Prediction of medical admissions after psychiatric inpatient hospitalization in bipolar disorder: a retrospective cohort study.

Objective: Bipolar Disorder (BD) is a severe mental illness associated with high rates of general medical comorbidity, reduced life expectancy, and premature mortality. Although BD has been associated with high medical hospitalization, the factors that contribute to this risk remain largely unexplored. We used baseline medical and psychiatric records to develop a supervised machine learning model to predict general medical admissions after discharge from psychiatric hospitalization. Methods: In this retrospective three-year cohort study of 71 patients diagnosed with BD (mean age=52.19 years, females=56.33%), lasso regression models combining medical and psychiatric records, as well as those using them separately, were fitted and their predictive power was estimated using a leave-one-out cross-validation procedure. Results: The proportion of medical admissions in patients with BD was higher compared with age- and sex-matched hospitalizations in the same region (25.4% vs. 8.48%). The lasso model fairly accurately predicted the outcome (area under the curve [AUC]=69.5%, 95%C.I.=55-84.1; sensitivity=61.1%, specificity=75.5%, balanced accuracy=68.3%). Notably, pre-existing cardiovascular, neurological, or osteomuscular diseases collectively accounted for more than 90% of the influence on the model. The accuracy of the model based on medical records was slightly inferior (AUC=68.7%, 95%C.I. = 54.6-82.9), while that of the model based on psychiatric records only was below chance (AUC=61.8%, 95%C.I.=46.2-77.4). Conclusion: Our findings support the need to monitor medical comorbidities during clinical decision-making to tailor and implement effective preventive measures in people with BD. Further research with larger sample sizes and prospective cohorts is warranted to replicate these findings and validate the predictive model.

Infections in patients with inflammatory bowel disease.

BACKGROUND/AIM: Inflammatory bowel diseases (IBD) are a group of conditions characterized by chronic inflammation of all or part of the digestive tract and primarily includes Ulcerative Colitis (UC) and Crohn's Disease (CD). This review has as target to summarize the complicated correlation between IBD and infections, which can affect patients' quality of life and increase substantially morbidity and mortality rates. RESULTS: Scientific evidence in recent years shows a growing recognition of the phenomenon although the association between these two aspects is not definitively clear. Despite the fact that our understanding of this linkage is still incomplete, it is easily deducible that infections can start whether it be the onset or the relapse of IBD. In addition to this, the course of the disease predisposes the patient to numerous infections caused by the drugs used to treat IBD and this also raises the risk of infection complications. CONCLUSIONS: Clinical trials have demonstrated that the combined use of immunomodulating agents may increase the risk of new infections. The infections might be intensified by an insufficient vaccination of adults with IBD. Physicians have to be aware of these risks and try to attenuate and treat them properly. KEY WORDS: Infections, Inflammatory bowel disease, Risk factors.

Mechanical comparison of 3 different clamp and 2 different rod types of a new veterinary internal fixation system, 4.5/5.5-mm VetFix.

OBJECTIVE: To compare the gripping force of a standard clamp with click-on and T clamps of the 4.5/5.5-mm VetFix (AO Research Institute, Davos, Switzerland), mounted on smooth and roughened rods. STUDY DESIGN: In vitro mechanical study. METHODS: Rods were mounted on a clamp-holding device. Each clamp type was tested on a materials-testing machine in groups of 6 specimens for torsional and axial load stability on smooth and roughened rods (total, 72 specimens). The variable evaluated was the discontinuity point (DP) as a measure for gliding resistance of the clamp on the rod. Means (+/-SD) were calculated for all groups separately. For statistical comparison, a multiple regression model was fitted with level of significance set at P =.05. RESULTS: The direction of torsion had a significant effect on DP for both asymmetric clamps (standard, click-on). In torsion and axial load, the roughened rod had significantly higher DP levels than the smooth rod for the standard clamp. Rods differed only in axial load for the T clamp, again favoring the roughened rod. The click-on clamp did not reach 10% of the values achieved by the other clamps, independent from the rods and loading conditions. Compared with the T clamp, standard clamp DP values were significantly higher in torsion on the roughened rod as well as in axial load on both rod types. CONCLUSIONS: The roughened rod with a standard clamp was mechanically superior. For the T clamp, the small loss of gripping force may be compensated for by the possibility of inserting 2 more screws. CLINICAL RELEVANCE: The roughened rod may enhance the bending, compressive, and torsional properties of the 4.5/5.5-mm VetFix system by reducing the risk of clamp gliding on the rod. The standard clamp is the clamp of choice, except for the metaphyseal or epiphyseal region, at which use of a T clamp may be indicated to increase the number of screws inserted at the end of the rod.