Predicting Hospital Readmission for Campylobacteriosis from Electronic Health Records: A Machine Learning and Text Mining Perspective

(1) Background: This study investigates influential risk factors for predicting 30-day readmission to hospital for Campylobacter infections (CI). (2) Methods: We linked general practitioner and hospital admission records of 13,006 patients with CI in Wales (1990–2015). An approach called TF-zR (term frequency-zRelevance) technique was presented to evaluates how relevant a clinical term is to a patient in a cohort characterized by coded health records. The zR is a supervised term-weighting metric to assign weight to a term based on relative frequencies of the term across different classes. Cost-sensitive classifier with swarm optimization and weighted subset learning was integrated to identify influential clinical signals as predictors and optimal model for readmission prediction. (3) Results: From a pool of up to 17,506 variables, 33 most predictive factors were identified, including age, gender, Townsend deprivation quintiles, comorbidities, medications, and procedures. The predictive model predicted readmission with 73% sensitivity and 54% specificity. Variables associated with readmission included male gender, recurrent tonsillitis, non-healing open wounds, operation for in-gown toenails. Cystitis, paracetamol/codeine use, age (21–25), and heliclear triple pack use, were associated with a lower risk of readmission. (4) Conclusions: This study gives a profile of clustered variables that are predictive of readmission associated with campylobacteriosis.

Characterization of upper respiratory tract isolates from children with recurrent tonsillitis

To analyze the profile of airway Upper Respiratory Tract isolates from children with recurrent tonsillitis. Samples were taken using nasal cavity, oropharynx and nasopharynx swabs from30 children called the test group before tonsillectomy. Counting, isolation, identification and sequencing of the 16S rRNA, biofilm production and antimicrobial sensitivity investigation were performed. Staphylococcus aureus (S. aureus) was the only microorganism recovered in 36.6% of patients, being more present in the oropharynx and with greater resistance to erythromycin 95%, penicillin 85% and cefoxitin 85%. All isolates were formed by biofilm, 20% formed by strongly adherent biofilm. S. aureus resistant and biofilm formed, were isolated in the three studied sites, suggesting that this species contributes to recurrent tonsillitis. Impact of the study: The ability of S. aureus to acquire resistance and its other associated factors such as biofilm formation, can make this microorganism recover more easily in the microbiota of patients, taking into account the other microorganisms present there after the use of antibacterial.

The use of Decasan in the local treatment of chronic inflammatory diseases of the tonsils

The local sanitation in 40 patients with recurrent tonsillitis was carried out, using Decasan for washing of the lacunae of the palatine tonsils. Clinical observations and bacteriological studies have shown greater efficacy of Decasan in relation to the main pathogens of the tonsillar lacunae, compared to antibiotic solutions traditionally used for washing. Decasan is a highly effective and safe antiseptic for local treatment of patients with chronic inflammatory diseases of the tonsils, contributing to the restoration of local biocenosis, which is confirmed by an increase in the plaiting of normal microflora from the surface of the tonsillar lacunae.

