Does percutaneous cholecystostomy affect prognosis of patients with acute cholecystitis that are unresponsive to conservative treatment?

Background: Percutaneous cholecystostomy (PC) can be used as bridging or definitive therapy in some cases of acute cholecystitis. We aimed to compare hospital stay and survival of patients that underwent PC insertion because of acute calculus cholecystitis (ACC) compared to those who did not. Methods: This is a retrospective study in which patients with gangrenous cholecystitis and perforation were excluded. Regression models were used to evaluate the influence of PC on mortality and hospital stay. Results: Six hundred and eighty-three patients were admitted because of ACC, and 50 patients were referred to PC. Indication for PC insertion were high disease severity index (DSI, 8 pts) and failure of conservative treatment with total disease duration >7 days (42 pts). Those who underwent PC were older (76.0 ± 12.4 vs. 60.8 ± 19.2, P < 0.001); PC was associated with longer hospital stay (12.8 vs. 6.5 days) and higher one-year mortality (20% vs. 4.9%, P < 0.001). Among patients with non-severe disease severity index (DSI), PC was associated with longer length of hospital stay and higher one-year mortality compared to patients treated conservatively (9.9 ± 0.6 vs. 6.0 ± 0.2 days, and 16.7% vs. 4.0%, respectively, P < 0.001 for both). For patients with severe DSI, PC was associated with similar length of hospital stay and one-year mortality compared to similar patients treated conservatively (16.1 ± 8.1 vs. 18.4 ± 4.0 days, and 37.5% vs. 22.6%, respectively, P = 0.802 and P = 0.389, respectively). Conclusions: In patients with mild–moderate DSI unresponsive to conservative treatment, PC may be associated with deteriorated prognosis compared to conservative treatment. The decision to insert PC in patients unresponsive to conservative therapy even with disease duration >7 days must be re-evaluated

Safety, immunogenicity and duration of immunity elicited by an inactivated bovine ephemeral fever vaccine.

Bovine ephemeral fever (BEF) is an economically important viral vector-borne cattle disease. Several live-attenuated, inactivated and recombinant vaccines have been tested, demonstrating varying efficacy. However, to the best of our knowledge, duration of immunity conferred by an inactivated vaccine has never been reported. In the last decade, Israel has faced an increasing number of BEF outbreaks. The need for an effective vaccine compatible with strains circulating in the Middle East region led to the development of a MONTANIDE™ ISA 206 VG (water-in-oil-in-water), inactivated vaccine based on a local strain. We tested the safety, immunogenicity and duration of immunity conferred by this vaccine. The induced neutralizing antibody (NA) response was followed for 493 days in 40 cows vaccinated by different protocols. The vaccine did not cause adverse reactions or a decrease in milk production. All cows [except 2 (6.7%) which did not respond to vaccination] showed a significant rise in NA titer of up to 1:256 following the second, third or fourth booster vaccination. Neutralizing antibody levels declined gradually to 1:16 up to 120 days post vaccination. This decline continued in cows vaccinated only twice, whereas cows vaccinated 3 or 4 times showed stable titers of approximately 1:16 for up to 267 days post vaccination. At least three vaccinations with the inactivated BEF vaccine were needed to confer long-lasting immunity. These results may have significant implications for the choice of vaccination protocol with inactivated BEF vaccines. Complementary challenge data should however be added to the above results in order to determine what is the minimal NA response conferring protection from clinical disease

Consumption of Nutrition Supplements Is Associated with Less Hypoglycemia during Admission—Results from the MENU Project

