The Burden of Hospitalisations for Herpes Zoster Ophtalmicus in Spain (1997-2008)

Purpose: This epidemiological retrospective survey aims to provide population-based estimates of the burden of hospitalisation for herpes zoster ophthalmicus in Spain during a twelve-year period (1997-2008). Methods: All hospital discharges and deaths related to herpes zoster ophthalmicus in patients older than 30 years old from 1997 to 2008 in Spain were obtained. Differences in proportions were assessed by the Chi-square test. ANOVA was used for multiple comparisons. Poisson regression was used to assess differences in the rates. Results: A total of 3029 hospital discharges in patients older than 30 years old were coded as herpes zoster ophthalmicus. Of those, 1009 were coded as primary cause of hospitalization. This corresponds to a hospitalization rate of 0.94 and 0.31 hospitalizations per 100,000 for any position and first diagnostic position, respectively. The 75% of the total discharges were in immunocompetent patients. The herpes zoster ophthalmicus hospitalization rate increased significantly during the study period. This increase was also observed for immunocompetent patients. A total of 127 and 21 deaths occurred in patients ≥ 30 year-old hospitalized with herpes zoster ophthalmicus in any diagnostic position and principal diagnostic code, respectively during the 12-year study period. Of them, 70 (53.4%) were in immunocompetent patients, and, of those 11 were in patients with HZO in the first diagnosis position. The hospitalization rate and case-fatality rate increase significantly with age from 50 years old onwards. Conclusion: HZO, a vaccine preventable disease, still causes hospitalization and death in adults in Spain.

Investigation of 25-Hydroxy Vitamin D Status and Related Factors in Hospitalised Patients with Type 2 Diabetes Mellitus

Objective: To investigate the distribution of 25-hydroxy Vitamin D level status in type 2 diabetes mellitus inpatients, as well as the differences in general conditions and clinical indicators in patients with different Vitamin D status. Methods: Retrospective analysis of 250 admitted type 2 diabetes inpatients admitted to the endocrinology department of qinghai provincial hospital of traditional chinese medicine from september 2022 to december 2023, collated and analysed the general data and laboratory indicators of the patient cases, and applied spss26.0 to process and analyse the data and explore the differences in the general conditions and commonly used clinical nutritional indicators of type 2 diabetes in patients with different 25-hydroxyVitamin D levels. The differences between the different 25-hydroxy Vitamin D levels in type 2 diabetes mellitus patients. Results: 1) A total of 250 inpatients with type 2 diabetes mellitus were included in this study, of which 56 cases (22.4%) were patients with 25 hydroxyvitamin D deficiency [25(OH)D P P P P > 0.05). 3) The distribution of some laboratory indexes among the three groups of patients was differentiated, with the average level of glycated haemoglobin in the lack group being significantly higher than that of the remaining two groups, the average level of albumin being significantly lower than that of the remaining two groups, and the average level of haemoglobin being significantly lower than that of the good group (P P > 0.05). Conclusion: The 25(OH)D level of type 2 diabetes mellitus inpatients is not optimistic. In clinical diagnosis and treatment, we should pay attention to the changes in 25 hydroxyvitamin D levels and other nutritional indexes of patients with type 2 diabetes mellitus, and focus on the control of blood glucose levels and timely supplementation of vitamins, proteins, and lipids, in order to improve the patients’ physical status, reduce the incidence of complications, and improve the clinical efficacy and the patients’ quality of life.

Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist

AIMTo investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist.METHODSCirrhotics listed for liver transplantation at a single centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection. Univariable and multivariable analysis was performed using negative binomial regression to associate baseline parameters including frailty with clinical outcomes and estimated incidence rate ratios (IRR).RESULTSOf 587 cirrhotics, 64% were male, median age (interquartile range) was 60 (53-64) years and MELD score was 15 (12-18). Median Fried Frailty Index was 2 (1-3); 31.6% were classified as frail (fried frailty ≥ 3). During 12 mo of follow-up, 43% required at least 1 hospitalisation; 38% of which involved major infection. 107/184 (58%) frail and 142/399 (36%) non-frail patients were hospitalised at least once (P < 0.001). In univariable analysis, Fried Frailty Index was associated with total hospitalisation days per year (IRR = 1.51, 95%CI: 1.28-1.77; P ≤ 0.001), which remained significant on multivariable analysis after adjustment for MELD, albumin, and gender (IRR for frailty of 1.21, 95%CI: 1.02-1.44; P = 0.03). Incidence of infection was not influenced by frailty.CONCLUSIONIn cirrhotics on the liver transplant waitlist, physical frailty is a significant predictor of hospitalisation and total hospitalised days per year, independent of liver disease severity.

