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Clinical Medicine (London, England) Jun 2024We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these...
OBJECTIVES
We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin.
METHODS
Opportunistic, prospective observational study of usual clinical care, between 16/05/23 and 14/08/23, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history.
RESULTS
Of the 123 patients admitted with a PenA (or sensitivity record) and exposed to a penicillin, data were collected for 50. Their PenA records were grouped follows: eligible for DDL 34 (68%), eligible for DOC 11 (22%), high risk 4 (8%) and unable to obtain history 1 (2%). In 14/50 (28%) patients there was no evidence of a current PenA assessment in the medical notes.
CONCLUSIONS
Using the allergy risk tool, most patients with penA records were exposed to penicillin appropriately. However, patients meeting high risk criteria were also exposed to penicillin when the tool excluded them. PenA assessment needs to be carried out with appropriate training and governance structures in place.
PubMed: 38944245
DOI: 10.1016/j.clinme.2024.100225 -
The Journal of Allergy and Clinical... Jun 2024Oral immunotherapy (OIT) has emerged as the most popular therapy for food allergy. However, data on the long-term adherence and efficacy of this approach are sparse.
BACKGROUND
Oral immunotherapy (OIT) has emerged as the most popular therapy for food allergy. However, data on the long-term adherence and efficacy of this approach are sparse.
OBJECTIVE
We aimed to assess the long-term adherence rates to OIT protocol and the associated risk of allergic reactions.
METHODS
Patients who completed milk OIT and reached a maintenance dose of 200 ml of milk were surveyed biannually on their dairy consumption and occurrence of allergic reactions. A survival analysis was performed to evaluate the association between the risk of reaction and adherence to OIT maintenance protocol.
RESULTS
The cohort consisted of 50 patients. Only 56% of the cohort adhered to protocol, which consisted of ingesting a minimum of 200 ml of milk at least 3 times per week. Adherent patients had a significantly reduced risk of allergic reactions, as well as a reduced incidence of anaphylaxis, healthcare/ER visits, and epinephrine/antihistamine administration.
CONCLUSION
The findings demonstrate the importance of consistent maintenance dose consumption in the management of food allergies, with regular milk consumption contributing to the maintenance of unresponsiveness and decreased risk of allergic symptoms.
PubMed: 38944196
DOI: 10.1016/j.jaip.2024.06.031 -
The Journal of Pediatrics Jun 2024To assess the role of adipose tissue insulin resistance (Adipo-IR) in the pathogenesis of pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) and...
OBJECTIVES
To assess the role of adipose tissue insulin resistance (Adipo-IR) in the pathogenesis of pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) and to determine Adipo-IR evolution during a lifestyle intervention program.
STUDY DESIGN
In this prospective, cohort study, children and adolescents with severe obesity were recruited between July 2020 and December 2022 at an inpatient pediatric rehabilitation center. Treatment consisted of dietary intervention and physical activity. Liver steatosis and fibrosis were evaluated using ultrasound and transient elastography with controlled attenuation parameter and liver stiffness measurement. Every 4 to 6 months, anthropometric measurements, serum biochemical analysis, ultrasound and elastography were repeated. Adipo-IR was estimated by the product of the fasting serum insulin times the fasting free fatty acid concentration and hepatic IR by the homeostatic model assessment for insulin resistance (HOMA-IR), respectively.
RESULTS
56% of 200 patients with obesity had evidence of steatosis on ultrasound and 26% were diagnosed with fibrosis (≥F2). Adipo-IR increased progressively from lean controls to patients with obesity to patients with MASLD and MASLD with fibrosis. Adipo-IR was already elevated in patients with only mild steatosis (p = 0.0403). Patients with more insulin-sensitive adipose tissue exhibited lower liver fat content (p < 0.05) and serum alanine transaminase levels (p = 0.001). Adipo-IR correlated positively with visceral adipose tissue weight, waist circumference, and the visceral adipose tissue/gynoid adipose tissue ratio (p < 0.001), but not with total body fat percentage (p = 0.263). After 4 to 6 months of lifestyle management, both MASLD and Adipo-IR improved.
CONCLUSIONS
Our data suggest that Adipo-IR is associated with the presence of pediatric MASLD, particularly steatosis.
PubMed: 38944185
DOI: 10.1016/j.jpeds.2024.114171 -
Journal of the American Medical... Jun 2024An unintended consequence of efforts to reduce antipsychotic medications in nursing homes is the increase in use of other psychotropic medications; however, evidence of...
OBJECTIVES
An unintended consequence of efforts to reduce antipsychotic medications in nursing homes is the increase in use of other psychotropic medications; however, evidence of substitution remains limited. Our objective was to measure individual-level prescribing patterns consistent with substitution of trazodone for antipsychotics.
