Volume 149, No. 1718

Stephan Baumeler, Wolfram Jochum, Jörg Neuweiler, Irina Bergamin, David Semela (Author)

Controlled attenuation parameter for the assessment of liver steatosis in comparison with liver histology: a single-centre real life experience

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BACKGROUND AND AIMS

Accurate diagnosis and staging of non-alcoholic fatty liver disease are essential for the management of this disorder. Controlled attenuation parameter (CAP) has been suggested as a new noninvasive measurement made during transient elastography to assess liver steatosis. The aim of this study was to evaluate CAP as a diagnostic tool for identifying the presence and degree of hepatic steatosis in consecutive patients in an outpatient liver unit of a tertiary centre.

METHODS

Between March 2015 and August 2016, all patients who underwent liver biopsy underwent liver stiffness measurement with simultaneous CAP determination using the FibroScan^® M or XL probe. Steatosis, inflammatory activity and fibrosis were assessed using the histological SAF scoring system. In addition, fibrosis was scored according to the METAVIR system, and body mass index (BMI) and the underlying liver disease were also recorded.

RESULTS

224 patients were included in the analysis; 146 (65.2%) were male. Steatosis grades were distributed as follows: S0 n = 85 (37.9%), S1 n = 82 (36.6%), S2 n = 33 (14.7%), S3 n = 24 (10.7%). Mean BMI was 26.8 kg/m², for the S0 group 24.9 kg/m², S1 26.5 kg/m², S2 27.3 kg/m² and S3 32.5 kg/m². The CAP differed significantly between steatosis groups S0 to S3. The area under receiver operating characteristics curve for S0 vs S1–S3 was 0.78, for S0/1 vs S2/3 0.83 and for S0–2 vs S3 0.82. Calculated cut-off values were 258.5 dB/m for S0 vs S1–3, 282.5 dB/m for S0/1 vs S2/3 and 307.5 dB/m for S0–2 vs S3.

CONCLUSIONS

CAP values are strongly associated with the degree of steatosis irrespective of the underlying liver disease. Integrating CAP measurements in the standard work-up may identify patients with NAFLD.

Véronique Andrey, Pierre-Alex Crisinel, Guy Prod’hom, Antony Croxatto, Jean-Marc Joseph (Author)

Impact of co-amoxicillin-resistant Escherichia coli and Pseudomonas aeruginosa on the rate of infectious complications in paediatric complicated appendicitis

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BACKGROUND

Choice of antibiotics for complicated appendicitis should address local antibiotic resistance patterns. As our local data showed a less than 15% resistance of Escherichia coli to co-amoxicillin (amoxicillin + clavulanic acid), we opted for this antibiotic in 2013. Subsequently, the increasing prevalence of Pseudomonas aeruginosa challenged this choice.

AIM OF THE STUDY

The aim of this study was to describe the bacteriology of peritoneal swabs from cases of complicated appendicitis in our paediatric patients, and to determine the risk of infectious complications (wound and/or intra-abdominal abscesses).

METHODS

We designed a retrospective cohort study including all children (<18 years old) who had surgery for complicated appendicitis between 1 January 2010 and 31 December 2016 and had a peritoneal swab culture. Microbiological results are presented descriptively. Univariate analyses were performed for potential determinants of infectious complications. All variables with a p-value <0.05 were then included in a multivariable logistic regression model, for which adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

One hundred and thirty-three patients were treated for complicated appendicitis and had cultures of peritoneal fluid. Median age was 9.5 years old (IQR 5.7–12.4), and there were 53 girls (40%). E. coli was isolated in 94 patients (71%) and was resistant to co-amoxicillin in 14% of cases. P. aeruginosa was isolated in 31 patients (23%). The rate of infectious complications was 38% (8/21 patients) when the empiric antibiotic did not cover P. aeruginosa and 0% (0/10 patients) when P. aeruginosa was covered adequately (p = 0.03). In a multivariable analysis, only co-amoxicillin-resistant E. coli significantly predicted infectious complications (OR 4.7; 95% CI 1.4–16.6; p = 0.015).

CONCLUSION

Results of the multivariable analysis of this small, retrospective study revealed a statistically significant increase in the risk of postoperative complications in the presence of co-amoxicillin-resistant E. coli. The choice of antibiotic should be adapted accordingly. More data are needed to justify the systematic coverage of P. aeruginosa in children with complicated appendicitis.

Rahul Gupta, Daniele R. Nolan, Donald A. Bux, Andres R. Schneeberger (Author)

Is it the moon? Effects of the lunar cycle on psychiatric admissions, discharges and length of stay

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BACKGROUND

There is an ongoing debate concerning the connection between lunar cycle and psychiatric illness.

AIMS OF THE STUDY

The purpose of the present study was to evaluate the rates of admission to and discharge from psychiatric inpatient treatment, as well as the length of stay, in relation to the lunar cycle, including 20 different categories of phases of the moon.

METHODS

The data of 17,966 cases of people treated in an inpatient setting were analysed. Routine clinical data and data about admission and discharge were used. The lunar calendar was obtained from the website of the US Naval Observatory and was used to calculate the dates of the full moon according to the geographic location of the clinics. The clinics are located in the Canton Grisons in Switzerland. The following phases of the moon throughout the lunar cycle were defined: (a) full moon, (b) quarter waxing moon, (c) new moon, and (d) quarter waning moon. In addition, we coded one day and two days preceding every lunar phase as well as the two days following the respective phases of the moon.

