Search Results (186)

Background: The implementation of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) has proven effective, offering significant benefits for patient outcomes. We therefore investigated trends in the implementation of IVT and MT in Germany between 2015 and 2023. Methods: We conducted a retrospective analysis using German Diagnosis-Related Group (DRG) statistics from 2015 to 2023. Treatment numbers were analyzed annually based on OPS codes. We examined the age and sex distribution of patients undergoing these treatments. Additionally, we analyzed all hospital cases coded with ICD-10 for acute ischemic stroke (AIS). Results: Between 2015 and 2023, the number of AIS cases in Germany slightly declined from 250,802 to 248,107 (−1.1%), with the largest annual decrease (−4.3%) occurring during the COVID-19 pandemic (2019–2020). Despite this, the use of IVT increased from 40,766 cases (16.25%) in 2015 to 48,378 (19.50%) in 2023. MT usage rose even more sharply, from 7840 cases (3.13%) to 22,445 (9.05%). Among MT recipients, the proportion of patients aged ≥80 years rose significantly, from 27.2% to 42.1%. In this age group, women consistently comprised the majority of MT patients—65.4% in 2015 and 65.5% in 2023. Conclusions: Despite a stable stroke incidence, the use of IVT—and particularly MT—continued to increase in Germany from 2015 to 2023, even during the COVID-19 pandemic. MT usage nearly tripled, especially among patients aged ≥80 years. These trends highlight a resilient stroke care system and underscore the need for future planning to meet the rising demand for endovascular treatment in an aging population. Full article

The objective of the present study was to evaluate the association between liver cirrhosis (LC) and subsequent Heart failure (HF). This retrospective cohort study utilized data from the Disease Analyzer database (IQVIA) and included adults with a first-time diagnosis of LC in 1293 general practices in Germany between January 2005 and December 2023. A comparison cohort without liver diseases was matched to the cirrhosis group using 5:1 propensity score matching. Univariable Cox proportional hazards models were used to assess the association between alcoholic vs. non-alcoholic LC and HF. The final study cohort included 5530 patients with alcoholic LC and 27,650 matched patients without liver disease, as well as 7063 patients with non-alcoholic LC and 35,315 matched patients without liver disease. After up to 10 years of follow-up, HF was diagnosed in 20.9% of patients with alcoholic LC compared to 10.3% of matched cohort, and in 23.0% of patients with non-alcoholic LC, compared to 14.2% in matched cohort. Alcoholic LC (Hazard Ratio (HR): 2.07 (95% CI: 1.85–2.31) and non-alcoholic LC (HR: 1.70; 95% CI: 1.56–1.82) were associated with an increased risk of HF. The association was also stronger in men than in women. LC, both alcoholic and non-alcoholic, is significantly associated with an increased long-term risk of HF. The association is particularly pronounced in patients with alcoholic cirrhosis and in men. To the best of the authors’ knowledge, this is the first real-world evidence for the positive association between LC and subsequent HF from Europe. Full article

Background/Objectives: The transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension in patients with liver cirrhosis. While its use has increased and indications have broadened in recent years, recent comprehensive data on patient characteristics, trends, and in-hospital mortality in Germany are lacking. This study aimed to evaluate current clinical patterns and mortality outcomes associated with TIPS. Methods: This nationwide cross-sectional study used anonymized hospital data from the German InEK database between 2019 and 2023. TIPS procedures were identified using relevant OPS codes. Patient demographics, liver cirrhosis stage (Child–Pugh), hepatic encephalopathy grade, comorbid conditions, and in-hospital mortality were analyzed descriptively. Analyses were conducted using SAS 9.4. Results: A total of 12,905 TIPS procedures were documented. Annual case numbers rose from 2180 in 2019 to 2954 in 2023. Most patients were male (66.3%) and aged 60–74 years. Ascites (68.6%) was the most frequent associated diagnosis, followed by variceal bleeding (16.4%) and hepatorenal syndrome (14.9%). The average hospital stay decreased from 19.6 to 16.8 days. Overall in-hospital mortality was 8.5%, increasing with age (13.0% in ≥75 years), Child–Pugh C cirrhosis (14.9%), PCCL grade 4 (17.6%), hepatorenal syndrome (16.7%), and grade 4 hepatic encephalopathy (56.1%). Conclusions: TIPS usage in Germany has increased over the past five years, with a shift toward earlier disease stages. Higher in-hospital mortality in clinically complex patients underscores the importance of careful patient selection and tailored management strategies in high-risk groups. Full article

