Sex Specific Differences in Nosocomial Infections in Patients with Decompensated Liver Cirrhosis

Background and aims: There are considerable differences between males and females regarding the etiology, progression and outcome of liver diseases. Infections are a frequent and severe complication in these patients. This study aimed to examine sex specific differences in the incidence and clinical course of nosocomial infections in patients with decompensated liver cirrhosis.Methods: A number of 555 consecutive patients with decompensated liver cirrhosis and ascites were analyzed. The patients were followed up for the incidence of nosocomial infections, acute kidney injury (AKI), acute-on-chronic liver failure (ACLF) as well as liver transplantation and death (LTx-free survival). Results: A number of 285 patients (111 women and 174 men) developed a nosocomial infection. Incidence was numerically lower in men (p=0.076). While the frequency of a nosocomial spontaneous bacterial peritonitis was similar between males and females, the incidence of a nosocomial urinary tract infection was significantly higher in women (p<0.001). No sex specific differences were documented regarding the outcome of an infection as indicated by a similar incidence of, AKI, ACLF as well as LTx-free survival.Conclusion: There seem to be no major differences in the incidence and outcome of nosocomial infections between male and female patients.

Reproductive Performance and Culling Rate of Purebred Holstein Cows and Their Crosses With Fleckvieh and Brown Swiss Cows Under Subtropical Conditions

This study aimed to elucidate the reproductive performance of purebred Holstein (HO) cows with their crosses with Fleckvieh (FV) and Brown Swiss (BS) cows under subtropical conditions. A total of 677 cows [487 HO, 104 HO × FV (HFV); 50% FV and 50% HO and 86 HO × BS (HB); 50% BS and 50% HO] were enrolled in this study. Pure HO cows had significantly greater service per conception (S/C; 3.69), days open (147.9 days), and calving interval (449.6 days), than the HFV (2.89, 116.7, and 407.4 days, respectively) and HB (3.07, 134.3, and 434.2 days, respectively) crossbred cows. At day 28, the conception percentage was significantly greater among HFV crossbred cows vs. pure HO cows [crude odds ratios (COR) = 2.16], but embryonic loss, abortion percentage, calving difficulty, and retained placenta percentage were similar (p &gt; 0.05) among pure HO cows and their crosses. HFV crossbreds had significantly lower incidence of endometritis (COR = 0.70, p = 0.035), mastitis (COR = 0.69, p = 0.015), and ketosis (COR = 0.53, p = 0.004) vs. other cows. HB and pure HO cows had a similar incidence of mastitis, lameness, and ketosis (COR = 0.76, 0.75, and 0.81; p = 0.223, 0.468, and 0.492, respectively). HFV crossbred cows had a lower risk of culling rate than HB crossbred cows. In summary, HFV cows demonstrated the best reproductive performance in terms of S/C, days open, calving interval, conception at 28 days, mastitis percentage, ketosis percentage, and endometritis.

Estimating the risk of thrombotic events in people with congenital hemophilia A using US claims data

Aim: Compare thrombotic risk in people with congenital hemophilia A (PwcHA) to the general non-hemophilia A (HA) population. Patients & methods: US claims databases were analyzed to identify PwcHA. Incidence rates of myocardial infarction, pulmonary embolism, ischemic stroke, deep vein thrombosis and device-related thrombosis were compared with a matched cohort without HA. Results: Over 3490 PwcHA were identified and 16,380 individuals matched. PwcHA had a similar incidence of myocardial infarction and pulmonary embolism compared with the non-HA population, but a slightly higher incidence of ischemic stroke and deep vein thrombosis. The incidence of device-related thrombosis was significantly higher in PwcHA. Conclusion: This analysis suggests that PwcHA are not protected against thrombosis, and provides context to evaluate thrombotic risk of HA treatments.

Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis

Background: Age affects the efficacy of pharmacological treatment for atrial fibrillation (AF). Catheter ablation, including radiofrequency (RF) or cryoballoon ablation, is an effective strategy for symptomatic AF. This meta-analysis aimed to analyze the efficacy and safety of AF ablation in elderly patients with AF compared to non-elderly patients with AF.Methods: We searched several databases for articles published between January 1, 2008 and March 31, 2020. Eighteen observational studies with 21,039 patients were analyzed. Data including recurrence of AF or atrial tachyarrhythmia (ATA), complications, procedural time, and fluoroscopic time were compared between the elderly and non-elderly groups.Results: The elderly patients had significantly higher incidences of recurrent AF or ATA after AF ablation compared to the non-elderly patients (&lt;60 years old) (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.11–1.33). The elderly patients had significantly higher incidences of complications of AF ablation compared to the non-elderly patients (OR, 1.37; 95% CI, 1.14–1.64). However, elderly AF patients with age ≥75 years old had similar incidence of recurrent AF or ATA and complication after AF ablation compared to non-elderly patients with AF.Conclusions: The elderly patients had significantly higher incidences of recurrent AF or ATA and complications after ablation for non-paroxysmal AF compared to non-elderly patients with AF (&lt;60 years old), except in patients ≥75 years old.