RESULTS

The lunar cycles showed no connection with either admission or discharge rates of psychiatric inpatients, nor was there a relationship with the length of stay.

CONCLUSIONS

Despite the widespread belief that the moon impacts peoples’ mental health and subsequently psychiatric treatment, this study provides no evidence that our celestial neighbour influences our mental well-being.

Julia Notter, Andrea Bregenzer, Pietro Vernazza, Christian R. Kahlert (Author)

Nevirapine in HIV maintenance therapy – can “old drugs” survive in current HIV management?

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AIMS OF THE STUDY

Nevirapine has an exceptional record for long-term tolerability with few side effects in human immunodeficiency virus (HIV) combined antiretroviral therapy (cART). Owing to relatively frequent hypersensitivity reactions (HSR) (15–25%) in the first 3 months after treatment initiation (especially in patients with a high CD4 count (>250/µl in women, >400/µl in men)), it is being used less and less. However, the rate of adverse events is lower when patients are already under suppressive cART. We present the results of a single centre strategy to offer the switch to a nevirapine-containing regimen and evaluate the potential role nevirapine could play in current antiretroviral treatment.

METHODS

All adult HIV-positive patients starting nevirapine at our centre since 2010 were evaluated in this retrospective analysis. We examined the proportion of patients on cART containing nevirapine, as well as the number of starts and stops every 6 months. Nevirapine discontinuation rates were analysed by sex, age, hepatitis C virus (HCV) status, time on nevirapine, ethnicity, CD4 nadir as well as CD4 count, HIV-RNA and ART backbone at nevirapine start.

RESULTS

Since 2014, more than a third of our treated HIV patients have been on nevirapine-containing therapy, with a stable percentage in the following years; 277 patients starting nevirapine for the first time were analysed. Thirty-three percent (92/277) of these first nevirapine therapies were discontinued, with 16 cases (17%) resuming nevirapine later during follow-up. Of the patients who continued nevirapine for more than 90 days (n = 221), 80% maintained nevirapine until their last follow-up. The nevirapine stop rate after the first 90 days was 15-fold lower (5.4 per 100 patient years, 95% confidence interval [CI] 4.0–7.2) than in the first 90 days. Overall, nevirapine was used for a median of 2.9 years (interquartile range [IQR] 0.5–5.6). In HCV co-infected patients, the treatment stop rate was 4-fold higher than in HIV mono-infected patients, but this difference was mainly due to treatment interruptions caused by drug-drug interactions with intermittent HCV therapy. Six out of seven Asian patients experienced HSR (hepatotoxicity / skin rash). In a population with 74% 3TC/ABC backbone, 81% fully suppressed, median CD4 nadir 240/µl (IQR 120–360) and median CD4 count at nevirapine start 590/µl (IQR 400–840), both high CD4 nadir and high CD4 count at nevirapine start were associated with lower rather than higher discontinuation rates. In fully suppressed patients with high CD4 count at nevirapine start, high CD4 nadir was not a risk factor for HSR. Major reasons for the discontinuation of nevirapine were HSR (liver, skin rash) in 38 cases (41% of all discontinuations) followed by other adverse drug reactions (n = 17) and non-adherence (n = 14). In patients who stopped nevirapine after more than 90 days, the major cause was non-adherence or other adverse drug reaction (both n = 12).

CONCLUSIONS

In this study, two thirds of the patients continued nevirapine with favourable long-term tolerability and efficacy. Thus, this low-cost “old drug” may still represent a valid treatment switch option for maintenance therapy in selected patients with a fully suppressed viral load. However, further evaluation is needed.

Boris Cheval, Stéphane Cullati, Denis Mongin, Ralph E. Schmidt, Kim Lauper, Jesper Pihl-Thingvad, Pierre Chopard, Delphine S. Courvoisier (Author)

Associations of regrets and coping strategies with job satisfaction and turnover intention: international prospective cohort study of novice healthcare professionals

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AIMS OF THE STUDY

(1) To assess the associations of care-related regrets with job satisfaction and turnover intention; and (2) to examine whether these associations are partially mediated by coping strategies.

METHODS

Data came from ICARUS, a prospective international cohort study of novice healthcare professionals working in acute care hospitals and clinics from various countries (e.g., Australia, Austria, Botswana, Canada, Denmark, France, Haiti, Ireland, Kenya, the United Kingdom and United States). Care-related regrets (number of regrets and regret intensity), coping strategies, job satisfaction and turnover intention were assessed weekly for 1 year.

RESULTS

229 young healthcare professionals (2387 observations) were included in the analysis. For a given week, experiencing a larger number of care-related regrets was associated with decreased job satisfaction, and experiencing more intense care-related regrets was associated with increased turnover intention. These associations were partially mediated by coping strategies. Maladaptive emotion-focused strategies were associated with decreased job satisfaction and increased turnover intention, whereas adaptive problem-focused strategies showed the opposite pattern.

CONCLUSIONS

Our results revealed that care-related regrets and maladaptive coping strategies are associated with job dissatisfaction and the intention to quit patient care. Helping healthcare professionals to cope with these emotional experiences seems essential to prevent early job quitting.