The insular cortex has emerged as a key region implicated in a wide array of cognitive, emotional, and sensory processes. The anterior part of the insula (AIC) is central to emotional awareness, decision-making, and interoception, while the posterior insula (PIC) is more associated with somatosensory processing. The insula acts as a functional hub within the salience network and integrates homeostatic, affective, and cognitive information; thus, its role in different mental disorders seems to be prominent. Altered structure and connectivity of the insular cortex are evident in several psychiatric conditions. In schizophrenia, reductions in insular volume—especially on the left—correlate with hallucinations, emotional dysregulation, and cognitive deficits. Bipolar and major depressive disorders exhibit AIC volume loss and aberrant connectivity patterns linked to impaired affect regulation and interoceptive awareness. Anxiety disorders show functional hyperactivity of the insula, especially in response to fear-inducing stimuli, though findings on structural changes are mixed. Overall, growing evidence underscores the insular cortex’s central role in psychiatric pathophysiology and highlights its potential as a target for future diagnostic and therapeutic strategies. Full article

The evidence regarding allopurinol’s effects on renal function among people with hyperuricemia and gout has been conflicting, though clinicians are often cautious about using allopurinol in chronic kidney disease (CKD). We sought to examine the relation between allopurinol use in those with gout and CKD and the risk of worsening renal function. We conducted a time-stratified propensity score (PS)-matched cohort study on the IQVIA Medical Research Data representative of the UK general population. Among participants 18–89 years old with gout and CKD 3–4 not on urate-lowering therapy within one year prior, we identified new users of allopurinol and matched them 1:1 with a non-user. We analyzed the relation between incident allopurinol use and the changes in the eGFR at one year of follow-up using linear regression adjusted for the potential confounders included in the PS model. We PS-matched 10,716 allopurinol initiators to 10,716 non-users, among whom 42% were female, the mean age was 74 years and 7% had CKD4. The progression to dialysis or kidney transplant was similar in both groups. The mean eGFR prior to the study entry was 48.4 mL/min among allopurinol initiators and 49.5 mL/min among non-users, while the last eGFR within one year was 49.4 and 49.7 mL/min, respectively. The allopurinol initiators had an adjusted mean increase in the eGFR of 0.81 mL/min (95% CI 0.57–1.05) greater than that of non-users. Among those with gout and CKD 3–4, allopurinol did not worsen renal function and may have slightly improved it, suggesting that allopurinol is not detrimental to patients with gout who have CKD. Full article

