteristics, hemodynamic measurements, complications during or immediately after CMR, and the rates of clinical changes resulting from CMR. Among the included patients, the primary indications for adenosine stress CMR were risk stratification in suspected CAD (70.8%) and the assessment of myocardial ischemia/viability in patients with known CAD (26.5%). There were no reported deaths or acute myocardial infarctions during the procedure. Major complications, specifically acute pulmonary edema requiring hospital observation or admission for further management, occurred in four patients (0.11%), all of whom were elderly (ranging from 75 to 91 years) with a history of heart failure. Non-major complications were observed in 13.7% of patients, with dyspnea (9.8%) and mild chest pain (5.6%) being the most common. CMR provided a completely new diagnosis in 26.2% of patients. Overall, stress CMR resulted in a change in diagnosis or management for 48% of patients. Adenosine stress CMR was found to be safe and to have a significant impact on clinical management in Asian patients with known or suspected CAD. These findings support the use of adenosine stress CMR as a valuable tool for evaluating and guiding treatment decisions in this patient population.

Maternal Outcome in Patients with Abruptio Placenta: A Comprehensive Analysis in A Tertiary Care Hospital

Background: Abruptio placenta is a critical obstetric condition characterized by the premature detachment of the placenta from the uterine wall, leading to significant maternal and fetal risks. Despite its rarity, the condition demands prompt diagnosis and intervention due to the high morbidity and mortality associated with it. Prior research has established a link between maternal hypertension and increased risk of severe complications such as hemorrhagic shock, disseminated intravascular coagulation (DIC), and organ failure. Objective: This study aimed to analyze the maternal outcomes of patients with Abruptio placenta in a tertiary care setting, with a specific focus on the association between hypertension and maternal complications. Methods: A prospective cohort study was conducted over a three-month period at the Obstetrics and Gynecology Department of Khyber Teaching Hospital, Peshawar. A sample size of 100 patients was determined based on the anticipated frequency of cases. Inclusion criteria were patients diagnosed with Abruptio placenta during antenatal care or at admission for delivery. Comprehensive data on demographics, medical history, clinical presentation, and management strategies were collected using standardized forms. Ethical approval was obtained from the institutional review board, and informed consent was secured from all participants. The statistical analysis was performed using SPSS version 25, with a significance level set at p &lt; 0.05. Results: The study included 105 patients with a mean age of 28.6 years; 64.8% were multiparous, and 40.0% had hypertension. Clinical presentation included vaginal bleeding (92.4%), abdominal pain (83.8%), and fetal distress (72.4%). The majority (59.0%) were diagnosed during antenatal care, while 41.0% were diagnosed at admission. Emergency Cesarean section was performed in 93.3% of cases. Blood transfusions were required for 23.8% of patients, and 28.6% presented with a low amniotic fluid index. The mean gestational age at delivery was 34.2 weeks. The analysis revealed a significant association between hypertension and the incidence of haemorrhagic shock (12 cases with hypertension, 2 without), DIC (5 cases with hypertension, 2 without), and organ failure (3 cases with hypertension, 1 without). Conclusion: The study affirms the heightened risk of severe maternal complications associated with hypertension in patients with Abruptio placenta. The high rate of emergency Cesarean sections and blood transfusions underscores the urgency and complexity of managing this condition. These findings highlight the necessity for vigilant antenatal monitoring and rapid intervention strategies in tertiary care settings.

Correlation between hematocrit and inferior vena cava collapsibility in adult patients with dengue fever: A prospective, observational study at a tertiary care setup in Eastern India

