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Background: The gold standard for gathering data from electronic health records (EHR) has been manual data extraction; however, this requires vast resources and personnel. Automation of this process reduces resource burdens and expands research opportunities., Objective: This study aimed to determine the feasibility and reliability of automated data extraction in a large registry of adult COVID-19 patients., Materials and Methods: This observational study included data from sites participating in the SCCM Discovery VIRUS COVID-19 registry. Important demographic, comorbidity, and outcome variables were chosen for manual and automated extraction for the feasibility dataset. We quantified the degree of agreement with Cohen's kappa statistics for categorical variables. The sensitivity and specificity were also assessed. Correlations for continuous variables were assessed with Pearson's correlation coefficient and Bland-Altman plots. The strength of agreement was defined as almost perfect (0.81-1.00), substantial (0.61-0.80), and moderate (0.41-0.60) based on kappa statistics. Pearson correlations were classified as trivial (0.00-0.30), low (0.30-0.50), moderate (0.50-0.70), high (0.70-0.90), and extremely high (0.90-1.00)., Measurements and Main Results: The cohort included 652 patients from 11 sites. The agreement between manual and automated extraction for categorical variables was almost perfect in 13 (72.2%) variables (Race, Ethnicity, Sex, Coronary Artery Disease, Hypertension, Congestive Heart Failure, Asthma, Diabetes Mellitus, ICU admission rate, IMV rate, HFNC rate, ICU and Hospital Discharge Status), and substantial in five (27.8%) (COPD, CKD, Dyslipidemia/Hyperlipidemia, NIMV, and ECMO rate). The correlations were extremely high in three (42.9%) variables (age, weight, and hospital LOS) and high in four (57.1%) of the continuous variables (Height, Days to ICU admission, ICU LOS, and IMV days). The average sensitivity and specificity for the categorical data were 90.7 and 96.9%., Conclusion and Relevance: Our study confirms the feasibility and validity of an automated process to gather data from the EHR., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Valencia Morales, Bansal, Heavner, Castro, Sharma, Tekin, Bogojevic, Zec, Sharma, Cartin-Ceba, Nanchal, Sanghavi, La Nou, Khan, Belden, Chen, Melamed, Sayed, Reilkoff, Herasevich, Domecq Garces, Walkey, Boman, Kumar and Kashyap.)

Importance: There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C)., Objective: To determine whether the use of steroids within 2 days of admission for non-MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence., Design, Setting, and Participants: This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non-MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry., Exposure: Administration of steroids within 2 days of admission., Main Outcomes and Measures: Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching., Results: A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators., Conclusions and Relevance: Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.

Background: Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C)., Methods: Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational, multicenter international cohort study of hospitalized children with acute COVID-19 or MIS-C from March 2020 to November 2020. The primary outcome measure was critical COVID-19 illness. Multivariable models were performed to assess for associations of GI involvement with the primary composite outcome in the entire cohort and a subpopulation of patients with MIS-C. Secondary outcomes included prolonged hospital length of stay defined as being >75th percentile and mortality., Results: Of the 789 patients, GI involvement was present in 500 (63.3%). Critical illness occurred in 392 (49.6%), and 18 (2.3%) died. Those with GI involvement were older (median age of 8 yr), and 18.2% had an underlying GI comorbidity. GI symptoms and liver derangements were more common among patients with MIS-C. In the adjusted multivariable models, acute COVID-19 was no associated with the primary or secondary outcomes. Similarly, despite the preponderance of GI involvement in patients with MIS-C, it was also not associated with the primary or secondary outcomes., Conclusions: GI involvement is common in hospitalized children with acute COVID-19 and MIS-C. GI involvement is not associated with critical illness, hospital length of stay or mortality in acute COVID-19 or MIS-C., Competing Interests: U.B. is currently funded by National Institute of Health (Site Principal Investigator