Background and objectives: ABs are widely used in dental practice in the treatment of odontogenic infections and as systemic prophylaxis in high-risk patients. However, AB overuse contributes to antimicrobial resistance (AMR), which is a major global concern. This study examined dental AB prescribing trends in Germany in 2024, focusing on the share of overall AB prescriptions, patient demographics, and commonly used agents. Methods: This retrospective cross-sectional study used data from the IQVIA Longitudinal Prescription Database (LRx), covering approximately 80% of prescriptions reimbursed by statutory health insurance funds in Germany. Patients with at least one AB prescription (ATC code: J01) issued by a dentist in 2024 were analyzed. Descriptive statistics covered age, sex, and prescribed substances. Results: In 2024, German dentists prescribed ABs to 2,325,500 patients, accounting for 13.9% of all patients in the database who received AB prescriptions. Dentists were the second-largest group of AB prescribers, surpassed only by general physicians. Amoxicillin (54.2%) was most frequently prescribed, followed by amoxicillin with clavulanic acid (24.5%) and clindamycin (21.0%). Dental patients receiving AB prescriptions were older (mean age: 49.8 years) than the general antibiotic patient population (44.7 years). Interestingly, dental AB prescriptions increased during the COVID-19 pandemic, in contrast to the sharp overall decline in AB prescriptions. Between 2015 and 2019, the proportion of dental antibiotic prescriptions showed a moderate upward tendency, followed by a marked increase during the COVID-19 pandemic and a subsequent decline. In contrast, the number of patients receiving antibiotic prescriptions from other medical disciplines decreased over the same period. One particularly notable finding was the extended use of clindamycin, a reserve AB with known side effects and resistance risks, in dentistry. Conclusions: Dentists are responsible for a significant share of AB prescriptions in Germany. The rise in dental AB prescriptions, particularly the frequent prescription of clindamycin, underscores the need for interventions such as updated clinical guidelines and awareness campaigns concerning AB-related risks and their mitigation directed at dentists. These could focus on microbial culture and sensitivity testing and patient adherence education and control for targeted AB interventions. Emphasizing preventive and alternative anti-infective treatment strategies in dentistry may also help to contain AMR. Full article

Background: Community-acquired bacterial pneumonia (CABP) is a common and costly cause of hospitalization. Although severe CABP (sCABP) occurs in 10–25% of all pneumonia hospitalizations, little generalizable data examine its characteristics and outcomes or hospital resource utilization. Methods: We conducted a retrospective single-group cohort study of adults within the IQVIA hospital Charge Data Master, 2018–2022. We identified CABP via an ICD-10 code algorithm and sCABP was defined as an episode requiring ICU care. We examined baseline characteristics and outcomes, including mortality, costs, and readmission rates. We developed models to identify risk factors associated with readmissions. Results: Among 24,149 patients with sCABP, 14,266 (58.4%) were ≥65 years old and 55.2% were male. The majority were hospitalized in large (300+ beds, 50.9%), urban (91.9%) teaching (62.7%) institutions in the US Southern region (52.3%). The mean (SD) Charlson Comorbidity Index was 1.35 (2.33). The most common comorbidities were hypertension (16.7%), diabetes mellitus (15.7%), and chronic obstructive pulmonary disease (COPD) (12.9%). Hospital mortality was 15.9%. The mean (SD) hospital length of stay (LOS) and costs were 13.6 (12.1) and USD 91,965 (USD 133,734), respectively. An amount of 20% required a readmission within 30 days. Readmission was most strongly associated with older age and the presence of select comorbidities (diabetes mellitus, congestive heart failure, and COPD), each with an odds ratio > 1.4 and 95% confidence intervals excluding 1.0. Conclusions: Patients with sCABP comprise a large population with high mortality and 30-day readmissions. The intrinsic factors related to the latter lend themselves to early recognition and aggressive efforts at reducing complications. Full article

Background/Objectives: In 2022, over 200 million outpatient antibiotic prescriptions were written in the U.S., with 30% deemed unnecessary. Previous studies have shown that demographic factors, such as age, gender, and race, influence antibiotic prescribing patterns. However, few studies have examined how social determinants of health contribute to health inequities in antibiotic prescribing. This study aims to explore these disparities in Tennessee using IQVIA data. Methods: The Tennessee Department of Health conducted a cross-sectional study using the IQVIA LRx and Dx databases, linking prescription data to diagnoses from 2022. Antibiotic prescriptions were categorized into three tiers based on appropriateness. A multivariable logistic regression model assessed factors such as age, gender, insurance type, and social vulnerability index (SVI) on antibiotic prescribing patterns. Results: Of 2,874,505 prescriptions analyzed, 59.3% were classified as inappropriate (Tier 3). Female patients and children were less likely to receive inappropriate antibiotics. Patients in lower SVI areas, indicating less social disadvantage, had lower odds of receiving unnecessary prescriptions. Medicaid and Medicare Part D beneficiaries had higher odds of receiving inappropriate antibiotics compared to those with private insurance. Conclusions: This study highlights significant health disparities in outpatient antibiotic prescribing in Tennessee. Male patients, older adults, and individuals in socioeconomically vulnerable areas are more likely to receive inappropriate prescriptions. These findings stress the need for targeted public health interventions to reduce unnecessary antibiotic use and address underlying health inequities, ultimately improving healthcare outcomes and reducing antimicrobial resistance. Full article

