Baylor University Medical Center Proceedings最新文献

Background: In previous studies, there was an increase in mortality with secondary coinfections in all COVID-19 variants. However, no prior study has explored the association of coinfection with outcomes of hospitalized patients among the COVID-19 variants (Alpha, Delta, and Omicron).

Methods: This observational cohort study involved 21,186 patients hospitalized with COVID-19 in 25 hospitals in Texas. Patients were divided into groups by surges of COVID-19: Alpha (November 1, 2020-February 10, 2021), Delta (July 10, 2021-October 14, 2021), and Omicron (December 21, 2021-March 3, 2022). Data were collected from electronic health records using methodology from the Viral Respiratory Illness Universal Study COVID-19 registry (NCT04323787) of COVID-19 hospitalizations. Multivariable Cox-proportional hazard regression model assessed the adjusted effect of different surge periods on mortality.

Results: Bacterial coinfections varied among hospitalization surges associated with Alpha (8.5%), Delta (11.7%), and Omicron (11.9%) variants. Adjusted analyses showed a higher 30-day and 90-day mortality in all variants when coinfections were present compared with isolated COVID-19 infection. In particular, 30-day and 90-day mortality were significantly worse with Delta compared to Alpha and Omicron.

Conclusions: All variants were associated with a higher mortality when bacterial coinfections were present. Delta was associated with a higher risk-adjusted mortality at 30 days and thereafter.

Background: Endoscopic submucosal dissection (ESD) has revolutionized the treatment of early stage gastrointestinal cancers. However, ESD can be associated with increased postprocedural pain and higher complication rates. This systematic review and meta-analysis evaluated the efficacy and safety of local anesthesia.

Methods: A comprehensive search was conducted to identify relevant randomized controlled trials investigating the effect of local anesthesia in ESD procedures. The Cochrane risk of bias tool for randomized trials was used to assess study quality. A meta-analysis was performed using Review Manager 5.4, with summary measures expressed as pooled odds ratios (OR) or mean differences with corresponding 95% confidence intervals (CI).

Results: Four randomized controlled trials with 296 patients undergoing ESD procedures were included. The use of local anesthesia did not significantly impact procedural time (mean difference = -2.05, 95% CI = -9.29, 5.18, I² = 30%, P = 0.58). Lastly, the use of local anesthesia did not increase the risk of bleeding or other adverse events (P > 0.05) and decreased the incidence of bradycardia (OR = 0.16, 95% CI = 0.03, 0.95; I² = 0%; P = 0.04).

Conclusion: Our study found that the use of local anesthesia did not significantly affect the procedural time of ESD. However, it effectively reduced postoperative pain in some trials with no risk of increased incidence of adverse events.

Background: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a complication of dual antiplatelet therapy (DAPT) and direct oral anticoagulant therapy (DOAC). There is a lack of data comparing mechanical therapy (clips) with thermal therapy in this population.

Methods: We conducted a retrospective chart review of patients undergoing urgent/emergent endoscopy for NVUGIB while being on DAPT or DOAC. Patients who had DAPT/DOAC held as per American Society of Gastrointestinal Endoscopy guidelines were excluded from the study.

Results: A total of 122 patients were included in the study. There was no difference in primary hemostasis, rebleeding rate, rescue hemostatic procedure, and 30-day mortality between the mechanical and thermal therapy groups. The mechanical therapy group had a significantly higher rate of prolonged length of stay (61.2% vs 38.9%, P = 0.02), serious clinical outcomes (56% vs 37.5%, P = 0.04), and intensive care unit admissions (50% vs 20.8%, P = 0.001) than the thermal therapy group.

Conclusion: Patients on DAPT/DOAC presenting with NVUGIB can undergo mechanical or thermal endoscopic intervention without a significant difference in achieving primary hemostasis, rebleeding, requiring a secondary procedure, or mortality outcomes.

Background: This study examined inpatient mortality factors in geriatric patients with acute myeloid leukemia (AML) using data from the 2016 to 2020 National Inpatient Sample.

Methods: Identifying patients through ICD-10 codes, a total of 127,985 individuals with AML were classified into age categories as follows: 50.58% were 65 to 74 years, 37.74% were 75 to 84 years, and 11.68% were 85 years or older. Statistical analysis, conducted with STATA, involved Fisher's exact and Student's t tests for variable comparisons. Mortality predictors were identified through multivariate logistic regression.

Results: Various hospital and patient-level factors, including an increase in age, race, a higher Charlson Comorbidity Index score, insurance status, and specific comorbidities such as atrial fibrillation and protein-calorie malnutrition, independently elevated the risk of inpatient mortality. Asthma, hyperlipidemia, and inpatient chemotherapy were linked to lower mortality. Although there was no statistically significant mortality rate change from 2016 to 2020, a decline in chemotherapy use in the eldest age group was noted.

Conclusion: This study highlights the complexity of factors influencing inpatient mortality among geriatric patients with AML, emphasizing the need for personalized clinical approaches in this vulnerable population.

A hyperechoic nodule in the liver has a broad differential; however, the vast majority are benign lesions. We report a case of a 29-year-old man with a history of anxiety and depression who presented to the hospital due to a 12-day history of epigastric pain with radiation to the back, fevers, and night sweats. Initial imaging revealed a small hyperechoic nodule on the liver, originally believed to be an abscess. Image-guided aspiration was attempted but no fluid could be drained. An endoscopic ultrasound was pursued to further evaluate the lesion and obtain a biopsy. An ulcerated esophageal mass was incidentally identified on endoscopy. Hepatic and esophageal biopsies demonstrated moderately differentiated adenocarcinoma, with esophageal adenocarcinoma as the primary source. This case highlights an interesting presentation for the rare occurrence of metastatic esophageal adenocarcinoma in a young, healthy individual without identifiable risk factors.

Approximately 6% of women with newly diagnosed breast cancer will present with metastatic disease. Proper staging workup and diagnosis of metastatic lesions is crucial prior to surgical treatment.¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is often included in the staging workup of locally advanced breast cancer. Recently, PET/CT with ¹⁸F-fluoroestradiol (¹⁸F-FES), a radiolabeled form of estradiol that binds to the estrogen receptor, has been approved as an additional imaging technique for the detection of estrogen receptor-positive lesions in patients with metastatic breast cancer. Though the two have been shown to have comparable sensitivity for diagnosis of metastatic lesions, there is still much debate regarding when to use ¹⁸F-FES PET/CT over ¹⁸F-FDG PET/CT imaging. We present the case of a 68-year-old patient diagnosed with estrogen and progesterone receptor-positive invasive ductal carcinoma of the left breast. Her staging workup included an ¹⁸F-FDG PET/CT that did not demonstrate any evidence of metastatic lesions. Due to discordant imaging findings, the patient then underwent ¹⁸F-FES PET/CT, which demonstrated over 90 metastatic osseous lesions. This study highlights the utility of ¹⁸F-FES PET/CT over ¹⁸F-FDG PET/CT in diagnosis of metastatic osseous lesions in a patient with metastatic estrogen receptor-positive breast cancer.