Background: Dengue fever (DF) is a vector-borne arboviral infection prevalent in tropical and sub-tropical countries. Early recognition of severity of the disease with appropriate fluid management is a challenge to the clinicians. Increase in capillary permeability is the pathophysiological hallmark of the disease which parallels with increase in hematocrit. This study aimed to evaluate the inferior vena cava (IVC) collapsibility and its relation to hematocrit. Methods: A prospective, observational study was conducted in the inpatient department of tropical medicine over a period of 1 year in a tertiary care set up in Eastern India. Clinical data and hematocrit of adult dengue cases were documented and their IVC collapsibility determined by bedside ultrasonography (USG) was recorded. Association was assessed between IVC collapsibility and hematocrit. Results were statistically analyzed. Results: Seventy dengue cases were included - 59 cases of DF with warning signs and 11 cases of dengue hemorrhagic fever (DHF). 85.7% of study population presented at febrile phase of their illness. Bedside USG was correlated with hematocrit on day 2 of admission. IVC was collapsible in 79.7% cases of DF and 90.9% cases of DHF. Of the 47 DF cases with collapsible IVC, 95.7% had high hematocrit, while all DHF cases with collapsible IVC had high hematocrit. A significant association between IVC collapsibility and hematocrit was noted (P = 0.000). Conclusion: The assessment of intravascular volume status by bedside USG-IVC collapsibility is a helpful noninvasive and better tool than hematocrit for determining fluid resuscitation in DF.

Histopathological Study and Clinical Correlation of Glial Tumors at a Tertiary Care Hospital of Karachi

Objective: To observe the spectrum of glial tumors in a resource-limited tertiary care setup of Karachi according to the modified WHO central nervous system tumor classification.Study Design:A retrospective analysis.Place and Duration of Study: The study was conducted at the Oncology Ward of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from August 2020 to January 2021.Methods: The study was done to record data of patients diagnosed with glioma, which were registered during 2017 - 2019. Patients were classified according to recent WHO brain tumor classification. Data analysis as performed by SPSS version 26.0.Results: A total of 115 glioma cases were included. The most common presenting age group was in the 4th decade of their life. Oligodendroglioma was the most common histological type 61 (53.5%). The most common presenting symptom was a headache in 46 (40%). The location of the tumor was temporoparietal lobe in 51/115 (44.3%). Immunohistochemical studies showed a significant association with histological subtypes (p-value: 0.002). Conclusion: Oligodendroglioma was found to be the most common histological type. Immunohistochemical marker GFAP expression was positive for the majority of diagnosed cases, where 1p19q / codeletion was observed specifically in oligodendrogliomas.&#x0D; How to cite this: Khan J, Bhatt IA, Jaffar N, Haider G, Zaman A, Shabbir SM Histopathological Study and Clinical Correlation of Glial Tumors: Tertiary Care Setting in Karachi. Life and Science. 2023; 4(4): 481-486. doi: http://doi.org/10.37185/LnS.1.1.337

FRI182 Cardiometabolic Risk And Outcomes In Patient With Adrenal Adenomas

Abstract Disclosure: H. Lam: None. H. Han: None. S. Athimulam: None. Background: Approximately 5% of adults undergoing cross-sectional imaging are reported to have an adrenal adenoma. Although most adenomas are considered non-functioning (NFAT), up to 48% can present with mild autonomous cortisol secretion (MACS). Published studies have reported an increased prevalence of cardiometabolic risk factors, cardiac and cerebrovascular events in MACS patients. Objective: To determine the prevalence of cardiometabolic disease and outcomes in a population-based cohort of patients with adrenal adenomas. Design: Retrospective cross-sectional study of patients with adrenal adenomas over a 10-year period (Jan 2012 – Dec 2021). Setting: Academic primary and tertiary care setting. Main outcomes measured: Prevalence of cardiometabolic disease, cardiovascular events requiring procedure (percutaneous coronary intervention, PCI or coronary artery bypass graft, CABG) and cerebrovascular events. MACS was diagnosed based on cortisol level ≥ 1.8cmg/dL after overnight 1mg dexamethasone suppression testing (DST) and NFAT if cortisol &amp;lt; 1.8mcg/dL. Patients who did not undergo 1mg DST were categorized as unknown cortisol status (UCS). Results: Preliminary results include 198 patients with adrenal adenomas [(135 women (67%) with a median age of 67y, 106 Black (54%), 83 White (42%) and 9 other races (4%)]. 74 (37%) were diagnosed with NFAT, 42 (21%) with MACS, and 82 (41%) with UCS. Hypertension (n=163,83%; MACS vs NFAT vs UCS: 23% vs 34% vs 43%) is the most prevalent cardiometabolic risk factor, followed by hyperlipidemia (n=146, 75%; MACS vs NFAT vs UCS: 21% vs 38% vs 41%), prediabetes (n=94, 50%; MACS vs NFAT vs UCS: 18% vs 43% vs 39%) and type 2 diabetes mellitus (n=82,43%; MACS vs NFAT vs UCS: 22% vs 35% vs 43%), respectively. 14% of patients with adrenal adenomas underwent procedures (PCI or CABG) for cardiovascular events (MACS vs NFAT vs UCS: 33% vs 26% vs 41%) and 11% were diagnosed with cerebrovascular events (MACS vs NFAT vs UCS: 29% vs 19% vs 52%). Conclusions: Patients with adrenal adenomas and mild autonomous cortisol secretion (MACS) are at increased risk of cardiovascular events requiring intervention and cerebrovascular events, compared to non-functioning adrenal tumors. 41% (n=82, 61% Blacks, 30% White, 2% Others) of patient population was classified as unknown cortisol status indicating further need to educate health care professionals on evaluation of adrenal adenomas to improve health care outcomes and disparities in management. Presentation: Friday, June 16, 2023

