Conditional risk of diverticulitis after non-operative management.

BACKGROUND: The objective of this study was to describe conditional recurrence-free survival (RFS) of patients after an index episode of diverticulitis managed without surgery, and to estimate the difference in conditional RFS for diverticulitis according to specific risk factors. METHODS: This was a multicentre retrospective cohort study including all patients managed without surgery for acute sigmoid diverticulitis at two university-affiliated hospitals in Montreal, Quebec, Canada. Conditional RFS for diverticulitis was estimated over 10 years of follow-up. A Cox proportional hazards model was performed at the index episode and again 2 years later. RESULTS: In total, 991 patients were included for analysis. The 1, 2- and 3-year actuarial diverticulitis RFS rates were 81·1, 71·5 and 67·5 per cent respectively. Compared with the 1-year actuarial RFS rate of 81·1 per cent, the 1-year conditional RFS increased with each additional year survived recurrence-free, reaching 96·0 per cent after surviving the first 4 years recurrence-free. A similar phenomenon was observed for 2-year diverticulitis conditional RFS. Lower age (hazard ratio (HR) 0·98, 95 per cent c.i. 0·98 to 0·99), Charlson Co-morbidity Index score of 2 or above (HR 1·78, 1·32 to 2·39) and immunosuppression (HR 1·85, 1·38 to 2·48) were independently associated with recurrence of diverticulitis from the index episode. At 2 years from the index episode, immunosuppression was no longer associated with diverticulitis recurrence (HR 1·02, 0·50 to 2·09). CONCLUSION: The conditional RFS of patients with diverticulitis improved with each year that was survived recurrence-free. Although several factors at index presentation may be associated with early recurrence, the conditional probability of recurrence according to many of these risk factors converged with time.

ANTECEDENTES: El objetivo de este estudio fue describir la supervivencia condicional libre de recidiva de diverticulitis (diverticulitis recurrence-free survival, Div-RFS) en pacientes tras un episodio de diverticulitis tratado de forma conservadora, y calcular la diferencia en la Div-RFS condicional de acuerdo con factores de riesgo específicos. MÉTODOS: Estudio de cohorte retrospectivo multicéntrico que incluyó a todos los pacientes tratados de forma no quirúrgica por diverticulitis sigmoidea aguda en dos hospitales afiliados a la universidad en Montreal, Quebec, Canadá. La supervivencia condicional libre de recidiva de la diverticulitis se calculó durante 10 años de seguimiento. Se realizó un análisis mediante un modelo de riesgos proporcionales de Cox en el episodio índice y nuevamente 2 años después. RESULTADOS: En total, se incluyeron 991 pacientes en el análisis. La Div-RFS actuarial a 1, 2 y 3 años fue del 81,1%, 71,5% y 67,5%, respectivamente. En comparación con la Div-RFS actuarial a 1 año del 81,1%, la Div-RFS condicional a 1 año aumentó con cada año adicional sobrevivido sin recidiva, alcanzando el 96,0% después de sobrevivir los primeros 4 años sin recidiva. Se observó un fenómeno similar para Div-RFS condicional a los 2 años. Una menor edad (cociente de riesgos instantáneos, hazard ratio, HR: 0,98; i.c. del 95%: 0,98 a 0,99), la puntuación de comorbilidad de Charlson ≥ 2 (HR: 1,78; i.c. del 95%: 1,32 a 2,39) y la inmunosupresión (HR: 1,85; i.c. del 95%: 1,38 a 2,48) se asociaron de forma independiente con la recidiva de la diverticulitis desde el episodio índice. En la regresión de Cox a los 2 años del episodio índice, la inmunosupresión ya no se asoció con recidiva de diverticulitis (HR: 1,02; i.c. del 95% 0,50-2,09). CONCLUSIÓN: La Div-RFS condicional mejoró con cada año de supervivencia sin recidiva. Si bien varios factores en la presentación del episodio índice pueden estar asociados con una recidiva precoz, la probabilidad condicional de recidiva en relación con muchos de estos factores de riesgo coincidió con el tiempo.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS: Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS: 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS: In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Recovery potential of cavitation-induced injured cells of common spore-forming bacteria in skim milk exposed to ultrasonication.

The presence of spore-forming microorganisms and their adhesion to contact surfaces in dairy plants is a major concern because dairy products are prone to cross-contamination. Spore formers and their spores can survive milk processing treatments due to their heat resistance. One source of these spore formers is bacterial biofilms, which grow and accumulate on most surfaces in dairy industrial plants, such as pipes, heat exchangers, pasteurized plates, and storage tanks. Their endospores form biofilms by attaching to these surfaces and germinating when conditions become more favorable. The cross-contamination of dairy products by bacterial biofilms may lead to reduced shelf life and spoilage. To minimize the problem caused by thermoduric bacteria, the dairy industry adopts several approaches. Pasteurization is an irreplaceable technique for milk processing. Unfortunately, some bacteria and endospores are resistant to heat treatment, which can grow and cause spoilage of dairy products. Thus, alternative approaches that could help to reduce microbial counts are needed. In our previous study, we demonstrated the effectiveness of ultrasonication to inactivate spore formers and reduce the overall microbial counts in milk. In the current study, we investigated the recovery of cavitation-induced injured cells during the storage of ultrasonicated skim milk. Three common spore formers-Geobacillus stearothermophilus (ATCC 15952), Bacillus licheniformis (ATCC 6634), and Bacillus sporothermodurans (DSM 10599)-were selected to conduct challenge studies by inoculating skim milk samples and exposing them to ultrasonication (10 min each at 80% amplitude). This treatment was done in an ice bath to control the resultant temperature increase. The ultrasonicated skim milk samples were then held for 1, 2, 4, or 12 h in the refrigerator (4°C) to study the recovery of cells following cavitation-induced injury. Ultrasonication resulted in cell injury, as demonstrated by scanning electron microscopy. The injured cells can potentially recover under appropriate conditions during the storage of ultrasonicated milk and could affect the microbiological quality of milk and products manufactured with such milk. The respective bacterial counts for the 3 organisms in the spiked skim milk, on average, were approximately 6.0 log cfu/mL; immediately after ultrasonication, these counts decreased to 3.50 ± 0.02, 4.38 ± 0.02, and 3.75 ± 0.05 log cfu/mL for G. stearothermophilus, B. licheniformis, and B. sporothermodurans, respectively. During 12 h of subsequent incubation at 4°C, their counts increased to 4.17 ± 0.05, 5.25 ± 0.1, and 5.69 ± 0.06 log cfu/mL, respectively. All experiments were done in triplicate for all 3 bacteria. To conclude, slow recovery of injured cells of spore-forming bacteria is possible in ultrasonicated milk during storage under refrigeration conditions.