766. Readmissions of Hospitalized Patients with Clostridioides difficile Infection (CDI) for Recurrent CDI Is Common

Background Hospital acquired infections (HAI) and hospital readmissions are of particular focus by Centers for Medicare and Medicaid Services. Clostridioides difficile infection (CDI) is an HAI notorious for causing recurrent illness and potentially resulting in re-hospitalizations. The purpose of our study was to identify the frequency of follow-up appointments in patients with CDI and determine the rate of re-hospitalization for recurrent CDI (rCDI). Methods This was a single-center, retrospective, chart review at a tertiary medical center. Through the electronic medical record, we queried all hospitalized patients with a positive stool test for C. difficile (GI panel PCR, FilmArray, Biofire, or C. difficile PCR, Xpert CD assay, Cepheid) with or without an ICD-10 code Enterocolitis due to C. difficile (A04.7, A04.71, A04.72) from January 2018 through April 2018. Demographic and clinical data at the time of diagnosis and up to 90 days after were collected from patient records. Results One-hundred and eighty-five patient episodes were evaluated. Of these, 147 (79.5%) were primary CDI, 13 (7.0%) were rCDI, and 25 (13.5%) were determined to be colonization. Twenty-two (11.9%) patients from the total cohort attended a follow-up appointment for CDI within 30 days, most often with a primary care provider or infectious disease physician. Twenty-three (12.4%) patients, 18 of whom were hospitalized for primary CDI episodes, developed a recurrent episode within 90 days of their initial CDI episode. Of these 23 patients with rCDI, 10 (43.5%) patients were re-hospitalized for their rCDI. Only 4 (17.4%) patients with rCDI had a follow-up appointment after their primary episode and among the 10 patients re-hospitalized for rCDI, only 2 (20.0%) patient had been seen for follow up for their previous CDI episode. Conclusion In our study, few patients had a follow-up appointment for CDI. Also, more than one third of the patients who had rCDI had to be re-hospitalized for the recurrent episode. Our study highlights a concern that the majority of patients re-hospitalized with rCDI did not have a follow-up appointment within 30 days of their initial diagnosis. Further study is necessary to determine if a dedicated follow-up appointment for CDI would result in decreased re-hospitalizations associated with rCDI. Disclosures Stuart Johnson, MD, Acurx Pharmaceuticals (Advisor or Review Panel member)Bio-K+ (Advisor or Review Panel member)Ferring Pharmaceutical (Advisor or Review Panel member)

The severity of immunocomplex responses in patients with recurrent depressive disorder

The immunocomplex responses in patients with recurrent depressive disorder (RDD) was studied. It has been established that the concentration of circulating immune complexes incl. most pathogenic average and small molecular fractions and phagocytic activity of monocytes in patients with RDD was changed. Changes in immunocomplex responses were most pronounced when more severely manifested in “Major depressive disorder, recurrent episode, severe without psychotic symptoms”(F33.2). Key words: recurrent depressive disorder, immunocomplex responses, conventional treatment

Recurrent immune thrombocytopenia following different vaccines

A boy developed immune thrombocytopenia 2 weeks after receiving his measles-mumps-rubella and varicella vaccines at 12 months of age. He then had a recurrent episode 1 week after the booster doses of his quadrivalent diphtheria-tetanus-pertussis-polio, pneumococcal and meningococcal group C vaccines at 5 years of age. On both the occasions he required hospitalisation and treatment with intravenous immunoglobulin. He received other vaccines, before and in between, without any adverse events. Future vaccines are to be determined on an individual risk-benefit basis and he will be reviewed at the age of 11 when his next routine immunisations are due.

Blood Cell Counts and Blood Cell Ratios as Non-Specific Major Depressive Disorder Biomarkers