P053 The place of ASLOs in the diagnosis of RAA in Morocco

Background The assay of antistreptolysin O antibodies “ASLO” can provide evidence of infection of streptococcal origin, but it cannot confirm the presence of rheumatic fever “RAA” or the degree of severity of the disease. However, it is widely prescribed in daily practice by pediatricians and general practitioners to diagnose RAA. Unfortunately, the only finding of a high rate of ASLO in front of recurrent tonsillitis in children is considered by some practitioners as sufficient evidence to support the diagnosis of RAA, especially in its minor form, without taking into account the Jones criteria. The objective of this study is to put the ASLO assay in its place in the diagnosis of RAA in children in the region of Fez in Morocco. Methods This is a prospective study carried out from January 2016 to July 2019 in the cardiopediatric unit of CHU Hassan II in Fez. Patients below 18 years of age were included in this study. The children are classified into 4 groups: group 1: RAA with cardiac involvement, group 2: RAA without cardiac involvement, group 3: recurrent pharyngitis and group 4: control. Children with RAA are diagnosed according to the modified Jones criteria. The repetitive angina group includes any child who has tonsillitis >5 times a year. The control group presents healthy children. The ASLO assay was carried out in the central analysis laboratory of the CHU Hassan II in Fez. Patient data is collected on operating sheets. Statistical analysis was performed using SPSS v 21 software. Results These are 153 children with RAA: 119 cases of RAA with cardiac involvement and 34 cases of RAA without cardiac involvement, 86 children with recurrent pharyngitis and 157 children controls. The most common age group in the four groups is the age group between 5 and 15 years old. The frequency of children of urban origin is greater than that of rural origin in all the groups studied. The average ASLO rates in each group are as follows: RAA with carditis: 281.1 IU/ml RAA without carditis: 331.9 IU/ml Repeated angina: 397.7 IU/ml Control: 208.8 IU/ml Monitoring the change in ASLO, every 3 months for a year, in the groups studied showed that the ASLO level is stable at high rates in the case of recurrent pharyngitis and it tends to decrease in the case of AAR. Regarding the relationship between ASLO means and gender, there is a high ASLO mean in boys more than girls in all groups. Also, the mean ASLO is high in children from urban areas for the recurrent angina group. In addition, the average rate of ASLO is high during cold seasons in all groups. Finally, our study shows that the increase in ASLO is related to age. There is a significant difference between ASLO rates and age in all groups. Conclusion ASLO levels do not correlate with cardiac involvement but rather with infection and the child's individual immunity. The evidence is that ASLO levels> 200 IU/ml are more common with recurrent pharyngitis than with rheumatic heart disease. So a high ASLO is not necessarily related to an RAA. Keywords ASLO, children, RAA, recurrent tonsillitis

Optimization of the approach to conducting tonsillectomy

Actuality: Recurrent tonsillitis considers to be one of the most common ENT diseases. Tonsillectomy as the method of recurrent tonsillitis’ treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how fast he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anesthetic management and perioperative medical hemostatic support. Aim: Our study aimed to optimize the approach to carry out tonsillectomy by preoperative application of the tranexamic acid 10% solution and optimize the approach to choosing between endotracheal anesthesia and local anesthesia. Materials and methods: Clinical studies were made among 212 patients with recurrent tonsillitis who went through a bilateral tonsillectomy. The patients were divided into three groups. The 1st group included 54 patients undergoing tonsillectomy using endotracheal anesthesia with the administration of tranexamic acid at the rate of 10 mg/kg of body weight. The 2nd group consisted of 97 patients undergoing tonsillectomy using local anesthesia. A 3rd (control) group included 61 patient undergoing tonsillectomy using endotracheal anesthesia. The first and control (3rd) groups of patients were compared to assess the efficacy of using tranexamic acid.Factors such as the duration of the surgery, the amount of blood loss, intraoperative events, the number of incidents of primary and secondary bleeding, and laboratory data were considered. The second and control (third) groups were compared to evaluate the impact of anesthetic management. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period. Conclusions: tonsillectomy surgery using local anesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and lessincidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anesthesia. The use of tranexamic acid 10% significantly reduces the amount of blood loss, helps to reduce intraoperative complications, and lower the emergence of postoperative bleeding and its intensity.

P054 Acute articular rheumatism at the Hassan II hospital center, Fez, Morocco (prospective study: about 152 cases)