Clinical Efficacy of Amlodipine Besylate Combined with Ligusticum on Patients with Both Hypertension and Heart Failure and Their Prognosis and Life Quality

Heart failure, a frequent complication of hypertension, is the primary risk factor of myocardial infarction. Therefore, it is important to find newer and effective treatments for hypertension comorbid with heart failure. A combination of amlodipine besylate and ligusticum, both known antihypertensives, was evaluated in hypertension complicated with heart failure with the goal of providing improved treatment. To this end, 172 hypertensive patients with heart failure received a conventional therapy or amlodipine besylate combined with ligusticum. Following treatment, all subjects were evaluated for clinical efficacy, safety, blood pressure, cardiac function, vascular endothelial function, and heart failure markers. The two groups were followed up for 1 year, and their prognosis and life quality were investigated. The treatment resulted in improvement in all markers, a higher total effectiveness rate with similar incidence of adverse reactions. Therefore, amlodipine besylate combined with ligusticum may be an effective and safe treatment for hypertension complicated with heart failure.

Evaluation of the Impact of Prior-to-Admission Sleep Aid Prescribing Practices on Sleep and Delirium in the Intensive Care Unit

Background: Sleep disruptions in the intensive care unit (ICU) may lead to complications such as delirium. There is limited evidence addressing how sleep aid use before and during ICU admission affects outcomes. Objective: The purpose of this study is to evaluate the impact of prior-to-admission sleep aid prescribing practices in the ICU on delirium and sleep outcomes. Methods: A retrospective review was conducted of adult patients admitted to any ICU from January to June 2018 receiving a sleep aid prior to admission. Patients were categorized based on sleep aid continuation, discontinuation, or alteration during the ICU admission. The primary end point was the incidence of delirium. Secondary end points included the incidence of sleep-wake cycle disturbances, delirium scores, and ICU length of stay. Results: A total of 291 patients were included with 109 in the continued group, 121 in the discontinued group, and 61 in the altered group. There was a similar incidence of delirium at 24 hours ( P = 0.71), 48 hours ( P = 0.60), 72 hours ( P = 0.25), and 5 days ( P = 0.48) after ICU admission. There was also no statistical difference in sleep-wake cycle disturbances or delirium scores at any time point. ICU length of stay was similar between the groups. Conclusion and Relevance: The incidence of delirium and sleep-wake cycle disturbances was not affected by differences in prior-to-admission sleep aid prescribing patterns during ICU admission.

Where is the nerve? Review of operation note documentation practice for inguinal hernia repair

Introduction Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice may inform postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in their operation notes. Methods We carried out a retrospective review of operation notes at a single district general hospital. We analysed operation notes for documentation of identification and intraoperative management (preservation or sacrifice) of the inguinal nerves (iliohypogastric, ilioinguinal, genital branch of genitofemoral nerve). We collected data on the baseline characteristics of the patients, hernia characteristics and primary operating surgeons for subgroup analysis. Results A total of 100 patients were included in the analysis. Identification of any inguinal nerves (generic ‘nerve’) was documented in 17% of operation notes. Documentation in the operation notes of named individual nerves was limited. No documentation of intraoperative management of inguinal nerves was found in 83% of operation notes. Preservation of the inguinal nerves (generic ‘nerve’) was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades. Conclusion This study reveals a lack of appreciation of the importance of documenting identification and management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.

Comparison of antibiotic-associated diarrhea caused by cefoperazone/sulbactam or piperacillin/tazobactam in neurosurgery patients

Objective To compare the occurrence and prognosis of antibiotic-associated diarrhea (AAD) between patients treated with cefoperazone/sulbactam and piperacillin/tazobactam in the neurosurgery department. Methods This study retrospectively analyzed patients who received cefoperazone/sulbactam or piperacillin/tazobactam to prevent or treat hospital-acquired infections in the Department of Neurosurgery of The First Medical Center of Chinese PLA General Hospital between October 2019 and October 2020. For patients with AAD, clinical data, antibiotic usage, the incidence of diarrhea, treatment, and prognosis were collected and analyzed. Results In total, 356 patients were enrolled, and 65 (18.6%) experienced AAD, 38 patients in the cefoperazone/sulbactam group and 27 patients in the piperacillin/tazobactam group. The AAD rate did not differ between the treatment arms. Conversely, the dosage, intensity, and duration of antibiotic therapy differed between the groups, whereas no differences were noted in the time to the appearance of diarrhea and prognosis. According to regression analysis, the incidence of AAD did not differ between the groups (odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.46–1.48). Conclusion Cefoperazone/sulbactam or piperacillin/tazobactam can lead to a similar incidence rate of AAD. The combined application of antibiotics and empiric therapy often occurs. The rational use of antibiotics should be improved.

Canadian Colorectal Cancer Screening Guidelines: Do They Need an Update Given Changing Incidence and Global Practice Patterns?

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second leading cause of cancer death in Canada. Organized screening programs targeting Canadians aged 50 to 74 at average risk of developing the disease have contributed to decreased rates of CRC, improved patient outcomes and reduced healthcare costs. However, data shows that recent incidence reductions are unique to the screening-age population, while rates in people under-50 are on the rise. Similar incidence patterns in the United States prompted the American Cancer Society and U.S. Preventive Services Task Force to recommend screening begin at age 45 rather than 50. We conducted a review of screening practices in Canada, framing them in the context of similar global health systems as well as the evidence supporting the recent U.S. recommendations. Epidemiologic changes in Canada suggest earlier screening initiation in average-risk individuals may be reasonable, but the balance of costs to benefits remains unclear.