for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (Site Principal Investigator for Pediatric Resuscitation Quality Collaborative-PediResQ), Voelcker Pilot Grant (PI for project on prearrest electrocardiographic changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to Society of Critical Care Medicine VIRUS (COVID-19) Registry and Society of Critical Care Medicine VIRUS electronic medical record automation pilot. The other authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry., Design: Retrospective study., Setting: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry., Patients: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021., Interventions: None., Measurements and Main Results: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased., Conclusions: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults., Competing Interests: Dr. Bhalala is currently funded by the National Institutes of Health (NIH) (Site Principal Investigator [PI] for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (Site-PI for Pediatric Resuscitation Quality Collaborative – PediResQ), Voelcker Pilot Grant (PI for project on prearrest electrocardiographic changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) (coronavirus disease 2019 [COVID-19]) Registry and SCCM VIRUS electronic medical records, automation pilot. Ms. Boman’s institution received funding from The Gordon and Betty Moore Foundation. Ms. Boman and Drs. Kumar and Kashyap's institutions received funding from Janssen Research and Development, LLC. Dr. Kumar is currently funded by Gordon and Betty Moore Foundation, Centers for Disease Control and Prevention (CDC) Foundation through University of Washington and Janssen Research & Development, LLC. Dr. Chiotos funded by Agency for Healthcare Research and Quality(K12-HS026393). Dr. Bjornstad’s institution received funding from the International Society of Nephrology, The NIH-National Institute of Diabetes and Digestive and Kidney Diseases/T32, and Bioporto. Dr. Dapul disclosed that the deidentified data of some patients submitted to the VIRUS registry were also used in the Overcoming COVID-19 Virus Registry. Dr. Blatz funded by NIH grant T32GM-075766. Dr. Levy’s institution received funding from the CDC (No. 75D30120C07725) and the National Institute of Allergy and Infectious Diseases (AI 144301); she received funding from SinoUnited Health Shanghai Children’s Hospital. Drs. Kaufman’s, Abdelaty’s, and Briton’s institutions received funding from SCCM. Dr. Kaufman received funding from EngleWood Health for consulting work as medical director. Dr. Khanna’s institution received funding for COVID-19 trials Blood Volume Analyzer-Daxor and Chair Steering Committee for the Siltuximab in Selected Hospitalized Patients With Viral Acute Respiratory Distress Syndrome trial. Dr. Khanna is currently funded by a Clinical Translational Science Institute NIH/National Center for Advanced Translational Science KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring and is a site PI (institutional funding) for a randomized trial of cytokine filtration in severe COVID-19 and a prospective observational trial of blood volume assessment in COVID-19. His institution also received funding for the SCCM VIRUS EMR automation pilot. Dr. Stulce received funding from the American Physician Institute. Dr. Anderson III disclosed that he is on the Advisory Board for the Gift of Life Michigan. Dr. Bello disclosed government work. Dr. Walkey currently funded the NIH/National Heart, Lung and Blood Institute (NHLBI) grants R01HL151607, R01HL139751, R01HL136660, Agency of Healthcare Research and Quality, R01HS026485, Boston Biomedical Innovation Center/NIH/NHLBI 5U54HL119145-07, and royalties from UptoDate. Dr. Bihorac received support for article research from the NIH. His institution received funding from the NIH (R01 GM110240 R21 EB 027344), Atox Bio, Astute Medical Research, Mallinckrodt Pharmaceuticals, and La Jolla Pharmaceuticals; she disclosed three institutional patents (20200161000, WO2020172607A12020, and 20190326013). Dr. Zimmerman’s institution received funding from the NIH-National Institute of Child Health and Human Development and Immunexpress; he received funding from Elsevier Publishing. Dr. Kashyap receives funding from the NIH/NHLBI: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Patients with congenital heart disease (CHD) that have surgical repair with cardiopulmonary bypass (CPB) reflect a unique population with multiple pulmonary and systemic factors that may contribute to increased alveolar dead space and low cardiac output syndrome. This study aimed to assess and compare changes in the alveolar dead space