Aim: We studied the effect of the addition of an oral nutrition supplement (ONS) on the rate of hypoglyemia among hospitalized type 2 diabetes mellitus (DM) patients. Methods: In this retrospective analysis, all DM patients with hypoalbuminemia (albumin &lt; 3.5 g/dL) admitted to internal medicine &ldquo;E&rdquo; at Wolfson Medical Center between 1 June 2016 and 30 April 2017 were included. One bottle of ONS (Glucerna, 330 KCAL, 28 g carbohydrates, 17 g protein, 17 g fat) was added to the morning meal. The consumption of the ONS was verified during the morning rounds. All glucose measurements were recorded automatically in the patients&rsquo; electronic medical records. A logistic regression model was used to evaluate the effect of the nutrition support on the occurrence of hypoglycemia. Results: 218 patients (mean age 77.4 &plusmn; 12.0 years, 63.3% female, mean albumin 3.13 &plusmn; 0.32 g/dL), of whom 27.9% had documented hypoglycemia during hospitalization were included. The patients consumed 69.5% &plusmn; 37.1 of the ONS provided, and ONS was started 4.3 &plusmn; 5.3 days from admission. A logistic regression model indicated that age (Odds ratio [OR] 1.048, 95% CI 1.014&ndash;1.083, p = 0.005), insulin treatment (OR 3.059, 95% CI 1.497&ndash;6.251, p = 0.002), and the day of ONS started from admission (OR 1.094, 95% CI 1.021&ndash;1.173, p = 0.011) were associated with an increased risk of hypoglycemia. Complete consumption of the ONS was associated with a reduced risk of hypoglycemia: OR 0.364, 95% CI 0.149&ndash;0.890, p = 0.027. Age, other DM medications and serum albumin did not affect the risk. Conclusion: The intake of a complete serving of ONS may be associated with a reduction of the risk of hypoglycemia among diabetes in-patients with hypoalbuminemia

Changes in Serum Creatinine May Cause Hypoglycemia among Non-Critically Ill Patients Admitted to Internal Medicine Units

Background: The association between changes in serum creatinine levels and hypoglycemia during hospitalization was investigated. Methods: This was a retrospective analysis of medical charts. Patients were categorized as having significant change in creatinine (SCIC) when serum creatinine levels rose or dropped &ge; 0.3 mg/dL from admission values at any time during their hospitalization. Patients were considered hypoglycemic if they had at least one documented glucose level &le; 70 mg/dL during the hospitalization. Multiple logistic, linear and Cox regression analyses were used to ascertain the association between incident SCIC, severity and timing with incident hypoglycemia. Results: Included were 25,400 (mean age 69.9 &plusmn; 18.0, 49.3% were males). The rate of SCIC was 22.2%, and 62.2% of them were diagnosed upon admission. Patients with SCIC had a higher incidence of hypoglycemia compared to patients without (13.1% vs. 4.1%, respectively, p &lt; 0.001). Patients with SCIC had an increased risk of hypoglycemia (OR 1.853, 95% CI 1.586&ndash;2.166, p &lt; 0.001). The magnitude of SCIC was associated with the incidence (OR 1.316, 95% CI 1.197&ndash;1.447, p &lt; 0.001) and the number of events (HR 0.054, 95% CI 0.021&ndash;0.087, p = 0.001). More than 60% of patients with hypoglycemia had their first event documented during days 0&ndash;6 after SCIC occurrence. Of those, the majority of events occurred on day 0&ndash;1, and the rate showed a gradual decrease throughout the first 5 days from SCIC occurrence. The results were similar for patients with and without DM. Conclusions: Changes in creatinine during hospitalization may cause hypoglycemia among patients admitted to internal medicine departments, regardless of DM status

Average neutralization antibody (NA) fractional dilutions induced by two or three to four vaccinations with inactivated BEF vaccine.

<p>Black squares: two vaccinations, Grey circles: three to four vaccinations. Whiskers represent standard deviation for each group.</p

Study flow diagram.

<p>Part I: study initiation. intramuscular vaccination: Group A; 1-ml vaccine, Group B; 2 -ml vaccine and Group C; non vaccinated. Part II: 1 month (30 days) post-study initiation (PSI), a second vaccination dose was administered to half of each vaccinated group as follows: A1; 1-ml, B1; 2- ml. Part III: 9 months (267 days) PSI, Group A was injected with 1 ml vaccine, Group B with 2 ml vaccine, Group C was not vaccinated and another group (Group D) was vaccinated with 1- ml. Part IV: 10 months (295 days) PSI, another vaccination dose was administered to half of each vaccinated group as follows: A3; 1- ml, B3; 2- ml, D1; 1- ml.</p

Daily measured rectal temperature (°C) and milk production (kg) pre vaccination and post vaccination.

<p>(I) Mean body temperature and (II) daily average milk production before and after vaccination with inactivated bovine ephemeral fever vaccine. Day 0: study initiation and first vaccination. Triangles: 1-ml vaccine. Squares: 2 -ml vaccine. Rhombuses: control group. Whiskers represent standard deviation for each group.</p