FRI180 Prevalence Of Vertebral Fractures In Patients With Adrenal Adenomas

Abstract Disclosure: H. Han: None. H. Lam: None. S.D. Rao: None. S. Athimulam: None. Background: Approximately 5% of adults undergoing cross-sectional imaging are reported to have an adrenal adenoma. Although most adenomas are considered non-functioning (NFAT), up to 48% can present with mild autonomous cortisol secretion (MACS). Published studies have reported an increased prevalence of vertebral fractures (VFx) in MACS. However, findings are limited by sample size, selection bias and lack of diversity in patient population. Objective: To determine the prevalence of vertebral fractures and associated risk factors in patients with adrenal adenomas Design: Retrospective cross-sectional study of patients with adrenal adenomas over a 10-year period (Jan 2012 - Dec 2021). Setting: Academic primary and tertiary care setting Main outcomes measured: 1) MACS was diagnosed based on cortisol level ≥ 1.8cmg/dL after overnight 1mg dexamethasone suppression testing (DST) and NFAT if cortisol &amp;lt; 1.8mcg/dL. Patients who did not undergo 1mg DST were categorized as unknown cortisol status (UCS).2) Bone mineral density (BMD), T- and Z-scores of the lumbar spine (LS). 3)Vertebral morphometry, as assessed by Genant scale, to identify asymptomatic vertebral fractures. Results: Preliminary results included 198 patients with adrenal adenomas [(135 women (67%) with a median age of 67y, 106 Black (54%), 83 White (42%) and 9 other races (4%)]. 74 patients (37%) were diagnosed with NFAT, 42 (21%) with MACS, and 82 (41%) with UCS. Prevalence of vertebral fractures by vertebral morphometry assessment was 6%. (n=12, 5 Black, 7 White). In those with VFx (8 UCS, 2 MACS, 2 NFAT), Black patients had lower BMD (Mean BMD ± SD in Black vs Caucasians: 0.85 ± 018 vs 1.02 ± 0.24 g/cm2, p=0.26). Overall, there was no significant difference in mean LS BMD ± SD (0.97 ± 0.23 vs 1.03 ± 0.20 g/cm2, p=0.41) and mean T-score LS ± SD (-1.11 ± 2.28 vs -0.60 ± 1.71, p=0.49), in patients with and without vertebral fractures, respectively. Conclusions: Patients with adrenal adenoma are at risk of vertebral fractures despite normal or osteopenic BMD. Black patients with adrenal adenomas and vertebral fractures have lower BMD compared to White patients. 41% (n=82, 61% AA, 30% Caucasians, 2% Other) of patients were classified as unknown cortisol status indicating further need to educate health care professionals on evaluation of adrenal adenomas to improve health care outcomes and disparities in management. Presentation: Friday, June 16, 2023

Factors associated with acute kidney injury in neonates admitted in a tertiary-care setting of a developing country: A cross-sectional study.