Background and Objectives: Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide and caused ~1.8 million deaths in the European Union from 2012 to 2020. This study aimed to analyze and quantify sex-based disparities, identifying both clinical and systemic contributors to in-hospital mortality differences between male and female patients. Materials and Methods: This multicenter cross-sectional study from 36 hospitals across Germany included all hospitalized patients aged ≥18 years with admissions between January 2019 and December 2023 and a primary diagnosis of AMI. The primary outcome of the study was the prevalence of in-hospital mortality as a function of sex. Multivariable logistic regression analyses were conducted to assess the associations between female sex as compared with male sex and in-hospital mortality. Results: The present study included 9142 male and 4128 female patients with AMI. Women were significantly older than men (74.4 years versus 67.7 years). The proportion of non-ST elevation (NSTE-MI)-MI was higher in women than in men (70.7% versus 66.7%). Overall, in-hospital mortality was higher in women than in men (8.5% versus 7.1%). In a multivariable regression model, female sex was not significantly associated with in-hospital mortality (OR: 0.89; 95% CI: 0.77–1.04) irrespective of the MI type. Conclusions: There were no significant sex-based differences observed in the in-hospital mortality among patients suffering from AMI in Germany. Full article

Background: The 2019 coronavirus disease (COVID-19) pandemic had a severe impact on frail, end-stage kidney disease (ESKD) patients, either on dialysis or transplanted, with a high mortality rate in the early waves. Vaccination against SARS-CoV-2 with mRNA vaccines has led to reduced hospitalization and mortality rates in the general population and ESKD patients. Neutralizing antibodies (NAbs) are a valuable correlate of protection after vaccination, and IgG anti-spike antibodies are considered a surrogate marker of protection. Methods: This study investigated the correlates of protection brought by NAb and anti-spike IgG antibodies against SARS-CoV-2 wild-type Wuhan strain and variants of concern in a cohort of 128 French patients on dialysis after vaccination with the BNT162b2 mRNA vaccine. The correlate was assessed using Receiver Operating Characteristic curves. Results: The level of protection for IgG anti-spike antibodies was set at 917 BAU/mL for the original Wuhan strain and 980 BAU/mL and 1450 BAU/mL, respectively, for the Delta and Omicron BA.1 variants. Conclusions: The level of protection can be regularly monitored by measuring IgG anti-spike antibody concentrations to allow tailored boosters of SARS-CoV-2 vaccination in this frail and immunocompromised ESKD population. Full article

Background and Objectives: The underdiagnosis of chronic kidney disease (CKD) is a critical issue worldwide. This present study aimed to explore the CKD subpopulation regarding underdiagnosed CKD in individuals with a pathological estimated glomerular filtration rate (eGFR) and/or urine albumin–creatinine ratio (UACR) values in Germany. Materials and Methods: This analysis used data from the IQVIA^TM Disease Analyzer database and included adult outpatients with at least two pathological consecutive eGFR and/or UACR values, documented at least 60 days apart between October 2018 and September 2023 in 758 general practices. According to the 2024 KDIGO clinical practical guidelines, CKD was defined based on both eGFR and UACR values. UACR values were used when no pathological eGFR values were documented. The main outcome of the study was the proportion of patients with a documented CKD in the total population as well as in defined subgroups. Results: A total of 113,996 CKD patients (mean age: 76.5 (SD: 10.1) years; 60.2% female; 71.5% with mildly to moderately, 21.1% with moderately to severely, and 4.6% with a severely decreased eGFR value; and 1.0% with end-stage kidney disease) were available for analyses. CKD diagnosis was documented in 46.9% of CKD patients and was more frequent in male than in female patients (53.3% versus 42.7%). The highest proportion was observed in patients with heart failure (57.0%), followed by patients with type 2 diabetes (52.7%). In patients without diabetes and heart failure, CKD was documented in 38.2%. The proportion of CKD diagnoses increased with decreasing eGFR values, from 22.0% in patients with nonpathological eGFR but moderately or severely increased UACR to 87.7% in patients with end-stage kidney disease. Conclusions: The study provides valuable insights into the subpopulation of underdiagnosed CKD patients among a large patient population. These results underscore the need for improved screening, timely diagnosis documentation, and treatment strategies for CKD, particularly among high-risk populations. Moreover, it raises the need to increase awareness of micro- and macroalbuminuria as diagnostic criteria for CKD independent of eGFR. Full article