Background Acute Articular Rheumatism (AAR) is a major public health problem in developing countries, due to the high prevalence of its main complication, which is rheumatic heart disease. The objective of this study is to determine the clinical and biological manifestations of rheumatic fever in children at CHU Hassan II in Fez, Morocco. Methods This is a prospective study carried out from January 2016 to July 2019 in the cardiopediatric unit of CHU Hassan II in Fez. Included were patients below 18 years of age. 152 children with RAA are diagnosed according to the modified Jones criteria. The patients are classified into 2 groups: group 1: RAA with carditis and group 2: RAA without carditis. Patient data is collected on operating sheets. Statistical analysis was performed using SPSS v 21 software. Results The average age of the patients was 12 years and 10 months. The male/female sex ratio was 0.7. The most represented age group was between 5 and 15 years (76.16%). Patients of urban origin presented 78.8%. The majority of children who are diagnosed with AAR with and without cardiac involvement are admitted in winter and fall respectively. A family history of RAA was found in 1 patient and recurrent tonsillitis were mentioned in 68.42%. Cardiac involvement is found in 78.3% of patients. Arthritis was the most common major end point in patients with and without carditis (24.4% and 12.1% respectively). Arthralgia was the most common minor outcome in these patients (67.2% and 78.8% respectively). Penicillin A was the most prescribed antibiotic in the two groups (80.83% and 79.31% respectively). The predominant valve disease in children with cardiac involvement is mitral leakage (69%). Serological proof of a streptococcal infection (ASLO> 300U/ml) was found in 37.2% of cases. A high biological inflammatory syndrome (ESR> 20) was noted in 29.4%. Corticosteroid therapy was used in 42.8% of patients with carditis and in 30.3% of patients without carditis. There was a recurrence in surveillance, this is an aggravation of the mitral leakage with in an 11-year-old boy. 6 patients (3.9%) underwent valve replacement: 4 valve replacements (mitral or aortic) and two double valve replacements (mitral and aortic). One death is noted, a form of acute carditis. Conclusion Cardiac involvement was very common in our series, which shows that AAR still remains a public health problem in our country. Keywords RAA, child, cardiac involvement

The Association between Vitamin D Deficiency and Chronic Tonsillitis in Children: an Evidence Based Case Reports

Background: vitamin D has an important influence on the host’s immune system by modulating both innate and adaptive immunity and regulating the inflammatory cascade. Vitamin D deficiency may be related with reduced immunomodulation, specifically in preventing the occurrence of chronic tonsillitis. Objective: to identify the association between vitamin D deficiency with chronic tonsillitis in pediatric patients. Methods: the search was conducted with advanced searching on PubMed® and Cochrane® according to the clinical question. The screening of title and abstract using inclusion and exclusion criteria, double filter, and reading full text led to six useful articles. The selected studies were critically appraised for validity, importance, and applicability. Results: three original articles were eligible for this evidence-based case report. All studies were considered to have good validity. All three studies reported an increased risk of chronic tonsillitis with the vitamin D deficiency and/or insufficiency. Conclusion: Vitamin D deficiency may be associated with the increased risk of chronic or recurrent tonsillitis in children.

Comparison Of Harmonic Scalpel, Coblation And Cold Dissection For Tonsillectomy In Adult

Objectives: To compare the safety and effectiveness of tonsillectomy with three different techniques. Design: A double-blinded randomized prospective clinical trial Setting and Participants: Totally120 patients with recurrent tonsillitis between April 2018 and April 2020 were included. Main Outcome Measures: Operative time, intra and post operative bleeding loss, pseudomembrane growth time, pseudomembrane shedding time, postoperative pain, and necrosis depth of specimens were compared of harmonic scalpel(HS), coblation and cold dissection(CD) tonsillectomy. Results: The operative time and intraoperative bleeding loss was significantly less in HS and coblation group than CD group(p < 0.05). Pseudomembrane growth time and pseudomembrane shedding time were significantly longer in the HS group compared with the other groups(p < 0.05). The postoperative pain levels were significantly higher on the first postoperative day in CD group(p < 0.05), and significantly lower on the third and seventh postoperative day in coblation group(p < 0.05). There was no significant difference among three techniques in terms of postoperative bleeding loss(p > 0.05). The deepest necrosis depth in specimen was found in HS group(p > 0.05), while in CD group, only edema was observed without necrosis. Conclusion: To compared with HS and CD, coblation is a faster, safer and more painless technique for tonsillectomy in adult.