Saint Thomas West Hospital, formerly Saint Thomas Hospital, is a 541-acute-care-bed health care facility located in Nashville, Tennessee, United States. The hospital sees 21,388 total admissions and 32,000 emergency department visits annually.Saint Thomas Hospital is one of the Saint Thomas Health family of hospitals,.Saint Thomas West Hospital has earned several distinctions from HealthGrades, a third-party organization that evaluates hospitals and physicians. In June 2009, Saint Thomas Hospital was recognized with a 2009/2010 HealthGrades Outstanding Patient Experience Award. In October 2009, HealthGrades gave Saint Thomas Hospital five-star ratings for joint replacement surgery, spine surgery, total knee replacement, treatment of stroke, overall pulmonary care, treatment of pneumonia, vascular surgery, repair of the abdominal aorta, carotid surgery, gastrointestinal surgery, pancreatitis and cholecystectomy.
INTRODUCTION:Medication availability and costs can be highly variable across countries and in different time periods. We aimed to conduct a survey among local experts to obtain information on the availability and costs of allergic rhinitis medications in different countries. METHODS:We sent a survey to members of the Allergic Rhinitis and its Impact on Asthma (ARIA) group, asking for the availability and the lowest cost of specific allergic rhinitis medications in their respective countries. Data in local currencies were converted to 2024 US Dollars adjusted for Purchasing Power Parity (PPP). We compared the costs of different medication classes, assuming, for each class, the least expensive drug in each country, as well as full treatment adherence. RESULTS:We received responses from ARIA experts in 51 different countries. Intranasal corticosteroids (INCS) and oral antihistamines (OAH) were available in all countries, but this was not observed for intranasal antihistamines (INAH) or for INAH+INCS. In most countries, OAH was the least costly drug class, while INAH+INCS was the most expensive. Among INCS, beclomethasone was the medication most frequently identified as the cheapest, while cetirizine and loratadine were the OAH most frequently reported as the least expensive. Among INAH+INCS, azelastine-fluticasone was more frequently identified as less costly than olopatadine-mometasone. CONCLUSION:There is an important across-country and across-class variability in terms of costs of allergic rhinitis medications. The results of this study will inform the ARIA-EAACI 2024-2025 guidelines.
Abstract Background Maternal vaccines can reduce the burden of diseases for both mother and neonate. The development and implementation of such vaccines require a thorough interpretation of safety data and standardized disease case definitions. This study aimed to evaluate the current rates for adverse pregnancy outcomes, maternal and neonatal events of interest (EOIs) that will be informative for preparing future phase III clinical trials on maternal vaccines conducted in low- and middle-income countries and further assisting in safety data interpretation (e.g., monitoring potential safety signals in clinical trials, and/or helping with the causality assessments of adverse events following immunization). Methods We performed a prospective cohort study on healthy 18–45-year-old women, with singleton, low-risk pregnancies, with a gestational age of ≥24 0/7 weeks at enrollment and ≤27 6/7 weeks at first visit, and their neonates. The study was conducted between 2019–2021 in 10 countries that were considered low- and middle-income countries by the World Bank Group at the time the study was designed. All pregnancy-related outcomes and maternal EOIs occurring from enrollment up to 42 days post-delivery and neonatal EOIs occurring within the first 28 days after birth were recorded. Results Of 2311 pregnant women and 2181 neonates enrolled, 2222 and 2094 were included in the analyses, respectively. Most livebirths (2088 [94.0%]) were without apparent congenital anomalies. Preterm delivery (166 [7.5%]), non-reassuring fetal status (137 [6.2%]), and hypertensive disorders of pregnancy (125 [5.6%]) were the most frequently reported EOIs related to pregnancy. The most frequent neonatal EOIs were low birthweight (including very low birthweight) (156 [7.4%]), preterm birth (141 [6.7%]), small for gestational age (111 [5.3%]), and congenital anomalies (103 [4.9%], including mainly major external structural defects, as well as detected internal and functional defects). Overall, there were similar frequencies in pregnancy outcomes, pregnancy-related and neonatal EOIs across countries, although some variation in the reporting rate was noted. Conclusion This multicountry study contributes to establishing the most recent background rates for pregnancy outcomes, maternal and neonatal EOIs in low- and middle-income regions. The clinical relevance in the context of the safety assessment in future trials will be applied. Trial registration NCT03614676 (03/08/2018).