DESIGN
Retrospective cohort study.
SETTING AND PARTICIPANTS
Residents of Ontario nursing homes aged 66-105 years with an admission assessment between April 1, 2010, and March 31, 2019, who were receiving an antipsychotic and had no antidepressant medication use at admission to the nursing home.
METHODS
We used linked health administrative data to examine changes in medication use over three quarterly assessments following admission. Antipsychotic and trazodone use were measured at each assessment. The rate of trazodone initiation was compared between residents no longer dispensed an antipsychotic (discontinued) and those with an ongoing antipsychotic (continued) using discrete time survival analysis, controlling for baseline resident characteristics.
RESULTS
We identified 13,306 residents dispensed an antipsychotic with no antidepressant use at admission (mean age 84 years, 61.5% women, 82.8% with dementia). As of the first quarterly assessment, nearly 20% of residents no longer received an antipsychotic and 9% received a new trazodone medication. Over time, residents who discontinued antipsychotics had a rate of trazodone initiation that was 82% higher compared to residents who continued (adjusted hazard ratio 1.82, 95% CI 1.66-2.00).
CONCLUSIONS AND IMPLICATIONS
Residents admitted to a nursing home with antipsychotic use had a higher rate of trazodone initiation if they discontinued (vs continued) an antipsychotic. These findings suggest antipsychotic substitution with trazodone after entering a nursing home.
PubMed: 38944053
DOI: 10.1016/j.jamda.2024.105113 -
Lancet (London, England) Jun 2024Neonatal sepsis remains one of the key challenges of neonatal medicine, and together with preterm birth, causes almost 50% of all deaths globally for children younger... (Review)
Review
Neonatal sepsis remains one of the key challenges of neonatal medicine, and together with preterm birth, causes almost 50% of all deaths globally for children younger than 5 years. Compared with advances achieved for other serious neonatal and early childhood conditions globally, progress in reducing neonatal sepsis has been much slower, especially in low-resource settings that have the highest burden of neonatal sepsis morbidity and mortality. By contrast to sepsis in older patients, there is no universally accepted neonatal sepsis definition. This poses substantial challenges in clinical practice, research, and health-care management, and has direct practical implications, such as diagnostic inconsistency, heterogeneous data collection and surveillance, and inappropriate treatment, health-resource allocation, and education. As the clinical manifestation of neonatal sepsis is frequently non-specific and the current diagnostic standard blood culture has performance limitations, new improved diagnostic techniques are required to guide appropriate and warranted antimicrobial treatment. Although antimicrobial therapy and supportive care continue as principal components of neonatal sepsis therapy, refining basic neonatal care to prevent sepsis through education and quality improvement initiatives remains paramount.
PubMed: 38944044
DOI: 10.1016/S0140-6736(24)00495-1 -
Acta Psychologica Jun 2024Socioeconomic status' (SES) impact on depressive symptoms has been extensively examined; however, previous studies have generally used variable-centered approaches and...
Socioeconomic status' (SES) impact on depressive symptoms has been extensively examined; however, previous studies have generally used variable-centered approaches and cross-sectional designs. Therefore, this study explored the subtypes of depression and examined the degree of association between SES and latent transition probabilities. We used latent profile and latent transition analyses with the 2015 and 2018 waves of data from the China Health and Retirement Longitudinal Study (N = 4904). Three subtypes of depression were identified based on symptoms: severe symptom (SS), low symptom (LS), and sub-health (MS). The SS subtype had the highest probability of staying within the original subtype. Individuals in the MS subtype were more likely to move to the SS subtype than those in the LS subtype. The heterogeneity analysis also showed that the effect of SES on latent transition probabilities is heterogeneous to the satisfaction with their relationship with their children, as well as the number of children. Additionally, decision tree analysis found SES and gender can predict transitioning. These findings add to literature on the effects of SES on the heterogeneity of depression and have implications for depression screening and identifying individuals in need of targeted interventions.
PubMed: 38943873
DOI: 10.1016/j.actpsy.2024.104381 -
International Journal of Pediatric... Jun 2024To define the essential elements of the intake questionnaire that will be a part of a larger multicenter registry for aerodigestive patients.
OBJECTIVE
To define the essential elements of the intake questionnaire that will be a part of a larger multicenter registry for aerodigestive patients.
METHODS
A modified Delphi method was utilized to obtain consensus on the data elements that should warrant inclusion in the final research database. Patient questionnaires from the eight participating institutions were reviewed and individual elements were aggregated into 14 categories.