fraction (AVDSf) in the immediate postoperative period with outcomes in children with CHD who underwent repair on CPB. A single-center retrospective review study of critically ill children with CHD, younger than 18 years of age admitted to the Pediatric Intensive Care Unit (PICU) after undergoing surgical repair on CPB and received invasive mechanical ventilation for at least 24 h. One hundred and two patients were included in the study. Over the first 24 h, mean AVDSf was significantly higher in patients who had longer hospital length of stay (LOS) (> 21 days) p = 0.02, and longer duration of invasive mechanical ventilation (DMV) (> 170 h) p = 0.01. Cross-sectional analyses at 23-24 h revealed that AVDSf > 0.25 predicts mortality and DMV (p = 0.03 and P = 0.02 respectively); however, it did not predict prolonged hospital LOS. For every 0.1 increase in the AVDSf, the odds of mortality, DMV, and hospital LOS increased by 4.9 [95% CI = 1.45-16.60, p = 0.002], 2.06 [95% CI = 1.14-3.71, p = 0.01], and 1.43[95% CI = 0.84-2.45, p = 0.184], respectively. The area under the ROC curve at 23-24 h for AVDSf was 0.868 to predict mortality as an outcome. AVDSf > 0.25 at 23-24 h postoperatively was an independent predictor of mortality with sensitivity and specificity of 83% and 80%, respectively and was superior to other commonly used surrogates of cardiac output. In the immediate postoperative period of pediatric patients with CHD, high AVDSf is associated with longer hospital length of stay and duration of invasive mechanical ventilation. Increased AVDSf values at 23-24 h postoperatively is associated with mortality in patients with CHD exposed to CPB., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Importance: Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population., Objectives: To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical illness and mortality in hospitalized young adults., Design Settings and Participants: A retrospective cohort study of the Society of Critical Care Medicine's Viral Infection and Respiratory Illness Universal Study registry. Patients 18-40 years old, hospitalized from coronavirus disease 2019 from March 2020 to April 2021, were included in the analysis., Main Outcomes and Measures: Critical illness was defined as a composite of mortality and 21 predefined interventions and complications. Multivariable logistic regression was used to assess associations with critical illness and mortality., Results: Data from 4,005 patients (152 centers, 19 countries, 18.6% non-U.S. patients) were analyzed. The median age was 32 years (interquartile range, 27-37 yr); 51% were female, 29.4% Hispanic, and 42.9% had obesity. Most patients (63.2%) had comorbidities, the most common being hypertension (14.5%) and diabetes (13.7%). Hospital and ICU mortality were 3.2% (129/4,005) and 8.3% (109/1,313), respectively. Critical illness occurred in 25% ( n = 996), and 34.3% ( n = 1,376) were admitted to the ICU. Older age ( p = 0.03), male sex (adjusted odds ratio, 1.83 [95% CI, 1.2-2.6]), and obesity (adjusted odds ratio, 1.6 [95% CI, 1.1-2.4]) were associated with hospital mortality. In addition to the above factors, the presence of any comorbidity was associated with critical illness from coronavirus disease 2019. Multiple sensitivity analyses, including analysis with U.S. patients only and patients admitted to high-volume sites, showed similar risk factors., Conclusions: Among hospitalized young adults, obese males with comorbidities are at higher risk of developing critical illness or dying from coronavirus disease 2019., Competing Interests: Dr. Kumar is currently funded by funding the Gordon and Betty Moore Foundation, Centers for Disease Control and Prevention Foundation through the University of Washington, and Janssen Research & Development, LLC. Dr. Khanna is currently funded by a Clinical and Translational Science Institute National Institutes of Health (NIH)/National Center for Advancing Translational Science KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring and is a site principal investigator (PI) (institutional funding) for a randomized trial of cytokine filtration in severe coronavirus disease 2019 (COVID-19) and a prospective observational trial of blood volume assessment and capillary permeability in COVID-19. He is funded for his position on the steering committee for the SILtuximab in Viral Acute Respiratory distress syndrome study. His institution also received funding for the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) Electronic Medical Records (EMR) automation pilot. Dr. Bhalala is currently funded by the NIH (Site-PI for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (Site