Edwards (United Kingdom)

(Abstracted from Contraception 2025:148:110936, doi:10.1016/j.contraception.2025.110936) Nearly 50% of women globally who are of childbearing age use contraception; although this practice is very common, the effects of different contraceptive methods on the vaginal microbiome are understudied and unclear. Previous studies have characterized the microbiome and have shown that certain bacteria can be protective against specific infections or can be related to certain gynecologic and obstetric outcomes, but studies examining disruptions to the microbiome are scarce.

e16376 Background: Disseminated intravascular coagulation (DIC) is a coagulopathy involving systemic thrombosis and increased bleeding risk due to consumptive coagulopathy. Pancreatic cancer (PCA) is strongly associated with hypercoagulability and thromboembolic complications. Sepsis, a severe immune response to infection, is common in cancer patients and further predisposes PCA patients to DIC. This study evaluates the epidemiology and outcomes of DIC in PCA patients with sepsis, addressing a critical gap in research. Methods: PCA patients hospitalized with sepsis were identified from the National Inpatient Sample (2019–2021) using ICD-10 codes and stratified by DIC status. Sociodemographic data, comorbidities, and clinical outcomes were analyzed. The primary outcome was all-cause mortality, while secondary outcomes included complications, treatments, length of stay (LOS), and costs. Multivariate regression models were used, with p < 0.05 indicating statistical significance. Results: Among 43,924 PCA patients hospitalized with sepsis, 780 (1.78%) had DIC. DIC patients were younger (65.5 vs. 68.6 years, p = 0.0012), more frequently white (51.7%, p < 0.001), and predominantly treated at teaching hospitals (89.1% vs. 77.5%, p = 0.0005), with higher prevalence in the southern U.S. (36.1%, p = 0.0084). DIC was strongly associated with blood transfusion (26.3% vs. 7.8%, p < 0.001) and liver cirrhosis (8.9% vs. 4%, p = 0.002) but less common in patients receiving chemotherapy (7.05% vs. 13.08%, p = 0.027). Overall mortality was 17.5% but significantly higher in the DIC group (62.2%). DIC patients had higher odds of mortality (aOR 8.02, 95% CI 5.64–11.41) and complications, including acute kidney injury (aOR 4.29, 95% CI 2.94–6.26), respiratory failure (aOR 3.82, 95% CI 2.69–5.44), septic shock (aOR 3.65, 95% CI 2.60–5.11), ischemic stroke (aOR 4.05, 95% CI 1.94–8.47), hemorrhagic stroke (aOR 5.02, 95% CI 1.42–17.71), sudden cardiac death (aOR 3.69, 95% CI 2.04–6.66), deep venous thrombosis (aOR 2.41, 95% CI 1.57–3.72), and acute hepatic failure (aOR 5.69, 95% CI 3.70–8.74). Invasive interventions, such as renal replacement therapy (aOR 2.99, 95% CI 1.51–5.93), mechanical ventilation (aOR 4.79, 95% CI 3.23–7.10), and vasopressors (aOR 2.79, 95% CI 1.73–4.50), were more frequently required. DIC was associated with higher costs ($151,577 vs. $85,578, aIRR 1.41, 95% CI 1.19–1.67), though LOS was comparable (mean 6.69 days). No differences were observed in rates of gastrointestinal hemorrhage, acute anemia, acute heart failure, or pulmonary edema. Conclusions: DIC significantly increases mortality, complications, and costs in pancreatic cancer patients with sepsis, emphasizing the need for tailored management strategies to improve outcomes in this high-risk population.