Introduction: Flexible bronchoscopy and its new methods have revolutionized the era of the diagnosis, staging, and restaging of lung cancer. A rare late complication is post-bronchoscopy respiratory infection, but it is critical due to treatment delays, treatment cancellation, and death. The aim of this study is to identify risk factors for respiratory tract infection after bronchoscopy in patients with lung cancer. Methods: A retrospective single-center observational study of 182 hospitalized patients was conducted at U.G.H. “ATTIKON” who underwent bronchoscopy for diagnosis/staging/restaging of lung cancer from January 2022 to April 2023. Patients were divided into two groups based on whether or not they developed post-bronchoscopy respiratory infection. Results: Analyzing the data between the groups, several potential risk factors for infection were identified, including recent hospitalization for COVID-19 within the last month (OR: 6.16; p = 0.01), history of COPD (OR: 8; p = 0.03), presence of emphysema on CT scan (OR: 8; p = 0.03), endobronchial lesions causing ≥ 50% bronchial obstruction with inability to advance the bronchoscope (OR: 9.6; p < 0.01), increased white blood cell count (≥8.5 K/μL) before bronchoscopy (OR: 8; p = 0.03), and advanced stage IV non-small-cell lung cancer (OR: 9.67; p = 0.02). Conclusions: Comparing our results with previous studies on risk factors for respiratory infections after bronchoscopy, we found that recent hospitalization for SARS-CoV-2 infection was a unique finding in our study. With the increasing incidence of lung cancer worldwide and the critical role of bronchoscopy in diagnosis/staging/restaging, large multicenter studies are needed to identify these risk factors and develop strategies for early detection, treatment, and prevention. Full article

Background: Dried ivy leaf extract EA 575^® (Prospan^®) is commonly used to treat coughs and may help reduce inappropriate antibiotic use for the common cold. This retrospective study investigated whether prescribing EA 575 is associated with reduced subsequent antibiotic use in children and adolescents with the common cold. Repeated EA 575 prescriptions were also analyzed to estimate treatment satisfaction. Methods: Data were sourced from the IQVIA Disease Analyzer database, including patients under 18 diagnosed with a common cold and prescribed either EA 575 or antibiotics between 2017 and 2020 (index date). Propensity score matching controlled for confounding factors. Antibiotic prescriptions were assessed 4–30 and 31–365 days after the index date, along with bacterial infections 4–40 days post-index. Repeated EA 575 prescriptions 2–5 years post-index were analyzed as a proxy for treatment satisfaction. Results: Overall, 10,390 children and adolescents were included in each matched cohort. Compared to antibiotics, EA 575 prescriptions were associated with significantly lower odds of antibiotic use 4–30 days (OR: 0.56; 95% CI: 0.49–0.64; p < 0.001) and 31–365 days (OR: 0.58; 95% CI: 0.54–0.62; p < 0.001) after the index date. The odds of bacterial infection 4–30 days after EA 575 prescription were also lower (OR: 0.67; 95% CI: 0.45–0.99; p = 0.047). Of the 42,677 patients in the EA 575 analysis, 50.5% had at least one repeated prescription, with the highest rates among children aged 0–2 years (54.7%) and the lowest in those aged 13–17 years (19.9%). Conclusions: EA 575 prescription was associated with reduced subsequent antibiotic use in children and adolescents with common colds. Frequent repeated prescription rates emphasize the therapeutic value of EA 575 as a treatment option for cold symptoms, especially in younger children. Full article