Objective: To assess the prevalence, risk factors and outcome of acute kidney injury (AKI) in neonates admitted in a neonatal intensive care unit (NICU) of developing country. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit at Sheikh Saeed Memorial Campus (SSMC) of Indus Hospital and Health Network (IHHN), Karachi, Pakistan. Period: April 2022 to September 2022. Material &amp; Methods: Four hundred and seventy-one newborns hospitalized to the NICU were analyzed. Demographic details along with maternal and neonatal history, vitals, and clinical signs of newborns were noted. All at-risk newborns had their urine output assessed. Serum creatinine levels were assessed to classify AKI into stages using modified KDIGO criteria. Results: Out of 471 participants, 256 (54.4%) neonates were male. The prevalence of AKI was noted in 42 (8.9%) neonates. Based on the modified KDIGO stages, 26 (61.9%), 7 (16.6%), 7 (16.6%), and 2 (4.7%) neonates met the requirements for AKI stages 0, 1, 2, and 3, respectively. In comparison to newborns with normal renal function, newborns with AKI had significantly higher serum creatinine levels (p&lt;0.001), lower urine output (p=&lt;0.001), and lower creatinine clearance rates (p=0.001). Multivariate analysis showed that sepsis enhanced the risk of acquiring AKI (OR: 60.50, 95% CI: 26.03-169.88). Neonates in distress, and on ventilator had a higher risk of having AKI (OR: 13.88, 95% CI: 1.26-152.91) and (OR: 20.77, 95% CI: 1.1-390.49) respectively. Conclusion: The prevalence of AKI among neonates admitted in NICU was 8.9%. Fetal distress, sepsis and mechanical ventilation were significantly associated with AKI.

Epidemiology and clinical characteristics of patients with carbapenem-resistant enterobacterales infections: experience from a large tertiary care center in a developing country

BackgroundCarbapenem-resistant Enterobacterales (CREs) are a significant source of healthcare-associated infections. These bacteria are difficult to treat and have a high mortality rate due to high rates of antibiotic resistance. These pathogens are also linked to major outbreaks in healthcare institutions especially those with limited resources in infection prevention and control (IPC). Therefore, our study aimed to describe the epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country.MethodsThis was a retrospective cross-sectional study that included 218 patients admitted to An-Najah National University Hospital between January 1, 2021, and May 31, 2022. The target population was all patients with CRE infection or colonization in the hospital setting.ResultsOf the 218 patients, 135 had CR-Klebsiella pneumoniae (61.9%), and 83 had CR-Escherichia coli (38.1%). Of these, 135 were male (61.9%) and 83 were female (38.1%), with a median age of 51 years (interquartile range 24–64). Malignancy was a common comorbidity in 36.7% of the patients. Approximately 18.3% of CRE patients were obtained from patients upon admission to the emergency department, the largest percentage among departments. Most CRE pathogens were isolated from rectal swabs, accounting for 61.3%. Among the 218 patients, colistin was the most widely used antimicrobial agent (13.3%). CR- E. coli showed resistance to amikacin in 23.8% of the pathogens tested and 85.7% for trimethoprim/sulfamethoxazole compared to CR- K. pneumonia, for which the resistance to trimethoprim/sulfamethoxazole was 74.1%, while for amikacin it was 64.2%. Regarding meropenem minimum inhibitory concentration, 85.7% of CR- E. coli were greater than 16 µg/mL compared to 84% of CR- K. pneumonia isolates.ConclusionThis study found that CRE is frequently reported in this tertiary care setting, implying the presence of selective pressure and transmission associated with healthcare setting. The antibiotics tested showed a variety of resistance rates, with CR-K. pneumoniae being more prevalent than CR-E. coli, and exhibiting an extremely high resistance pattern to the available therapeutic options.