PI for Pediatric Resuscitation Quality Collaborative), Voelcker Pilot Grant (PI for the project on Prearrest Electrocardiographic Changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to SCCM VIRUS (COVID-19) Registry, and SCCM VIRUS EMR automation pilot. Dr. Kashyap receives funding from the NIH/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. Inc. Dr. Gajic receives funding from the Agency of Healthcare Research and Quality R18HS 26609-2, NIH/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Department of Defense DOD W81XWH; American Heart Association Rapid Response Grant—COVID-19; and royalties from Ambient Clinical Analytics. Inc. Dr. Walkey currently receives funding from the NIH/National Heart, Lung and Blood Institute grants R01HL151607, R01HL139751, R01HL136660, Agency of Healthcare Research and Quality, R01HS026485, Boston Biomedical Innovation Center/NIH/NHLBI 5U54HL119145-07, and royalties from UpToDate. The remaining authors have disclosed that they do not have any conflicts of interest., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Objectives: To compare clinical characteristics and outcomes of children admitted to the PICU for severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. The secondary objective was to identify explanatory factors associated with outcome of critical illness defined by a composite index of in-hospital mortality and organ system support requirement., Design: Retrospective cohort study., Setting: Thirty-eight PICUs within the Viral Infection and Respiratory Illness Universal Study registry from March 2020 to January 2021., Patients: Children less than 18 years with severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children., Measurements and Main Results: Of 394 patients, 171 (43.4%) had multisystem inflammatory syndrome in children. Children with multisystem inflammatory syndrome in children were more likely younger (2-12 yr vs adolescents; p < 0.01), Black (35.6% vs 21.9%; p < 0.01), present with fever/abdominal pain than cough/dyspnea (p < 0.01), and less likely to have comorbidities (33.3% vs 61.9%; p < 0.01) compared with those without multisystem inflammatory syndrome in children. Inflammatory marker levels, use of inotropes/vasopressors, corticosteroids, and anticoagulants were higher in multisystem inflammatory syndrome in children patients (p < 0.01). Overall mortality was 3.8% (15/394), with no difference in the two groups. Diagnosis of multisystem inflammatory syndrome in children was associated with longer duration of hospitalization as compared to nonmultisystem inflammatory syndrome in children (7.5 d[interquartile range, 5-11] vs 5.3 d [interquartile range, 3-11 d]; p < 0.01). Critical illness occurred in 164 patients (41.6%) and was more common in patients with multisystem inflammatory syndrome in children compared with those without (55.6% vs 30.9%; p < 0.01). Multivariable analysis failed to show an association between critical illness and age, race, sex, greater than or equal to three signs and symptoms, or greater than or equal to two comorbidities among the multisystem inflammatory syndrome in children cohort. Among nonmultisystem inflammatory syndrome in children patients, the presence of greater than or equal to two comorbidities was associated with greater odds of critical illness (odds ratio 2.95 [95% CI, 1.61-5.40]; p < 0.01)., Conclusions: This study delineates significant clinically relevant differences in presentation, explanatory factors, and outcomes among children admitted to PICU with severe acute respiratory syndrome coronavirus 2-related illness stratified by multisystem inflammatory syndrome in children., Competing Interests: Dr. Bjornstad’s institution received funding from the International Society of Nephrology and Bioporto. Drs. Kashyap’s, Ms. Boman’s, Dr. Kumar’s institutions received funding from The Gordon and Betty Moore Foundation. Drs. Kashyap’s, Ms. Boman’s, and Dr. Kumar’s institutions received funding from Janssen and Janssen LLC. Dr. Kashyap receives funding from the National Institutes of Health (NIH)/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation Janssen Research and Development, LLC; and royalties from Ambient Clinical Analytics. Inc. Dr. Chiotos funded by Agency for Healthcare Research and Quality (K12-HS026393). Dr. Heneghan’s institution received funding from Society of Critical Care Medicine (SCCM). Dr Zimmerman’s institution received funding from the NIH, Immunexpress, Seattle, and he received funding from Elsevier Publishing Company. Dr. Kumar receives funding from the Gordon and Betty Moore Foundation, Centers for Disease Control and Prevention Foundation through the University of Washington, and Janssen Research and Development, LLC. Dr. Bhalala currently funded by NIH (site-principal investigator [PI] for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (site-PI for Pediatric Resuscitation Quality Collaborative), Voelcker Pilot Grant (PI for a project on prearrest electrocardiographic changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to SCCM Viral Infection and Respiratory Illness Universal Study (VIRUS) (coronavirus disease 2019) Registry and SCCM VIRUS electronic medical record automation pilot. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Background: Malnutrition is highly prevalent among the elderly and is associated with poor clinical prognosis, decreased functional status, and increased morbidity and mortality., Objective: To estimate the prevalence of geriatric malnutrition among outpatients of a geriatric clinic and to determine factors associated with malnutrition., Design: Cross-sectional study., Setting: Geriatric outpatient clinic of the King Abdul Aziz University Hospital, Jeddah., Patients and Methods: All patients older than 60 years of age who attended the clinic during January 2016 were eligible for inclusion. Nutritional status was assessed using anthropometric data and by hemoglobin and albumin levels and lymphocyte count. The MNA was used to define malnutrition., Main Outcome Measures: Anthropometric measures, biochemical tests, and the scores on the short version of the Mini Nutritional Assessment (MNA)., Results: According to the MNA results, 8 (5.3%) of 152 elderly patients suffered overt malnutrition and 50 (32.9%) were at risk of malnutrition (71 males and 41 females; aged 72.4 [8.6] years). The prevalence of malnutrition was significantly higher among females (44.6%; 95% CI, 1.01-4.08; P=.044) than in males (28.3%). Malnourished patients were older than patients with normal nutritional status (mean 72.4 [8.6] years), and more common in patients who lived alone (62.5%). The malnourished patients had significantly smaller calf circumferences (63.4; 95% CI, 1.51-3.20; P=.001), and lower albumin and hemoglobin levels (P=.001). A significantly higher percentage of the malnourished patients compared with normal patients had experienced weight loss (37.9%; P < .001) and decreased food intake (56.9%; P < .001) during the previous three months. Binary logistic regression revealed that being female and living alone were significant predictors for being categorized as malnourished or at risk of malnutrition., Conclusion: The prevalence of malnutrition is high among geriatric outpatients. Routine screening for malnutrition among geriatric patients would allow early diagnosis and prompt intervention., Limitations: The heterogeneity of the study group (different diseases at different stages) could influence the generalizability of our findings. The relatively small number of patients (P=.002) is a potential limitation.

Objectives: Little is known about the factors that affect the length of stay (LOS) of children hospitalized for perforated appendicitis. The objective of this study was to identify clinical and demographic factors associated with a prolonged LOS (PLOS) in children with perforated appendicitis., Methods: A retrospective cohort study was conducted using the records of 197 children 0 to 17 years old with perforated appendicitis. The children were hospitalized at one of two teaching hospitals located in El Paso, Texas, and were discharged between January 2008 and January 2014. PLOS was defined as an LOS greater than the 75th percentile value in our patient cohort, which was 7 days. An initial log-binomial regression model failed to converge, and hence logistic regression was used to calculate adjusted incidence odds ratios (OR) for PLOS, 95% confidence intervals, P values, and a receiver operating characteristic curve. The best subset method was used to identify predictors for inclusion in the final model., Results: The overall risk of PLOS was 23.4% (46/197). Approximately 76% of the children who experienced PLOS and 94% of those who did not have PLOS were Hispanic. After adjusting for insurance status, presence of an abscess, asthma, consulting interventional radiology, and various antibiotics, Hispanics were less likely than non-Hispanics to experience PLOS (adjusted OR 0.20; P = 0.003). Children whose providers consulted the interventional radiologist had an increased odds of PLOS (adjusted OR 3.64; P = 0.01)., Conclusions: Hispanic ethnicity was associated with a lower odds of PLOS, whereas children who required the services of an interventional radiologist were more likely to experience PLOS.

