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Get OUT: Factors Associated With a Longer Length of Stay in Patients Admitted With an Acute Gout Flare, and the Effects of Anakinra on Length of Stay

2025-09-23T00:00:00Z

Title: Get OUT: Factors Associated With a Longer Length of Stay in Patients Admitted With an Acute Gout Flare, and the Effects of Anakinra on Length of Stay Authors: Weerawardena, H.; Adams, C. L.; Kamalaraj, N.; Pile, K. Abstract: Objective Acute gout flares (AGF) are a significant burden to healthcare systems globally, due to the prolonged length of stay (LOS). The study's aim was to audit patients admitted to our facility with AGF, then re‐audit after the introduction of interleukin‐1 receptor antagonist anakinra in select patients to assess whether it would result in a reduced LOS. Methods A single‐center retrospective audit was conducted on 62 hospitalizations for AGF in 2019 that met inclusion criteria. Data on patient demographics, comorbidities, and clinical parameters (number of joints involved, C‐reactive protein (CRP), urate levels, and tophi) were analyzed using multivariable Poisson regression models to determine predictors of LOS. We then compared patients that received anakinra in 2020 (n = 7) with a historical control group (n = 13). Results The average LOS in 2019 for AGF was 3.36 days (1.22–4.28). CRP, prior use of allopurinol, and impaired mobility levels were significant predictors of prolonged LOS, with respective coefficients of 0.0036 (95% CI: 0.0023–0.0050, p < 0.0001), 0.321 (95% CI: 0.043–0.599, p = 0.023), and 0.708 (95% CI: 0.416–1.000, p < 0.0001). When CRP was treated as a controlled variable, patients treated in 2020 with anakinra demonstrated a 0.493‐day reduction in LOS compared to the control group, which was statistically significant (p = 0.043). Conclusion CRP levels, allopurinol use, and impaired mobility are key predictors of prolonged LOS in AGF. Although the use of anakinra shows promise in reducing LOS and costs, larger studies are needed to confirm its efficacy.

Splenic injury in severe cases of the zoonoses Q fever and rickettsial infection: diagnostic challenges

2025-11-03T00:00:00Z

Title: Splenic injury in severe cases of the zoonoses Q fever and rickettsial infection: diagnostic challenges Authors: Drury, A.; Harrison, P.; Bannan, A. Abstract: Zoonotic infections account for a small proportion of hospital presentations, even when focusing solely on the eastern states of Australia.1, 2 In rare instances, however, these infections can progress to severe, life‐threatening complications. The cases presented here underscore the importance of including zoonotic infections in the differential diagnosis of patients with unexplained sepsis and maintaining a high index of suspicion for potential complications. Serological testing for zoonotic pathogens can be slow to return results, particularly when sent from regional or remote areas. Given this delay, we recommend continuing empirical treatment when clinical suspicion for a zoonotic infection is high, pending confirmation through diagnostic testing.

Case report: a case of foramen of Winslow hernia causing portal venous compression

2025-05-01T00:00:00Z

Title: Case report: a case of foramen of Winslow hernia causing portal venous compression Authors: Yang, C. M.; Sabat, N.; Jayewardene, I. D. Abstract: Foramen of Winslow hernias are a rare pathology that often have a delayed diagnosis and can lead to bowel obstruction and ischemia. We present a case of pre-operatively diagnosed foramen of Winslow hernia in a female in her 70s that presented with right upper quadrant pain. This involved herniation of the colon, causing transient portal venous compression. In this case it was managed operatively with a laparoscopic converted to open reduction of the herniated colon, with resolution of venocongestion post operatively.

Anncaliia algerae microsporidial myositis

2014-02-01T00:00:00Z

Title: Anncaliia algerae microsporidial myositis Authors: Watts, M. R.; Chan, R. C. F.; Cheong, E. Y. L.; Brammah, S.; Clezy, K. R.; Tong, C.; Marriott, D.; Webb, C. E.; Chacko, B.; Tobias, V.; Outhred, A. C.; Field, A. S.; Prowse, M. V.; Bertouch, J. V.; Stark, D.; Reddel, S. W. Abstract: The insect microsporidian Anncaliia algerae was first described in 2004 as a cause of fatal myositis in an immunosuppressed person from Pennsylvania, USA. Two cases were subsequently reported, and we detail 2 additional cases, including the only nonfatal case. We reviewed all 5 case histories with respect to clinical characteristics, diagnosis, and management and summarized organism life cycle and epidemiology. Before infection, all case-patients were using immunosuppressive medications for rheumatoid arthritis or solid-organ transplantation. Four of the 5 case-patients were from Australia. All diagnoses were confirmed by skeletal muscle biopsy; however, peripheral nerves and other tissues may be infected. The surviving patient received albendazole and had a reduction of immunosuppressive medications and measures to prevent complications. Although insects are the natural hosts for A. algerae, human contact with water contaminated by spores may be a mode of transmission. A. algerae has emerged as a cause of myositis, particularly in coastal Australia.