Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy

The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.

All-cause hospitalizations for inflammatory bowel diseases:Can the reason for admission provide information on inpatient resource use?A study from a large veteran affairs hospital

Background:Inflammatory bowel diseases(IBDs) are group of chronic inflammatory illnesses with a remitting and relapsing course that may result in appreciable morbidity and high medical costs secondary to repeated hospitalizations.The study's objectives were to identify the reasons for hospitalization among patients with IBDs,and compare inpatient courses and readmission rates for IBD-related admissions versus non-IBD-related admissions.Methods:A retrospective chart review was performed on all patients with IBD admitted to the Minneapolis Veterans Affairs(VA) Medical Center between September 2010 and September 2012.Results:A total of 111 patients with IBD were admitted during the 2-year study period.IBD flares/complications accounted for 36.9% of the index admissions.Atherothrombotic events comprised the second most common cause of admissions(14.4%) in IBD patients.Patients with an index admission directly related to IBD were significantly younger and had developed IBD more recently.Unsurprisingly,the IBD admission group had significantly more gastrointestinal endoscopies and abdominal surgeries,and was more likely to be started on medication for IBD during the index stay.The median length of stay(LOS) for the index hospitalization for an IBD flare or complication was 4(2–8) days compared with 2(1–4) days for the other patients(P=0.001).A smaller percentage of the group admitted for an IBD flare/complication had a shorter ICU stay compared with the other patients(9.8% vs.15.7%,respectively); however,their ICU LOSs tended to be longer(4.5 vs.2.0 days,respectively,P=0.17).Compared to the other admission types,an insignificantly greater percentage of the group whose index admission was related to an IBD flare or complication had at least one readmission within 6 months of discharge(29% versus 21%; P=0.35).The rate of admission was approximately 80% greater in the group whose index admission was related to an IBD flare or complication compared to the other types of admission(rate ratio 1.8,95% confidence interval 0.96 to 3.4),although this difference did not reach statistical significance(P=0.07).Conclusion:Identifying the reasons for the patients' index admission,IBD flares versus all other causes,may provide valuable information concerning admission care and the subsequent admission history.

Risk factors for 90-day readmission in veterans with inflammatory bowel disease——Does post-discharge follow-up matter?

Background: Repeat hospitalizations in veterans with inflammatory bowel disease(IBD) are under studied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions.Methods: A retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center(MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission.Results: There were 130 unique patients(56.9% with Crohn's disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8±15.2 years. The median time to re-hospitalization was 26 days(IQR 10-49), with 30-and 90-day readmission rates of 17.3%(35/202) and 29.2%(59/202), respectively. Reasons for all-cause readmission were IBD-related(71.2%), scheduled surgery(3.4%) and non-gastrointestinal causes(25.4%). The following reasons were independently associated with 90-day readmission: Crohn's disease(OR 3.90; 95% CI 1.82-8.90), use of antidepressants(OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician(PCP)(OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist(GI)(OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively.Conclusion: Early readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn's disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.

Catheter Ablation of Atrial Fibrillation:Where Are We?

Atrial fibrillation(AF)is the commonest cardiac arrhythmia,with significant morbidity and mortality.More than half of patients with AF are still symptomatic despite adequate anticoagulation and rate control.If antiarrhythmic drugs are ineffective or poorly tolerated,AF patients are then typically treated with catheter ablation to restore sinus rhythm.In the past 20 years,AF ablation has developed from a specialized,experimental procedure into a common treatment in the cardiovascular field.Various ablation techniques and mapping technologies have been described and are continuing to evolve for increased safety and efficacy.An incomplete list of such techniques and technologies would include focal and segmental,circumferential and linear,complex fractionated atrial electrogram,ganglionated plexus,focal impulse and rotor modulation,body surface potential mapping–guided,real-time MRI–guided,cryoballoon,visually guided laser balloon,radiofrequency hot balloon,contact force sensing catheter,multielectrode catheter,and hybrid ablations.This review examines the history of invasive AF treatment and its evolution into catheter ablation but mainly focuses on the discussion of various ablation techniques and technologies leading to our current understanding of the ablation therapy of this most common arrhythmia.

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Colon in a Patient with <i>Borrelia burgdorferi</i>Infection (Lyme Arthritis)

Mucosa-associated lymphoid tissue (MALT) lymphoma generally occurs in the context of chronic inflammation or autoimmune disorders. The most common infections linked to MALT lymphomas include Helicobacter pylori (Hp)-associated gastritis, Chlamydophila psittacii and hepatitis C infection. Although Borrelia burgdorferi infection has been linked to primary cutaneous B-cell lymphoma (PCBCL), there is no known link between Borrelia burgdorferi infection and MALT lymphomas in the US. We report a patient who developed mucosa-associated lymphoid tissue (MALT) lymphoma of the colon in the context of untreated Lyme arthritis, and no other autoimmune disorders or infections known to be associated with MALT lymphoma. We recommend that Lyme disease due to Borrelia burgdorferi be considered as a possible underlying infection potentially contributing to the emergence of extranodal lymphoma.