Journal of hospital medicine最新文献

Child physical abuse did not increase early in the coronavirus disease 2019 (COVID-19) pandemic as anticipated. However, abuse epidemiology has not been evaluated during later periods of the pandemic. This study's objective was to compare the volume of hospital encounters (i.e., emergency department visits and hospitalizations) for abuse and injuries concerning for abuse at 42 US children's hospitals across three pandemic periods compared with prepandemic, during January 1, 2018 through June 30, 2023. Median monthly volumes of encounters as well as child- and encounter-level characteristics for each pandemic period were compared with pre-pandemic. Hospital encounters for abuse and injuries concerning for abuse remained relatively unchanged throughout the pandemic, including during the late-pandemic period when many pandemic-related economic and relief policies had been discontinued. Hispanic children, however, accounted for an increasing proportion of cases throughout the pandemic, indicating potential emerging demographic changes in child abuse epidemiology.

A 34-year-old man recently immigrated from Guam to Colorado presented with a 3-year history of skin lesions and months of worsening eye irritation and vision loss. Examination revealed leonine facies, tender erythematous nodules, corneal neovascularization, and granulomatous anterior uveitis. Diagnosed with multibacillary leprosy complicated by erythema nodosum leprosum, he responded well to multidrug therapy and immunosuppressive treatment, with significant improvement in systemic symptoms, ocular inflammation, and skin lesions at follow-up.

Introduction: Gram-negative bacteremia (GNB) is associated with significant morbidity and mortality. Transition to oral therapy has traditionally utilized fluoroquinolones or trimethoprim-sulfamethoxazole rather than beta-lactams due to concerns about pharmacokinetics and bioavailability despite a dearth of clinical data. The purpose of this meta-analysis is to evaluate the clinical efficacy of transition to oral beta-lactam therapy in uncomplicated GNB.

Methods: We performed a meta-analysis of published articles in MEDLINE, Embase, and Web of Science databases from inception to September 2024. Inclusion criteria included any study with adults (age >18 years of age) with uncomplicated GNB from any source. Primary outcomes included 30-day all-cause mortality and 30-day antibiotic failure rate.

Results: Eight retrospective cohort studies were reviewed comprising 7500 patients. Twice as many patients were in the fluoroquinolones/trimethoprim-sulfamethoxazole group compared with the beta-lactams group (4998 vs. 2482). Patients in each group had similar average age (70 vs. 71), percent male (54% vs. 56%), percent urinary source (78% vs. 80%), duration of IV antibiotics (4.2 vs. 4.5), Pitt bacteremia score (1.1 vs. 1.4) and Charleston comorbid index (2 vs. 2). There was no statistically significant difference in the 30-day all-cause mortality rate between the fluoroquinolones/trimethoprim-sulfamethoxazole and the beta-lactams group: 2.06% versus 1.89% with a weighted relative risk ratio of 1.24 (95% confidence interval [CI]: 0.86-1.77) or the 30-day antibiotic failure rate: 2.08% vs. 3.42%, weighted relative risk ratio of 1.29 (95% CI: 0.97-1.71).

Conclusions: There is no statistically significant difference in 30-day mortality or antibiotic failure rates between BL and FQ/TMP-SMX as transition to oral therapy in treating uncomplicated GNB.

Venous blood gases (VBGs) are safe and effective at screening for hypercarbic respiratory failure. Multiple studies have validated that a VBG with a PvCO₂ less than 45 reliably rules out hypercarbia. The use of VBGs for the initial screening of hypercarbia when hypercarbic respiratory failure is suspected can reduce the overall use of arterial blood gases which are more painful and take more time and expertise to perform.