In LMIC, respiratory tract infections (RTI) are a leading cause of child morbidity/mortality, yet their epidemiology remains poorly defined. We established a birth cohort to investigate RTI and factors associated with progression to lower RTI (LRTI) at CEIP (Cali, Colombia) and CEVAXIN (Panama City, Panama) study centers; this abstract summarizes initial findings.Table 1a).Demographic and clinical characteristics 1b). Outcomes of infants with LRTI This ongoing cohort study enrolled and followed pregnant women and newborns from May 2024 to Feb 2025. Infants underwent routine study visits every 6 months and twice-weekly RTI (cough or coryza) and LRTI (+tachypnea/difficulty breathing) surveillance via electronic app. Nasal swabs (NS) collected from symptomatic infants within 4 days of symptom onset, and asymptomatic controls, were analyzed via the TrueMark™ Respiratory Panel 2.0 (OpenArray™), targeting 31 pathogens. Among 436 infants (59 (13.5%) born to enrolled women (Fig. 1)), RTI occurred in 264 (61%), with 42 (16%) progressing to LRTI. Cumulative incidence of RTI and LRTI by 250 days of life was 65% and 12%, respectively (Fig. 2). LRTI was associated with higher number of household members, fewer prenatal visits, lower maternal vaccination and family history of allergy (Table 1a). Among LRTI cases, 14% required ICU admission, and 38% received antibiotics (Table 1b). NP were analyzed from 11 LRTI, 53 RTI episodes and 19 controls from CEIP participants followed between May and Nov 2024. Bacteria were identified in NS from 82% of LRTI episodes and 100% of controls. Common viruses were rhinovirus and cytomegalovirus in symptomatic and control infants. RSV was detected at low frequencies, exclusively in symptomatic infants (18% of LRTI, 2% RTI, 0% controls) (Figure 3). There was a high incidence of RTIs that often progressed to LRTIs; this progression was influenced by prenatal care interventions. Both viruses and bacteria, were identified in NS in cases and controls. The role of NS bacteria in LRTI pathogenesis—especially during co-infections with respiratory viruses—remains a research gap. This study will assess comprehensive clinical and molecular data, including cytokines, antibody profiling, transcriptomics, and immune cell phenotype analyses to enhance understanding of disease activity and risk of RTI progression. Flor M. Munoz, MD, Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support Octavio Ramilo, MD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi: Advisor/Consultant Asuncion Mejias, MD, PhD, MsCS, Enanta: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant
To update the recommendations of the Pan American Crohn's and Colitis Organisation (PANCCO) for the treatment of moderate-to-severe ulcerative colitis (UC) in adults, incorporating recent evidence on new biologics, small molecules, subcutaneous formulations and appendectomy. The PAHO rapid GRADE methods were applied. PANCCO adapted the Colombian guideline 2025 for upadacitinib, tofacitinib, ozanimod and the switch to subcutaneous formulations, and developed de novo recommendations for etrasimod, guselkumab, risankizumab, ustekinumab, mirikizumab, filgotinib and appendectomy. The search was carried out in MEDLINE, Embase, Cochrane and Epistemonikos through February 2026, with quality appraised with ROBIS, AMSTAR-2, RoB 2.0 and ICEMAN; strength of recommendations was established using GRADE. Recommendations were issued for nine clinical questions. In moderate-to-severe UC, upadacitinib, tofacitinib, filgotinib, ustekinumab, mirikizumab, risankizumab and guselkumab are recommended; ozanimod and etrasimod are conditionally suggested, considering the cardiovascular profile. In patients with response to intravenous induction, switching to subcutaneous vedolizumab or subcutaneous infliximab is suggested. In UC refractory to advanced therapies, laparoscopic appendectomy is conditionally suggested as an adjuvant strategy. This third update expands the therapeutic armamentarium for moderate-to-severe UC in Latin America. Treatment choice should be individualized according to prior therapy, comorbidities, cardiovascular and thrombotic risk, availability and patient preferences.