e16068 Background: Esophageal cancer (EC) originates in the lining of the esophagus and often necessitates hospitalization in advanced stages. Sepsis, a severe and potentially fatal complication, poses significant challenges for hospitalized patients with EC. This study investigates and compares the outcomes of EC hospitalizations complicated by sepsis to enhance understanding and improve patient care strategies. Methods: Hospitalizations with a diagnosis of esophageal cancer were identified from the 2019 National Inpatient Sample (NIS) using ICD-10 codes. Patients were categorized based on the presence or absence of sepsis. Sociodemographic characteristics and comorbidities were analyzed. The primary outcome was in-hospital all-cause mortality, while secondary outcomes included complication rates. Multivariable regression analyses were performed to assess associations, with statistical significance defined as p < 0.05. Results: Among the 34,030 hospitalizations for esophageal cancer, 4,190 (12.3%) involved sepsis. Patients in the sepsis group were older, with a mean age of 68.1 years compared to 67.3 years in those without sepsis (p < 0.05). Sepsis was also associated with a significantly higher risk of in-hospital mortality (adjusted odds ratio [aOR] 2.74; 95% CI: 2.22–3.38, p < 0.001). Additionally, patients with sepsis had significantly higher odds of developing respiratory failure ([aOR] 4.21; 95% CI: 3.57–4.97, p < 0.001), requiring mechanical ventilation (aOR 2.64; 95% CI: 1.95–3.58, p < 0.001), and experiencing pulmonary embolism (aOR 1.59; 95% CI: 1.06–2.38, p < 0.001). Patients with sepsis also exhibited significantly higher odds of acute kidney injury (aOR 2.80; 95% CI: 2.35–3.33, p < 0.001) and deep venous thrombosis (aOR 2.94; 95% CI: 1.74–4.98). However, there were no statistically significant differences in the odds of gastrointestinal hemorrhage. Conclusions: Hospitalizations for esophageal cancer complicated by sepsis are strongly linked to increased in-hospital mortality and severe complications. These findings highlight the urgent need for tailored interventions to reduce the morbidity and mortality associated with sepsis in this high-risk population. Future research should prioritize refining preventive measures and therapeutic strategies to enhance clinical outcomes for oncology patients facing these challenges.

e16411 Background: Ascites is a frequent complication in cancer patients, significantly contributing to morbidity. Pancreatic cancer patients, particularly those with metastatic disease, are at an increased risk of developing ascites. Despite its clinical importance, the impact of ascites on hospitalization outcomes in pancreatic cancer patients remains inadequately studied. This research aims to investigate the effects of ascites on inpatient outcomes in this population, addressing a notable gap in the current body of knowledge. Methods: The 2019 National Inpatient Sample was analyzed to identify patients with a diagnosis of pancreatic cancer using International Classification of Diseases, 10th Revision (ICD-10) codes. The study cohort was divided into two groups: patients admitted with ascites and those without ascites. Sociodemographic characteristics and comorbidities were systematically compared between the groups. The primary outcome was all-cause in-hospital mortality, while additional secondary outcomes were also evaluated. Multivariate regression models were used to examine differences in outcomes between the groups, with statistical significance defined as p < 0.05. Results: Among 93,330 adult patients hospitalized with pancreatic cancer, 15,180 (16.2%) had concurrent ascites. These patients were significantly younger, with a mean age of 66.1 years compared to 69.0 years in those without ascites (p < 0.005), and included a higher proportion of males (56%) compared to females (44%). Patients with pancreatic cancer and concurrent ascites exhibited significantly increased odds of all-cause mortality (adjusted odds ratio [aOR] 2.30, 95% confidence interval [CI] 2.02–2.62, p < 0.001), concurrent gastrointestinal hemorrhage (aOR 1.25, 95% CI 1.04–1.51, p = 0.019), acute kidney injury (aOR 1.86, 95% CI 1.68–2.05, p < 0.001), and septic shock (aOR 1.77, 95% CI 1.52–2.05, p < 0.001). Additionally, these patients experienced longer hospital stays (mean length of stay: 7.4 days vs. 5.6 days; p < 0.005) and higher hospitalization costs ($81,420 vs. $63,100; p < 0.001). Conclusions: Pancreatic cancer patients with concurrent ascites had substantially higher odds of mortality, acute kidney injury, gastrointestinal hemorrhage, and septic shock. They also experienced longer hospital stays and incurred greater hospitalization costs compared to patients without ascites. These findings provide important insights into the prognosis of pancreatic cancer patients with ascites and highlight the need for targeted management strategies for this high-risk population.

