Multi-center nationwide study on pediatric psychiatric inpatients 2000–2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13–18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children’s Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13–18. In the 13–18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000–2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

Amiodarone-Induced Hyponatremia in An Elderly Patient: A Rare Case Report

Amiodarone is an antiarrhythmic drug belonging to Vaughan-Williams Class III with additional Class IV effects, which is known to cause many adverse drug reactions (ADRs) necessitating close monitoring. In about 20% of patients, their therapy is discontinued due to adverse effects such as hepatic impairment, thyroid dysfunction, and several pulmonary complications. Although dyselectrolytemia is a common adverse reaction reported with many cardiac medications, the incidence of hyponatremia associated with amiodarone intake is not reported widely in the literature. We are reporting a case of a 73-year-old female patient, with hypertension and ischemic heart disease (IHD) receiving oral amiodarone, presenting with severe hyponatremia, requiring recurrent hospitalization. Amiodarone was found to be responsible after evaluating for the possible causes of hyponatremia. As the incidence of amiodarone-associated hyponatremia is unknown, and not many cases are reported, this case report serves to sensitize the clinician to consider amiodarone-induced hyponatremia as one of the differential diagnoses in cases of unexplained hyponatremia.

Motivational Interviewing as a new Approach to Improve Outcome Through Self-care Behavioral Changes in Advanced Heart Failure Patient: a case report

Background A lack of adherence and inadequate self-care behaviors are common reasons for recurrent hospitalizations among patients with heart failure (HF). Although patients recognize the importance of HF self-care, it is sometimes difficult to correct their behavioral patterns. Motivational interviewing is a communication technique to resolve ambivalence toward changing behavior, and it has been widely used to promote behavioral changes and improve outcomes in various chronic diseases. We described a case of advanced HF with reduced ejection fraction in which motivational interviewing lead to stabilize the patient’s condition. Case summary A 33-year-old man was diagnosed with dilated cardiomyopathy (DCM) who experienced repeated episodes of HF requiring hospitalization despite optimal guideline-based HF treatment. Transthoracic echocardiography disclosed a severely reduced LV contraction (LVEF 18%) and CPET disclosed markedly reduced functional capacity and increased ventilatory response (peak VO2 of 10.7 mL/min/kg, predicted peak VO2 of 34.7% and VE/VCO2 slope of 35.2). In this case, poor adherence to self-care such as excessive fluid intake and excessive daily activities after hospital discharge was the main cause of recurrent hospitalization for HF. Despite repeated patient education to correct his diet and lifestyle, he could not change his lifestyle behavior. However, motivational interviewing dramatically helped stabilize the patient’s condition and prevent HF re-hospitalization. Discussion In general, patients with advanced HF and reduced ejection fraction despite optimal medical therapy should be evaluated to assess their eligibility of cardiac transplantation or palliative care. Motivational interviewing might represent a new therapeutic approach for stabilizing and preventing HF through self-care behavioral changes, even in patients with advanced HF and severely reduced ejection fraction.

Revival of a forgotten valve: use of the percutaneous clip for the treatment of tricuspid regurgitation

Tricuspid regurgitation (TR) is common in patients with left-sided valvular heart disease and is independently associated with increased mortality and morbidity because it leads to right-sided heart failure and recurrent hospitalization. The prognostic benefit of isolated TR surgical repair or replacement is unclear and medical treatment of decompensated right heart failure alone does not prevent the progression of the disease. Recently, minimal invasive catheter-based techniques have emerged as a feasible and effective option for TR treatment in selected high-risk patients who would clinically benefit from tricuspid valve repair. We provide an overview of the current state of transcatheter TR treatment using the edge-to-edge technique.

From bed-side to web-side, Advanced-Telemedicine platform for Spinal Muscular Atrophy

We aimed to assess feasibility, accuracy, satisfaction of an advanced-telemedicine (A-TM) platform designed for remote physical evaluation, especially focused on lung auscultation, in spinal muscular atrophy (SMA) patients. Children affected by type 1 and 2 SMA, typically present generalized weakness, scoliosis, chest deformities the leading cause of progressive respiratory insufficiency and recurrent hospitalization. Covid-19 stimulated efforts to adopt innovative digital health solutions especially when caring for people living with disabilities. Because of chest asymmetry and scoliosis, SMA patients are not always the ideal candidates for telemedicine tools that have proved to be useful in the general population. 23 children affected by SMA (15 type 1 and 8 type 2) with different degree of scoliosis and chest asymmetry. Prospective study: We localized optimal thoracic auscultatory landmarks with traditional stethoscope and lung ultrasound for each child. Carers were trained to record complete lung auscultation independently and share data with our physicians via A-TM platform. After the first remote exam, carers videorecorded their experience (satisfaction). Our physicians blindly rated the audio files shared via A-TM which were compared to traditional auscultation findings for each child. to assess. Overall feasibility and accuracy of carers-performed remote physical evaluation. Our study showed that remotely performed lung auscultation was possible in all type 1 and 2 SMA children but adaptations to find optimal landmarks were needed in cases with asymmetrical or rotated chest and trunk. A-TM tools may simplify access to care, reduce logistic/economic burden for families, improve communication, safety and disease management while limiting infection exposure.

SICKLE CELL DISEASE IN BIHAR: AN EXPERIENCE OF TERTIARY HEALTH INSTITUTES.