Proton pump inhibitor use increases mortality and hepatic decompensation in liver cirrhosis

BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermore,PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017.PPI users were defined as cumulative defined daily dose(cDDD)≥28 within a landmark period,after hospitalisation for hepatic decompensation.Cox regression analysis for comparison was done after propensity score adjustment.Further risk of hepatic decompensation was analysed by Poisson regression.RESULTS Among 295 decompensated cirrhosis patients,238 were PPI users and 57 were non-users.PPI users had higher mortality compared to non-users[adjusted HR=2.10,(1.20-3.67);P=0.009].Longer PPI use with cDDD>90 was associated with higher mortality,compared to non-users[aHR=2.27,(1.10-5.14);P=0.038].PPI users had a higher incidence of hospitalization for hepatic decompensation[aRR=1.61,(1.30-2.11);P<0.001].CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation.Longer PPI exposure with cDDD>90 increases the risk of mortality.

Impact of thiopurines and anti-tumour necrosis factor therapy on hospitalisation and long-term surgical outcomes in ulcerative colitis

Ulcerative colitis(UC) is a chronic inflammatory condition affecting the large bowel and is associated with a significant risk of both requirement for surgeryand the need for hospitalisation. Thiopurines, and more recently, anti-tumour necrosis factor(a TNF) therapy have been used successfully to induce clinical remission. However, there is less data available on whether these agents prevent long-term colectomy rates or the need for hospitalisation. The focus of this article is to review the recent and pertinent literature on the long-term impact of thiopurines and a TNF on long-term surgical and hospitalisation rates in UC. Data from population based longitudinal research indicates that thiopurine therapy probably has a protective role against colectomy, if used in appropriate patients for a sufficient duration. a TNF agents appear to have a short term protective effect against colectomy, but data is limited for longer periods. Whereas there is insufficient evidence that thiopurines affect hospitalisation, evidence favours that a TNF therapy probably reduces the risk of hospitalisation within the first year of use, but it is less clear on whether this effect continues beyond this period. More structured research needs to be conducted to answer these clinically important questions.

Hospitalization Can Correct Behavioral Feeding Disorders in Children by Resetting the Pedagogic Climate

Background: Behavioral feeding disorders are common among children, which sometimes become progressive, and consequently, children may refuse to eat anything. Parents have lots of difficulties to reset such a disturbed eating pattern. The aim of this study was to perform an analysis of clinical intervention in behavioral feeding disorders in young children. Methods: We conducted a retrospective analysis of data of 28 children aged 1 - 9 years with behavioral feeding disorders. A pediatrician and pediatric social worker conducted the training in two groups: outpatient or inpatient setting. Both groups were treated with parental education and guidance. The inpatient group also had a temporarily (2 weeks) resetting of the pedagogic climate in a pediatric ward of a general hospital under guidance of a pediatric social worker. Results: Almost all parents were inconsistent in applying appropriate behavioral contingencies during meals. Eleven patients followed 8 months of outpatient treatment and 25 patients followed 2 weeks of inpatient treatment. The overall success rate of outpatient treatment after 2 weeks was 18%, and that of inpatient treatment after 8 months was 88%. The corrected relapse rates are 18% and 56% respectively after 6 months. Conclusion: Short clinical intervention in a structured pedagogic environment is a successful treatment in behavioral feeding disorders. Herewith, pediatricians have a powerful tool for treating behavioral feeding disorders by temporarily resetting and changing the pedagogic climate.