e16002 Background: Among solid tumors, esophageal cancer (EC) is notably associated with atrial fibrillation (AF). The development of AF in EC is influenced by age-related comorbidities (e.g., hypertension, valvular heart disease), cancer-specific factors such as mechanical compression of the left atrium or pulmonary veins, and treatment-related factors like stent placement, esophagectomy, and chemoradiation. Previous studies have shown that AF in EC is linked to poorer long-term outcomes. However, the impact of AF on in-hospital outcomes in EC patients with sepsis has not been fully investigated. This study explores sepsis-related outcomes and healthcare burden in EC patients with AF, using United States population data. Methods: We identified adult patients with EC hospitalized for sepsis as the principal diagnosis between 2018 and 2021 using ICD-10 codes from the National Inpatient Sample. The cohort was divided by the presence or absence of AF, with complex sampling weights applied to ensure national representation. The primary outcome was all-cause mortality, and several secondary outcomes were also analyzed. Multivariate regression models were used to compare outcomes between groups, with statistical significance set at p < 0.05. Results: We identified 17,670 adults with EC admitted with sepsis between 2018 and 2021. Of these, 4,285 patients (24.3%) had concurrent AF. The overall mortality rate was 21.6%, compared to 24.6% in the AF group. Patients with AF were older (71.8 vs. 66.4 years, p < 0.001), had a higher proportion of males (82.7% vs. 79.2%, p < 0.05), white individuals (84.0% vs. 74.6%, p < 0.001), and Medicare beneficiaries (74.9% vs. 57.9%, p < 0.001). AF was associated with higher odds of all-cause mortality (adjusted odds ratio [aOR] 1.32, 95% CI 1.09–1.60), respiratory failure (aOR 1.37, 95% CI 1.16–1.62), and septic shock (aOR 1.63, 95% CI 1.38–1.93). AF patients also had higher odds of requiring renal replacement therapy (aOR 1.83, 95% CI 1.01–3.30) and mechanical ventilation (aOR 1.79, 95% CI 1.38–2.31). There were no significant differences in the odds of acute kidney injury, ischemic stroke, or vasopressor use. AF was associated with longer hospital stays (8.0 vs. 7.3 days, p < 0.05; adjusted incidence rate ratio [aIRR] 1.12, 95% CI 1.04–1.20) and higher mean hospitalization charges ($107,911 vs. $91,379, p < 0.05; aIRR 1.21, 95% CI 1.10–1.33). Conclusions: Atrial fibrillation in esophageal cancer patients hospitalized for sepsis is associated with higher mortality, increased complications, greater need for intensive care, and higher healthcare resource use. These findings underscore the need for improved management strategies to enhance outcomes and reduce costs in this high-risk population. Future research should investigate the mechanisms linking AF to these adverse outcomes to identify targeted interventions for better patient care.

e24016 Background: Exploring the risk of coronary artery disease (CAD) in breast cancer patients is important due to the growing number of breast cancer survivors and the intriguing overlap of risk factors between the two conditions. This study aimed to examine the risk of CAD in breast cancer patients using a large dataset from the National Inpatient Sample. Methods: A retrospective cohort analysis was conducted using data from 2016 to 2019. The dataset included 589,940 unweighted cases of breast cancer matched to an equal number of controls, resulting in a total of 2,949,699 weighted cases. The study population comprised adult females aged 18 years and older with either active or previous breast cancer, compared to matched controls without a history of breast cancer. Confounding factors, such as hypertension, diabetes, and other comorbidities, were addressed using propensity score matching and logistic regression. Results: Surprisingly, the results revealed a lower risk of CAD among breast cancer patients. In the unmatched cohort, the odds ratio (OR) for CAD was 0.84 (95% CI: 0.84–0.85). After matching, the adjusted OR was 0.99 (95% CI: 0.98–0.99). Additionally, breast cancer patients exhibited a decreased likelihood of specific CAD events, including ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. Conclusions: The study revealed an unexpected finding of lower risk of CAD in breast cancer patients. The complexity of the relationship between breast cancer and CAD highlights the need for further research. By understanding how breast cancer may mitigate CAD risk can provide valuable insight into developing more personalized treatments for a growing population of survivors.