Skin preparation of the patient begins before arriving to the operating room; its purpose is to reduce the risk of post operative wound infection. The objective of this study was to assess the skin preparation for surgical procedures in 3 different hospitals of the General Organization for Teaching Hospitals & Institutes (GOTHI) and to determine their conformity to the existing protocol and make comparisons between them in their performance. A prospective study using the audit was done for 1 month, nearly for the same period in each of the 3 hospitals (A,B,C) to observe the skin preparation practices considering showering, hair removal and the 5 steps of patient skin preparation on table in the operating room. The global results revealed that the compliance rate in the three hospitals together as regards performing the 5 steps of skin preparation in the operating room was 36.2%. It was 50.6% in hospital A, 43.3% in hospital B and 18.7% in hospital C. As regards showering before surgery, it was 55%, removing hair appropriately (clipping) was 23.7% and removing hair by means was 44.6%.

No doubt climate conditions are of sound influence in both prevalence of helminthic infection and the physiology of the host. Fewer studies have been done on this relationship on farm animals. To complete the view, one thousand, two hundred and seventy eight buffaloes owned by farmers from 160 herds belong to 32 villages in the middle Delta of Egypt were randomly chosen to study factors which influence the infection with gastrointestinal parasites. Relationship between number of parasites, herd size, resources of water and season of the year were investigated. The main results showed that: (1) Fasciola gigantica infection recorded the highest percentage, 48.04% followed by Neoascaris vitulorum and Eimeria spp. (2) Percentage rates of parasitic infection (single, double or triple) in each animal were 62.80%, 29.43% and 7.77%, respectively. (3) Infection rate tended to increase with herd size in most cases. (4) Resource of water had highly significant effect on infection rate. (5) The highest infection was recorded in summer and the lowest in spring or winter. (6) A negative and highly significant correlation between infection and number of parasites (0.99). Herd size did not associate with infection, while temperature and relative humidity correlated significantly with infection rate (0.67 and 0.78) respectively.

This study was conducted using fourty cross-bred ewes in 5 groups of which one was kept as a control and the others were infected with metacercariae of Fasciola gigantica twice at the beginning of the experiment and 200 days from the first. The four infected groups fed on basal ration or high protein ration with or without mineral mixture. Blood samples were taken from the five groups to assess the concentrations of plasma fibrinogen and serum total proteins, albumin, globulin, calcium and inorganic phosphorous. Results indicated that ewes total serum protein, albumin and globulin were decreased by Fasciola infection. The decrease was only significant in ewes fed basal ration with or without mineral mixture. Mineral mixture had no effect on the later blood parameters of infected ewes although little improvement in blood serum globulin was noticed. Plasma fibrinogen decreased significantly by infection. The level of plasma fibrinogen was improved by feeding high protein ration but did not affect by adding mineral mixture to any of the ration used. Infection was also found to decrease blood serum inorganic phosphorous but not calcium level. Feeding high protein ration with or without mineral supplement maintained blood serum inorganic phosphorous as that of the uninfected ewes. Blood serum calcium to phosphorous ratio of ewes fed only basal ration was significantly higher than that of other groups.

Polyacrylamide gel isoelectric focusing (PAGIF) in thin layer was used to resolve proteins of Mycoplasma spp., Acholeplasma spp., and eight strains of Ureaplasma urealyticum (T-strain). A mixture of urea, Triton X-100, and dithioerythritol was used to solubilize sonically disrupted cells. PAGIF was performed in the range of pH 3 to 10. Protein patterns were carefully compared, demonstrating resolved and distinguishable species-specific protein bands. The eight serotypes of U. urealyticum (T-strain) gave identical protein patterns in the pH 3 to 10 range. The characteristic "fingerprints" of a species appeared to correlate with the biochemical nature and not the habitat in each case. Arginine-hydrolyzing species seemed to show more diverse focusing than those that ferment glucose, or prefer an acid environment. Characterization and identification of highly resolved species-specific proteins, ease of performance, and reproducibility of this method suggest that PAGIF might be employed as a taxonomic aid.