Introduction: With an increasing prevalence of major depressive disorder (MDD) in population there is a particular interest in finding a suitable biomarker for diagnosis and prognosis of the disease. Many studies have shown that MDD is linked to a systemic inflammatory process, so blood elements counts and ratios have been suggested to be promising indicators in the management and effectiveness of the disease therapy. The aim of this retrospective study was to compare absolute and relative white blood cells counts and to search for any changes in their ratios before and after the therapy of the patients. Methods: Our study included 36 patients who were admitted to hospital with either a new diagnosis or a recurrent episode of MDD and who were treated by a standard protocol. The peripheral blood samples were collected both at admission and at hospital discharge. Absolute white blood cell count and counts of neutrophils, lymphocytes, monocytes, platelets, as well as mean platelet volume, red blood cell distribution width, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and monocyte/lymphocyte ratio before and after hospitalization (14–29 days) were evaluated and compared. The test of normality was performed and, accordingly, single t-test or Mann-Whitney U-test was used for data analysis. Results: There were no significant differences between any blood cell ratios in blood samples before and after stay in hospital and appropriate treatment. Monocyte count was significantly higher in MDD patients after hospital discharge (p=0.007), there was a significantly higher difference in discharged patients suffering from MDD recurrent episode (F.33) compared to newly diagnosed MDD (F.32) patients (p=0.010). In patients treated with venlafaxine (N=23) there was a significant increase in monocyte/lymphocyte ratio observed at the end of hospitalization (p=0.018). Conclusions: The pharmacotherapy and additive treatment of the patients suffering from MDD led only to mild changes in blood cells counts. As our study included only a small number of patients, and blood cell parameters and ratios were compared after a relatively short duration of treatment, further and more detailed research is needed for final conclusions.

Reccurent episodes of vomiting and hyperpigmentation---Addison,s disease, a case report

Addison’s disease can remain unrecognized for a longtime until acute adrenal insufficiency is precipitated by an acute stress. Addison’s disease usually presents with non-specific symptoms like fatigue, nausea, vomiting, hyperpigmentation and generalized weakness. These symptoms are most often ignored or misinterpreted with other more common diseases. This is the major reason that this disease is under-diagnosed. Therefore, to establish a diagnosis high index of suspicion is needed.We are reporting a case of 10 years old boy who presented with recurrent episode of severe vomiting and generalized weakness. This kind of presentation of Addison’s disease is rather unusual and mainstay of diagnosis is clinical based.TAJ 2016; 29(2): 66-69

A Recurrent Episode of Dermatomyositis Associated with Papillary Thyroid Cancer

Objective. It is uncommon for dermatomyositis to be associated with papillary thyroid cancer. We report an unusual case of papillary thyroid cancer presenting with dermatomyositis. Methods. The case history, imaging and laboratory data is reviewed. Results. We report the case of a 62-year-old female with a prior history of dermatomyositis and breast cancer who presented with a recurrent episode of dermatomyositis. Extensive evaluation of the cause of the dermatomyositis recurrence revealed no recurrence of the breast cancer but a thyroid nodule was identified. The nodule was biopsied and the patient was noted to have papillary thyroid cancer. The patient subsequently underwent total thyroidectomy and had gradual improvement in her dermatomyositis. Conclusion. It is very uncommon for dermatomyositis to be associated with papillary thyroid cancer.

Family therapy preventing the recurrent major depression with alcohol dependence patient against recurrent episode: A case study of three cases

Major depressive disorder with alcohol dependence is an easily recurrent disorder, and its dysfunction has increased risk of recurrence. The main purpose of the family therapy model at issue is to prevent the recurrent major depression with alcoholism patient against recurrent episode.All three patients have had more than 10 relapses and hospitalizations during the past 5 years. Focuses of the therapy are on the apples drawn by the patient (DDAA), the patient, the couple, and the patient–child relationship. Keywords are gathered from every participant during the therapy session. Besides, the subjects to have verbalized meaningful ideas or successful experiences are immediately, intensely praised by applause. DAILY DRAW AN APPLE (DDAA) homework is that the patient has drawn an apple on a calendar everyday and shares with family members about the apple as well as the patient's feelings of the day. The participants of the therapy are the patient, wife/husband, children and the therapists (psychiatrist, social worker). The frequency of the model is from once weekly to twice monthly. Each session consists of the 10 minutes pre-session, the 40 minutes therapeutic session, the 10 minutes post-session. All patients have never been relapsed over the past 18 months after receiving our family therapy under medications.Finally, with the aid of the family therapy, they have been almost free from affective symptoms and the ambivalence, guilty feeling toward family, frustrations have been steadily gradually improved. To prevent the recurrent major depression with alcohol dependence patient against recurrent episode has been achieved in family therapy presented here.Disclosure of interestThe authors have not supplied their declaration of competing interest.