e20032 Background: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition among smokers, often leading to substantial morbidity. Lung cancer patients, many of whom have a history of smoking, frequently experience concurrent COPD and are at an increased risk of COPD exacerbations. However, the impact of COPDE on clinical outcomes in patients with lung cancer remains insufficiently studied. This study aims to explore the effects of COPDE on inpatient outcomes in this population, addressing an important gap in the current body of knowledge. Methods: Data from the 2019 National Inpatient Sample were analyzed to identify patients with a diagnosis of lung cancer using International Classification of Diseases, 10th Revision (ICD-10) codes. The study population was divided into two groups: those with COPD exacerbation (COPDE) and those without. Sociodemographic variables and comorbidities were compared between the groups. The primary outcome was all-cause in-hospital mortality, with several secondary outcomes also assessed. Multivariate regression models were utilized to evaluate differences in outcomes between the groups, with statistical significance set at p < 0.05. Results: Among 317,180 adult patients hospitalized with lung cancer, 10,155 (3.2%) were admitted with a diagnosis of chronic obstructive pulmonary disease exacerbation (COPDE). These patients were older on average (mean age: 70.1 years vs. 69.5 years) and included a higher proportion of females (54.6%) compared to males (45.4%). Patients with lung cancer and COPDE demonstrated significantly reduced odds of all-cause mortality (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.21–0.38; p < 0.001), concurrent pulmonary embolism (aOR: 0.39; 95% CI: 0.26–0.59; p > 0.001), acute kidney injury (aOR: 0.59; 95% CI: 0.51–0.69; p < 0.001), and sudden cardiac death (aOR: 0.31; 95% CI: 0.14–0.66; p = 0.002). Additionally, patients with COPDE had shorter hospital stays (mean length of stay: 4.4 days vs. 6.1 days; p < 0.001) and incurred lower hospitalization costs ($44,103 vs. $70,100; p < 0.001). Conclusions: Lung cancer patients with concurrent COPDE demonstrated significantly lower odds of mortality, acute kidney injury, pulmonary embolism, and sudden cardiac death. They also experienced shorter hospital stays and reduced hospitalization costs compared to those without COPDE. These findings provide important insights into the prognosis of lung cancer patients with COPDE, highlighting potential differences in outcomes that may guide clinical management strategies.

Objective: This study examined sex differences in subacute plasma biomarkers in adolescents post-concussion and their associations with post-concussion symptom (PCS) burden. We hypothesized that biomarker levels would differ by sex and relate to PCS severity. Setting: Participants were recruited from outpatient settings as part of the Concussion Assessment, Research, and Education for Kids (CARE4Kids) multi-site observational study. Participants: Adolescents 11 to 17.99 years with a concussion based on Concussion In Sport Group criteria were eligible. Participants were assessed 7 to 35 days post-injury and required to report at least one PCS exceeding pre-injury baseline. A total of 339 participants (174 females, 145 males) with both blood biomarkers and PCS data were analyzed. Design: Plasma levels of glial fibrillary acidic protein, neurofilament light chain (NFL), ubiquitin C-terminal hydrolase (UCH-L1), tau, and phosphorylated tau at threonine 181 (p-tau181) were measured and compared between sexes. PCS severity was assessed using the Post-Concussion Symptom Inventory, 2nd Ed (PCSI-2) Retrospective Adjusted Post-Injury Difference (RAPID) scoring system. Main Measures: Primary outcomes were sex differences in biomarker levels and their associations with RAPID scores. Results: Females had significantly higher tau (females: M = 6.18, SD = 8.02; males: M = 4.55, SD = 5.53; P = .012) and lower p-tau181/tau ratios (females: M = 6.18, SD = 8.02; males: M = 4.55, SD = 5.53; P = .002) after adjusting for age, BMI, and days post-injury. In both sexes, cognitive symptoms were associated with higher p-tau181. In females, emotional symptoms were associated with elevated NFL and UCH-L1. In males, physical and overall symptoms were associated with lower NFL, UCH-L1, and p-tau181. Conclusion: This study highlights sex-specific biomarker differences during adolescent concussion recovery and the importance of understanding how sex differences may influence symptom burden and recovery trajectories. Future research should examine hormonal influences on biomarker profiles and prolonged symptomatology.

As an equine registered veterinary nurse (RVN), it is essential to understand the fundamental welfare, health, and husbandry requirements for equine patients. This chapter includes information on welfare legislation, housing, nutrition, exercise, grooming, dental care, vaccinations, parasite control, breeds and markings, passports requirements and exports, handling and restraint, transport techniques, and equine behaviour,. The information in this chapter is an important foundation to developing and delivering a high standard of individualised nursing care to equine patients.