Treatment resistance due to gene alterations remains a challenge for patients with EGFR-mutated advanced or metastatic non-small-cell lung cancer (a/mNSCLC). A systematic literature review (SLR) was conducted to describe resistance mutation profiles and their impact on clinical outcomes in adults with a/mNSCLC in the United States (US). A comprehensive search of MEDLINE and Embase (2018–August 2022) identified 2986 records. Among 45 included studies, osimertinib was the most commonly reported treatment (osimertinib alone: 15 studies; as one of the treatment options: 18 studies), followed by other tyrosine kinase inhibitors (TKIs; 5 studies) and non-TKIs (1 study). For first-line (1L) and second-line (2L) osimertinib, the most frequent EGFR-dependent resistance mechanisms were T790M loss (1L: 15.4%; 2L: 20.5–49%) and C797X mutation (1L: 2.9–12.5%; 2L: 1.4–22%). EGFR-independent mechanisms included MET amplification (1L: 0.6–66%; 2L: 7.2–19%), TP53 mutation (1L: 29.2–33.3%), and CCNE1 amplification (1L: 7.9%; 2L: 10.3%). For patients receiving osimertinib, EGFR T790M mutation loss, EGFR/MET/HER2 amplification, RET fusion, and PIK3CA mutation were associated with worse progression-free survival. Resistance mechanisms resulting from current NSCLC treatments in the US are complex, underscoring the need to address such heterogeneous resistance profiles and improve outcomes for patients with EGFR-mutated a/mNSCLC. Full article

Background: Blood pressure elevation in children is an important health concern. The extent to which hypertension is diagnosed in German pediatric practices is not yet known. The aim of this study is, therefore, to examine the prevalence of hypertension diagnosis in children and adolescents treated in pediatric practices, as well as the factors associated with hypertension in this population. Methods: This retrospective case–control study used electronic medical records from 258 primary care pediatricians in Germany and included children and adolescents aged 0–17 years with an initial documented diagnosis of primary hypertension between January 2005 and December 2023. Hypertension patients were matched 1:5 with non-hypertension patients by age and sex. Conditional multivariable logistic regression models were used to estimate the association of chronic diseases and therapies with a risk of hypertension. Results: After 1:5 matching, the present study included 7482 children and adolescents with hypertension, and 37,410 controls without hypertension. The average prevalence of hypertension was 0.12% and the incidence was 1.24 cases per 1000 person-years, both increasing with age. In the multivariable regression analysis, a significant positive association was observed between hypertension and ten disorders including obesity (odds ratio, OR: 6.91; 95% confidence intervals, CI: 6.28–7.60), type 1 diabetes mellitus (OR: 2.85; 95% CI: 2.13–3.82), dyslipidemia (OR: 1.99; 95% CI: 1.46–2.72), chronic bronchitis (OR: 1.63; 95% CI: 1.39–1.90), hypothyroidism (OR: 1.62; 95% CI: 1.30–2.02), migraine (OR: 1.52; 95% CI: 1.17–1.98), ADHD (OR: 1.45; 95% CI: 1.28–1.65), scoliosis (OR: 1.40; 95% CI: 1.13–1.73), chronic rhinitis (OR: 1.31; 95% CI: 1.14–1.50), and reaction to severe stress and adjustment disorders (OR: 1.31; 95% CI: 1.04–1.65). Furthermore, paracetamol prescription was positively associated with hypertension risk (OR: 1.68; 95% CI: 1.41–2.00). Conclusions: The significant associations between hypertension and chronic disorders, particularly obesity, underscore the need for early prevention strategies. Prospective studies are needed to confirm these associations. Similarly, pathophysiological and mechanistic explanations for the associations identified need to be explored and verified in properly designed studies. Full article