Sickle cell disease is commonly seen in rural population of western part of India. It is one of the common causes of recurrent hospitalization, morbidity and mortality in paediatric population. As there are limited studies addressing the pattern of sickle cell disease amongst paediatric population in Bihar, This study was taken up to evaluate the clinic-haematological prole of paediatric population with sickle cell in tertiary health centres. METHODS: This was a retrospective observational study. Data were retrieved from haemato-pathology departments of tertiary care centres of Bihar. Data of children diagnosed with sickle cell disease from January 2019 to January 2021 were collected and analyzed to assess the , clinical ,haematological and HPLC prole at the time of diagnosis. RESULTS: 10 patients were included in the study. Clinically, Vasoocclusive crisis was the most common presentation (43.93 %) followed by generalized body ache and joint pain (36.99 %) and acute febrile illness (26.39 %), while 3 (30%) patients presented with severe anemia. Haematological nding was suggestive of moderate anemia, low Mean corpuscular volume and low Mean hemoglobin concentration. CONCLUSION: At the time of diagnosis vasoocclusive crisis and generalized bodyache were the most common manifestations in patients with sickle cell disease while haematological picture was suggestive of microcytic hypochromic moderate anemia. All cases were conrmed with HPLC.There was a positive correlation between age at presentation and severity of anemia at the time of diagnosis.

Ayurvedic Management of Chronic Pancreatitis in Adolescent Girl: A Case Report

Background- Chronic pancreatitis is the primary life-threatening nutritional & metabolic condition of gastrointestinal system that becomes a significant threat to the children's growth and induces educational loss due to recurrent hospitalization. Its mortality rate in childhood is up to 10 %. Malnutrition is one of the primary causes of pancreatitis in children. Modern science provides various types of medical and surgical therapies for Chronic pancreatitis, but it is realized that more research is needed for its management satisfactorily. Aim - To study the efficacy of Ayurvedic management of chronic pancreatitis induced due to Malnutrition in an adolescent girl. Material & Methods- It is a single case study of 12 years old teenage girl who was presented herself predominantly with pain in the epi-gastric region (recurrent attacks-especially after intake of the fatty or heavy meal), tenderness in the epi-gastric area, loss of appetite, fever on and off, general malaise, loss of weight, constipation (intermittent), anxious & uncomfortable mental irritation since one & half month. After taking conservative treatment from modern science for one & a half months, she did not get satisfactory relief & therefore; she was advised to under ERCP. However, the patient & her relative was not willing to undergo the same, that’s they approached Panchakarma OPD. After examination, she was advised for Shodhana(Panchtikta & Guduchyadi Niruha Vasti) & Shaman Chikitsa(Amruttotara Kashayam, Arogyavardhini Vati, Kumariasava; Dhanvantara Kashayam, Avipattikar Churna), Panchatikta Ghrita with Vasant Kusumakar Rasa- 10tab+Guduchi Satva- 20gm + Shatavari Churna- 15gm+ Ashwagandha Choorna-15 gm with honey. Observation & Results- After 16 months of regular treatment, the patient has become entirely symptom-free & to date, there was no need for hospitalization. There was no educational loss due to ill-health. Discussion:-Utilizing the basic concepts of Ayurveda(Nidanpanchaka), Jirna Jwarahara, Yakrutottejak, Pramehaghna, or pancreatic-protective, Mrudu Virechak, Bruhana (Shamana & Bruhana Snehapana), Rasayana Chikitsa was planned in this case which showed the promising result. Conclusion- Ayurvedic management with Shodhana & Shamana Chikitsa based on the fundamentals of Ayurveda is effective in Chronic pancreatitis induced due to Malnutrition in children, which may become a ray of hope for pediatric patients.

MO816PULSE PRESSURE IS AN INDEPENDENT PREDICTOR OF THE RISK OF RECURRENT ALL-CAUSE HOSPITALIZATION IN CHRONIC HEMODIALYSIS PATIENTS

Background and Aims Pre - and peri-dialytic systolic blood pressures (SBP) have been linked to heightened cardiovascular morbidity and mortality in hemodialysis (HD) patients. High pulse pressure (PP) is clinically associated with increased arterial stiffness and atrial fibrillation, while low PP is associated with cardiac insufficiency. We studied the relationship between PP and all-cause hospitalization in patients undergoing maintenance HD. Method This retrospective cohort study was performed in HD patients from January 2015 to May 2020. To be included in the study, patients were required to be 18 or older, dialysis vintage of at least a year, and must have received treatment within the first 30 days after dialysis initiation. We developed Cox proportional hazards models with spline corrected terms for recurrent all-cause hospitalizations. 95% confidence interval (CI) were also computed. Further, we stratified the patient population into 4 SBP categories, namely: SBP &lt; 120, 120 ≤ SBP &lt; 150, 150 ≤ SBP &lt; 180, and SBP ≥ 180 mmHg, and investigated the mediating effects of SBP on hospitalization risk. Results We studied 2453 HD patients (age 58.9±16.1 years, 58% male) dialyzed between January 2014 and October 2018 in Renal Research Institute facilities. We observe that PPs between 45 and 70 mmHg were associated with lower risk of recurrent hospitalization (Figure 1a), possibly driven by the behavior of SBPs between 120 to 180 mmHg (Figure 1c-e). No statistically significant association was seen between PP and hospitalization for patients with SPB &lt;120mmHg and &gt;180mm (Figures 1b-d). A decreasing trend with PP greater than 90mmHg is noted but rendered negligible, and a statistical artifact caused by a case mix at these unusually high levels. The lack of significant associations between inflammatory (NLR) and nutritional (Albumin and phosphorus) factors renders PP a significant and independent predictor of recurrent hospitalization adding to the current knowledge in the field. Conclusion Our analysis found associations between PP (with and without SBP stratification) and the risk of recurrent hospitalization and all-cause mortality. Even after adjustment for hospitalization risk and other clinical, inflammatory, and nutritional parameters at baseline PP remained an independent predictor of recurrent hospitalizations. Further investigations into the relationship are needed to better understand the mediating effects of PP as a driver of hospitalization and mortality risk.

Neuropathic Pain in the Elderly

Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.