INTRODUCTION Situs inversus totalis, dextrocardia with interrupted inferior vena cava and azygos vein continuation concomitant with symptomatic atrial fibrillation requiring ablation. This case was deemed not suitable for percutaneous ablation due to anatomic variations and the lack of case reports in literature. METHODS AND RESULTS We performed bilateral thoracoscopic epicardial ablation and epicardial left atrial appendage exclusion. The direct vision allowed for a complete box lesion set with bipolar radiofrequency device. Patient remained in sinus rhythm at 12-months follow-up. CONCLUSION Surgical thoracoscopic epicardial ablation is safe and effective also in congenital defects. Multidisciplinary expertise can offer minimally invasive ablation treatments.

Background: In academic hospitals, cardiology fellows may be the first point of contact for patients presenting with suspected STE elevation myocardial infarction (STEMI) or acute coronary syndrome (ACS). In this study, we sought to determine the role of handheld ultrasound (HHU) in patients with suspected acute MI (AMI) when used by fellows in training, its association with year of training in cardiology fellowship, and its influence on clinical care. Methods: This prospective study’s sample population was comprised of patients who presented to Loma Linda University Medical Center Emergency Department with suspected acute STEMI. On call cardiology fellows performed bedside cardiac HHU at time of AMI activation. All patients subsequently underwent standard TTE. The impact of the detection of WMA on HHU in regards to clinical decision making, including whether the patient would undergo urgent invasive angiography, was also evaluated. Results: 82 patients (mean age 65 years, 70% male) were included. The use of HHU by cardiology fellows resulted in a concordance correlation coefficient of 0.71 (95% confidence interval: 0.58 - 0.81) between HHU and TTE for LVEF, and a concordance correlation coefficient of 0.76 (0.65 - 0.84) for wall motion score index (WMSI). Patients with WMA on HHU were more likely to undergo invasive angiogram during hospitalization (96% vs 75%, p<0.01). The time interval between performance of HHU to initiation of cardiac catheterization (time-to-cath) was shorter in patients with abnormal vs normal HHU exams (58 ± 32 minutes versus 218 ± 388 min, p=0.06). Lastly, among patients who underwent angiography, those with WMA were more likely to undergo angiography within 90 minutes of presentation (96% vs 66%, p<0.001). Conclusion: HHU can be reliably used by cardiology fellows in training for measurement of LVEF and assessment of wall motion abnormalities, with good correlation to findings obtained via standard TTE. HHU-identified WMA at first contact were associated with higher rates of angiography as well as sooner angiography compared to patients without WMA.

Satyrium is an endangered and rare genus of plant that has various pharmacodynamic functions. In this study, MaxEnt default parameters were adjusted by the ENMeval package. Optimized MaxEnt models were used in analyzing potential geographical distributions under current and future climatic conditions (the 2050s and 2070s) and dominant environmental variables influencing their geographic distribution. The results provided reference for implementation of long-term conservation and management approaches for the species. The results showed the area of the total suitable habitat for S. ciliatum in China is 32.51 × 104 km2, the total suitable habitat area for S. nepalense in China is 61.76 × 104 km2, and the area of the total suitable habitat for S. yunnanense in China is 89.73 × 104 km2 under current climatic conditions. The potential suitable habitat of Satyrium is mainly distributed in Southwest China. The major environmental variables influencing the geographical distribution of S. ciliatum were isothermality (bio3), temperature seasonality (bio4), and mean temperature of coldest quarter (bio11). Environmental variables such as isothermality (bio3), temperature seasonality (bio4), and precipitation of coldest quarter (bio19) affected the geographical distribution of S. nepalense; and environmental variables such as isothermality (bio3), temperature seasonality (bio4), and lower temperature of coldest month (bio6) affected the geographical distribution of S. yunnanense. The distribution range of Satyrium was extended as global warming increased, showing emissions of greenhouse gases with lower concentration (SSP1-2.6) and higher concentration (SSP5-8.5). According to the study, the distribution of suitable habitat will shift with a change to higher elevation areas and higher latitude areas in the future.

Involution of a rapidly involuting congenital hemangioma is an unknown cause of neonatal ascites. As involution phase is completed by 14 months after birth, conservative management with diuretics and drainage is possible and may avoid surgical resection.

