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Abstract Disclosure: G. Herrington: None. S. Abouzaglo: None. E. Chapa: None. C. Helm: None. O. Hamidi: None. J. Sutaria: None. Background: Exogenous glucocorticoid (GC) use in the general population is estimated to be ∼1-3%. Surreptitious GC-containing supplements place patients at risk for GC-induced adrenal insufficiency (AI) via suppression of hypothalamic-pituitary-adrenal axis (HPA). Objective: To describe clinical outcomes in hospitalized patients taking GC-containing supplements, and to determine factors associated with the development of GC-induced AI. Methods: In this retrospective longitudinal cohort study, we identified adult patients (≥18 years) who were taking GC-containing supplements and hospitalized in our center between 2013 and 2023. We assessed initial presentation at hospitalization, adrenal crisis rate, and factors associated with the development of GC-induced AI. Results: 19 patients (median age 59 years [range, 35-74], 57.8% women) who reported taking GC-containing supplements were hospitalized at our center during the study period. Supplements included: Artri King (n=11), Ardosons (n=5), AK Forte (n=1), Ortiga Mas Ajo Rey (n=1), and Rumoquin (n=1). All (100%) patients reported using the supplements for joint pain related to osteoarthritis, gout, or rheumatoid arthritis. 15 (79%) patients were diagnosed with GC-induced AI based on clinical and biochemical data. The median self-reported duration of supplement use was 24 months (IQR, 12-36). The median early morning serum cortisol value was 2.25 mcg/dL (IQR, 1-3.25) and ACTH was 5 pg/mL (IQR 1.85-10). 12 (63%) patients had Cushingoid features. Of 15 patients with GC-induced AI, all presented with Grade 3 (60%, severe) or Grade 4 (40%, life-threatening) AI symptoms, as per CTCAE Grading. 5/15 (33.3%) had adrenal crisis at the time of index hospitalization. 4/15 (26.7%) patients with GC-induced AI required intensive care unit admission. GC-attributable complications during hospitalization were noted in 79% of patients, including severe anemia, acute kidney injury, and shock. Factors associated with GC-induced AI were: female sex (73.3% with AI vs 0% without AI, P=0.008), Cushingoid features (80% vs 0%, P=0.003), and higher Clinical Disease Severity score for Cushing syndrome (13 vs 1.5, P= 0.006). At study conclusion, only 4 (26.7%) patients recovered HPA axis. Median duration of follow-up was 21.3 month (IQR, 11.3-37.5). Conclusions: Surreptitious GC-containing supplements targeted to alleviate joint pain can cause severe GC-induced AI and adrenal crisis (upon abrupt cessation). Female sex, Cushingoid features, and higher Clinical Disease Severity Score were associated with the development of GC-induced AI. We observed high incidence (33.3%) of adrenal crisis in our hospitalized cohort, in contrast to previous data suggesting low risk for adrenal crisis in patients with GC-induced AI. Surreptitious GC exposure should be considered for inpatients presenting with Cushingoid features and symptoms concerning for AI. Presentation: Saturday, July 12, 2025

BACKGROUND:In recent years, a number of therapeutic drug for patients with ulcerative colitis (UC) has been developed. Meanwhile, 5-aminosalicylic acid (5-ASA) has few serious adverse events, and remains as the first-line drug in induction therapy and maintenance therapy for UC. However, 5-ASA often cause diarrhea, fever and skin rash, and it is often difficult to maintain remission in these cases. There are few studies about the effect of 5-ASA intolerance on the prognosis of patients with UC. In this study, we aimed to clarify the optimal treatment strategy for patients with 5-ASA intolerance by examining the 5-ASA intolerance using the IBD registry of our hospital.METHODS:A multi-center retrospective cohort study of UC patients, who visited our hospital from January 2015 to June 2018, was performed, and we enrolled 793 UC patients in IBD registry. We collected the detail clinical information of enrolled patients in the prior year, and the primary outcome was hospitalization. Risk factors for hospitalization were assessed by binary logistic regression analysis. This study was approved by the ethics committee of Keio University School of Medicine (approval number: 20160038).RESULTS:We defined 5-ASA intolerance as patients who had at least one in the following symptoms due to 5-ASA administration; headache, gastrointestinal symptoms, cutaneous symptoms, and fever. The rates of 5-ASA intolerance were 28.5% (22/77) in admission group and 5.1% (37/716) in no admission group. Our multivariate analysis showed that the following 3 factors have significant correlations with hospitalization; 5-ASA intolerance (odds ratio (OR) = 5.46, 95% confidence interval (CI) = 2.20–13.5), extent of disease (OR = 9.47, 95% CI = 1.25–71.6), and serum albumin level (OR = 0.122, 95% CI = 0.07–0.20). On the other hand, IM intolerance, age, duration of disease, and 5-ASA non-administration were not significantly correlated with hospitalization. Furthermore, compared with 5-ASA tolerance group, the intolerance group had significantly greater incidences of corticosteroid usage (P < 0.001) and calcineurin inhibitor usage (P < 0.01).CONCLUSION(S):It became clear for the first time that 5-ASA intolerance is the risk factor for hospitalization and worsen the prognosis of patients with UC. Therefore, even when we encounter patients with UC who are intolerant to one of the 5-ASAs, switching to another 5-ASA and continuing 5-ASA administration under strict observation may improve the prognosis of patients with UC.

