Inappropriate Hospital Stay of Patients Admitted Under Care of General Medicine Units: A retrospective study.

Objectives: This study aimed to assess the incidence of inappropriate hospital stay and to identify the reasons behind inappropriate hospitalisation. Methods: This retrospective cohort study included patients admitted in the General Internal Medicine Unit, Sultan Qaboos University Hospital, Muscat, Oman, from January to June 2020. The average length of hospital stay for all included patients was calculated. The appropriateness evaluation protocol technique was used to examine admissions that exceeded the average length of hospital stay; subsequently, the reasons for the inappropriate hospital stay were identified. Results: There were 855 admissions during the study period. In this cohort, 53.1% were male and the median age was 64 years (interquartile range [IQR]: 44-75 years). There was a total of 6,785.4 hospitalisation days and the average length of hospital stay was five days (IQR: 3-9 days). A total of 31.8% of admissions (n = 272) and 9.9% of hospitalisation days (n = 674 days) were classified as inappropriate. Delay in complementary tests (29.0%) and unavailability of extra hospital resources (21.7%) were identified as the most common reasons associated with inappropriate hospital stays. Old age was associated with increase in inappropriate hospital stay. Conclusion: A significant proportion of hospitalisation days were inappropriate due to hospital-related factors. Therefore, auditing hospital services and investing in home-based care are among the top strategies that are likely to improve early discharge and minimise inappropriate hospital bed occupancy.

Elevated levels of circulating invariant natural killer cell subsets are skewed toward Th2-like phenotype in children with sickle cell disease.

Invariant natural killer T (iNKT) cells are being considered as potential targets for immunotherapeutic strategies in a variety of conditions including sickle cell disease (SCD). However, relatively little is known about the fate of iNKT cell subsets in children with SCD. Herein, quantitative and qualitative analyses of circulating iNKT cell subsets were carried out in 120 children in steady state and 30 healthy controls. Children with SCD displayed significantly elevated levels of circulating iNKT cell subsets with a preferential polarization toward Th2-like cells. The known SCD modifiers did not influence levels of iNKT cell subsets, except that children carrying the Bantu haplotype exhibited elevated levels of CD4iNKT cells, and to a lesser degree CD8iNKT cells. Collectively, these findings indicate that circulating iNKT cell subsets are significantly increased in children with SCD, and highlight the existence of imbalanced production of cytokines toward Th2-like phenotype, which seems to be associated with genetic polymorphisms.