The mitogenic property of supernatants from M. arthritidis cultures (MAS) is shown to be nonsedimentable, nondialyzable, labile to 56 degrees C for 1 hr, and active against spleen cells from both normal and germfree mice. Both viable M. arthritidis and MAS were active for T lymphocytes because anti-Thy-1 antiserum and C eliminated responsiveness. Spleen cells enriched for T lymphocytes by passage over nylon columns lost responsiveness unless supplemented with a radioresistant adherent cell population that was shown to bear Ia antigens. Evidence is also presented that the genetic control of T lymphocyte responses to the mycoplasma mitogen was exercised at the level of the Ia-bearing adherent cells. Thus adherent cells from positive responder mouse strains, but not those from nonresponder mouse strains, restored the responses of T cells from F1 hybrids between responder and nonresponder strains.

A high-density lipoprotein with growth-promoting activity for Ureaplasma urealyticum was purified in high yield from equine serum by ammonium sulfate fractionation and molecular filtration. Fractions enriched in growth-promoting activity represented 5% of the total serum protein, and 30 micrograms of the purified protein per ml gave an activity equivalent to that from 100 micrograms of whole serum per ml. The serum was totally replaced by purified lipoprotein when tested in a soy peptone-yeast dialysate or when added to a chemically defined synthetic medium. Polyacrylamide gel electrophoresis indicated that one major protein with growth-promoting activity is present. A total of 10 proteins were distinguished by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, with 75% of the total contributed by two proteins with molecular weights of 160,000 and 170,000. A total of 90% of the lipoprotein was an alpha-protein with a mobility of 0.67 in two-dimensional immunoelectrophoresis (albumin = 1.0). The active component was further characterized as high-density lipoprotein by density ultracentrifugation. Two components with S = 6.4 and S = 15.8 were distinguished by velocity sedimentation. The lipid was removed from lipoprotein during its precipitation with acetone. The growth-promoting activity of delipidized protein was dependent upon the addition of exogenous cholesterol, and [14C]cholesterol was transferred to urea-plasmic cells in cultures containing the delipidized protein. A major portion of the [14C]cholesterol remained associated with the protein during filtration on Sepharose 4B columns.

The effects of catalase and reducing agents on the growth of Ureaplasma urealyticum type VIII in broth cultures were studied, and used medium was examined for the presence of toxic factors. Growth of U. urealyticum was slower in aged or pre-aerated medium than in fresh medium, although equivalent final yields were achieved. Generation times were 2.9 hr in pre-aerated broth and were 1.34 hr in pre-aerated broth supplemented with either 2mM dithioerythritol or catalase (300 units/ml). Growth and death of U. urealyticum in cultures rendered the broth medium deficient for growth when reinoculated. Filtration of spent medium, adjustment of pH, addition of urea, and reinoculation permitted growth at the same rate and to the same titer as that observed in unused medium. Omission of filtration allowed growth but the final yield was less than that in filtered medium. Addition of sonicated dead cells to filtered, supplemented, spent medium also resulted in only poor growth. Therefore, spent medium appears toxic because it contains organisms (either while or disrupted) that hydrolyze the urea added and again render the medium deficient for growth by depleting an essential growth factor.

The effect of ammonium ion concentration and osmotic pressure on growth of Ureaplasma urealyticum type VIII was determined by using a well-buffered broth medium containing 10 mM urea. The addition of NH4Cl to the medium at concentrations up to 10 mM did not affect growth; however, addition of larger quantities progressively decreased both the specific growth rate (mu) and the maximum yield of the culture, with concentrations of 80 mM completely inhibiting growth. Addition of either 150 mM KCl or NaCl to the medium did not inhibit growth, indicating that the growth-inhibitory effect was specific to NH4+ and was neither a result of increased Cl- concentration nor increased osmotic pressure. Concentrations of NH4Cl as high as 100 mM did not affect growth of either Acholeplasma laidlawii or Mycoplasma hominis. U. urealyticum was more sensitive to osmotic pressure: osmotic pressures of 710 to 780 mosmol/kg (with KCl, NaCl, or sucrose) resulted in both a substantially lower growth rate and a 5- to 10-fold lower peak yield of organisms. Both A laidlawii and M. hominis were less sensitive to increased osmotic pressure.