RESULTS
A total of 198 initial elements were voted on for inclusion. The categories included demographics, respiratory symptoms, gastrointestinal symptoms, ear nose and throat symptoms, feeding, birth history, medical history, surgical history, family history, social history, medications prior to evaluation, devices used prior to evaluation, prior diagnostic evaluations, and prior evaluation by aerodigestive team members. 83 of the 198 elements met consensus for inclusion in the final registry for an inclusion rate of 41.9 %. Three separate rounds of ranking were required to obtain consensus.
CONCLUSION
The aerodigestive registry is an important initiative that will help foster research and help guide future management. The intake questionnaire of the registry is a critical component of this project, and the consensus obtained during this study should help create a streamlined and efficient registry that will help all aerodigestive patients on a national level.
PubMed: 38943832
DOI: 10.1016/j.ijporl.2024.112016 -
Waste Management (New York, N.Y.) Jun 2024Cities are a major source of litter pollution. Determination of the abundance and composition of plastic litter in cities is imperative for effective pollution...
Cities are a major source of litter pollution. Determination of the abundance and composition of plastic litter in cities is imperative for effective pollution management, environmental protection, and sustainable urban development. Therefore, here, a multidisciplinary approach to quantify and classify the abundance of litter in urban environments is proposed. In the present study, litter data collection was integrated via the Pirika smartphone application and conducted image analysis based on deep learning. Pirika was launched in May 2018 and, to date, has collected approximately one million images. Visual classification revealed that the most common types of litter were cans, plastic bags, plastic bottles, cigarette butts, cigarette boxes, and sanitary masks, in that order. The top six categories accounted for approximately 80 % of the total, whereas the top three categories accounted for more than 60 % of the total imaged litter. A deep-learning image processing algorithm was developed to automatically identify the top six litter categories. Both precision and recall derived from the model were higher than 75 %, enabling proper litter categorization. The quantity of litter derived from automated image processing was also plotted on a map using location data acquired concurrently with the images by the smartphone application. Conclusively, this study demonstrates that citizen science supported by smartphone applications and deep learning-based image processing can enable the visualization, quantification, and characterization of street litter in cities.
PubMed: 38943818
DOI: 10.1016/j.wasman.2024.06.026 -
Injury Jun 2024Homicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast,...
INTRODUCTION
Homicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment.
METHODS
We identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher's exact test, Mann-Whitney U test and logistic regression models.
RESULTS
The inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68-0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides.
DISCUSSION AND CONCLUSION
Causation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.
PubMed: 38943797
DOI: 10.1016/j.injury.2024.111694 -
Injury Jun 2024Animal-related injuries are among the major causes of morbidity and mortality all over the world, especially in rural areas. This study aims to determine the...
BACKGROUND
Animal-related injuries are among the major causes of morbidity and mortality all over the world, especially in rural areas. This study aims to determine the characteristic features of animal-related injury cases presented to the emergency department and to evaluate their temporal trends and relationships with climatic factors.
METHODS
Among the animal-related injury cases, those who applied between January 1, 2017, and December 31, 2021, in a small seaside town in Turkey were included in the study. Application date, age, gender, ICD code, and prognosis constitute the variables from the hospital information management system within the relevant date range. Meteorological data were taken from Hatay Meteorological Directorate as average daily temperature ( °C) and humidity (g/m). Descriptive statistics are presented using mean, standard error, number, percentage, and ratio. Kruskal-Wallis, Pearson correlation analysis, linear trend analysis, chi-square, and t-test were used in the analyses. The statistical significance level was accepted as p < 0.05.
RESULTS
A total of 6634 animal-related injuries were included in the study. The average age of the injured was 26.1 ± 21.1 years and 60.3 % were male. Injuries were most frequently observed in the 0-9 age group (29.9 %). Of all the cases, around 0.1 % were hospitalized and there were no reported deaths. Injuries caused by mammalian species accounted for 85 % of the cases. The number of recorded cases was lowest in 2018 and highest in 2021. Over the five years, animal-related injuries showed an increase trend which was not statistically significant (R2 = 0.216, p= 0.430). The injury cases showed a marked seasonality; numbers tended to increase in March and reached the highest level between June and September. While a significant and positive relationship was observed between the daily average temperature and the number of cases (r = 0.428, p < 0.001), there was no correlation between the average relative humidity and the injury numbers (p = 0.537).
CONCLUSION
This study revealed that animal-related injuries were commonly seen in children and young middle-aged adult groups and during warmer seasons. Based on the results of the study, we suggest several strategies to reduce the public health impact of animal-induced injuries, such as region-specific intervention programs adapted to animal species and seasonal changes, educational campaigns targeting children during the warmer seasons, and improved data recording systems for the cases.
PubMed: 38943796
DOI: 10.1016/j.injury.2024.111688