Objectives: Clinical characteristics, follow-up and treatment outcomes of patients with isolated traumatic sternal fracture were presented and our clinical experiences on these patients were shared. Methods: Between January 2010 and December 2017, a total of 87 patients with isolated traumatic sternal fracture who were admitted to the emergency department and were hospitalized, were included in this observational cohort study. Medical data of these patients were collected from hospital records and then were retrospectively reviewed. Results: There were 65 (74.7%) male and 22 (25.3%) female patients. Mean age was 42.4 ± 13.7 years (range: 17-83). The most common etiological reason was traffic accident in vehicle. Sternal fractures were localized at corpus in 64 (73.6%) patients and at manubrium in 23 (26.4%) patients. The most common concomitant pathology was rib fracture with a ratio of 23% (20 patients). Mean length of hospital stay of patients was 3.1 ± 0.8 days. During the hospitalization period, no evidence of cardiac injury was observed in any patient. Conclusions: In view of rising healthcare costs and increasing demand for acute hospital and intensive care beds, it is crucial to determine hospitalization criteria for cases with traumatic sternal fracture. We believe that the hospitalization is not necessary in isolated traumatic sternal fractures where there is no other major injury.

AbstractObjectiveTo assess risks and costs of hospital admission associated with short term exposure to fine particulate matter with diameter less than 2.5 µm (PM2.5) for 214 mutually exclusive disease groups.DesignTime stratified, case crossover analyses with conditional logistic regressions adjusted for non-linear confounding effects of meteorological variables.SettingMedicare inpatient hospital claims in the United States, 2000-12 (n=95 277 169).ParticipantsAll Medicare fee-for-service beneficiaries aged 65 or older admitted to hospital.Main outcome measuresRisk of hospital admission, number of admissions, days in hospital, inpatient and post-acute care costs, and value of statistical life (that is, the economic value used to measure the cost of avoiding a death) due to the lives lost at discharge for 214 disease groups.ResultsPositive associations between short term exposure to PM2.5 and risk of hospital admission were found for several prevalent but rarely studied diseases, such as septicemia, fluid and electrolyte disorders, and acute and unspecified renal failure. Positive associations were also found between risk of hospital admission and cardiovascular and respiratory diseases, Parkinson’s disease, diabetes, phlebitis, thrombophlebitis, and thromboembolism, confirming previously published results. These associations remained consistent when restricted to days with a daily PM2.5 concentration below the WHO air quality guideline for the 24 hour average exposure to PM2.5. For the rarely studied diseases, each 1 µg/m3 increase in short term PM2.5 was associated with an annual increase of 2050 hospital admissions (95% confidence interval 1914 to 2187 admissions), 12 216 days in hospital (11 358 to 13 075), US$31m (£24m, €28m; $29m to $34m) in inpatient and post-acute care costs, and $2.5bn ($2.0bn to $2.9bn) in value of statistical life. For diseases with a previously known association, each 1 µg/m3 increase in short term exposure to PM2.5 was associated with an annual increase of 3642 hospital admissions (3434 to 3851), 20 098 days in hospital (18 950 to 21 247), $69m ($65m to $73m) in inpatient and post-acute care costs, and $4.1bn ($3.5bn to $4.7bn) in value of statistical life.ConclusionsNew causes and previously identified causes of hospital admission associated with short term exposure to PM2.5 were found. These associations remained even at a daily PM2.5 concentration below the WHO 24 hour guideline. Substantial economic costs were linked to a small increase in short term PM2.5.

Amaç: Parapnömonik efüzyon, çocuklarda pnömoninin en sık görülen komplikasyonlarından biridir. Bu çalışmada, parapnömonik efüzyonu olan pediatrik hasta kohortumuzu retrospektif olarak analiz ederek mevcut belirsizlikleri ele almayı amaçladık.Gereç ve Yöntemler: Çalışmaya, parapnömonik plevral efüzyon nedeniyle hastaneye yatırılan 61 hasta dâhil edildi. Hastaların demografik ve klinik özellikleri, tedavi yaklaşımları, kısa dönem klinik sonuçları ve hastanede kalış süresini etkileyen faktörler değerlendirildi.Bulgular: Hastaların medyan yaşı 8 yıl (25–75. persentil: 5–14 yıl) olup %54,1’i (n=33) erkekti. Hastaların %55,7’sine (n=34) torasentez, %45,9’una (n=28) tüp torakostomi uygulandı. On hastaya (%16,4) video aracılı torakoskopik cerrahi (VATS) yapıldı. Yaş, cinsiyet ve kültür sonuçları hastanede kalış süresiyle ilişkili bulunmazken; septalı efüzyon varlığı, ampiyem ve VATS gereksinimi uzun süreli hastanede yatış ile ilişkiliydi.Tartışma: Septalı efüzyonların ve ampiyem ile uyumlu efüzyonların erken tanı ve tedavisi, uzun dönem sekellerin önlenmesi açısından önemlidir. Gecikmiş tedavi, hastanede kalış süresinin uzamasına ve daha fazla invaziv girişim ihtiyacına yol açabilir.