Objective: Limited data are available on adverse drug reactions (ADRs) of gender-affirming hormone therapy (HT), mainly due to the lack of population-based studies with adequate controls, thus making spontaneous reporting systems a valuable tool to detect potential side reactions. In this nationwide retrospective study, we aimed to analyze ADRs related to gender-affirming HT reported in the French pharmacovigilance database (FPVD). Design: We requested all the individual case safety reports related to gender-affirming HT recorded in the FPVD before the 27th of May 2020. We excluded previously published cases and those for which gender-affirming hormone therapy was not the suspected drug. Results: A total of 28 reports of ADRs were identified. Six concerned transgender men (age range 21-40 years) and 22 transgender women (age range 22-68 years). In transgender men taking testosterone enanthate, all reported adverse effects were cardiovascular events with pulmonary embolism in 50% of cases. In transgender women, antiandrogens, mainly cyproterone acetate, were involved in 68% of cases. Estrogens were involved in 77% of cases, mostly in association with progestin or cyproterone acetate. Meningioma was the principal ADR, followed by cardiovascular events. Conclusions: Our data show a previously unreported and non-negligible proportion of cases indicating cardiovascular ADRs in transgender men younger than 40 years, taking testosterone enanthate. In transgender women, cardiovascular events were the second most frequently reported ADR. Further research is necessary to identify risk factors that might help to the individualization of treatment strategies. There is a necessity to increase awareness and implement preventive and education measures.

Network structure is a key driver of animal survival, reproductive success, pathogen transmission, and information spread in animal societies. Yet our knowledge of animal social structure is mostly limited to species’ main activity periods. Here, we investigated the role of nocturnal sociality in a wild herbivore population, the rock hyrax (Procavia capensis). Using proximity loggers, we recorded nearly 15,000 encounters over 27 days. We show that hyraxes are choosier regarding their social partners at night. At multiple temporal scales, they maintain their overall network topology while reallocating the weights of social relationships. Our results show that nighttime underground sociality can be an optimal baseline shaping hyrax diurnal interactions above ground. The results also suggest that complex social dynamics are not reserved to species characterized by high cognitive abilities and shed light on the function of nocturnal social interactions in diurnal social species.

Objective Aortic stenosis has traditionally been addressed with surgical aortic valve replacement with a stented prosthesis. Several technologies have emerged as an alternative treatment method for aortic valve disease. Among them, Perceval Sutureless valve has been used in clinical practice for more than a decade. The aim of this study was to evaluate the results of Perceval Sutureless valve from single centre in Indian population. Method Between April 2018 to December 2021, 30 elective patients underwent aortic valve replacement with the Perceval Sutureless valve. 19 patients had isolated AVR and 11 patients underwent AVR + Coronary artery bypass grafting (CABG) with average grafts 2.1 ± 0.8. Majority of isolated AVR, 12 of 19, were done by minimally invasive approach. Result Mean age was 67.3 ± 13.8 and mean STS score was 2.7 ± 1.5. Mean aortic cross clamp time for isolated AVR and combined procedure were 42 ± 11 and 74 ± 23 respectively. There was no in-hospital mortality. 3 patients required ventilation for > 24 hours. New onset left bundle branch block occurred in 4 patients which recovered before discharge in 2 patients. The peak and mean valve gradients were satisfactory. None of implanted valve showed para-valvular leak. Conclusion SAVR using Perceval Sutureless valve is associated with excellent results and represent a safe and effective treatment option for patients with severe AS. This valve also facilitates MI approach and reduces aortic x-clamp and cardiopulmonary bypass time.

Background: Acute type B aortic dissection (TBAD) is a rare condition that can be divided into complicated (CoTBAD) and uncomplicated (UnCoTBAD) based on certain presenting clinical and radiological features, with UnCoTBAD constituting the majority of TBAD cases. The classification of TBAD directly affects the treatment pathway taken, however, there remains confusion as to exactly what differentiates complicated from uncomplicated TBAD. Aims: The scope of this review is to delineate the literature defining the intervention parameters for UnCoTBAD. Methods: A comprehensive literature search was conducted using multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on intervention parameters and protocols for UnCoTBAD. Results: A TBAD without evidence of malperfusion or rupture might be classified as uncomplicated but there remains a subgroup who might exhibit high-risk features. Two clinical features representative of “high risk” are refractory pain and persistent hypertension. First line treatment for CoTBAD is TEVAR, and whilst this has also proven its safety and effectiveness in UnCoTBAD, it is still being managed conservatively. However, TBAD is a dynamic pathology and a significant proportion of UnCoTBADs can progress to become complicated, thus necessitating more complex intervention. While the “high risk” UnCoTBAD do benefit the most from TEVAR, yet, the defining parameters are still debatable as this benefit can be extended to a wider UnCoTBAD population. Conclusion: Uncomplicated TBAD remains a misnomer as it is frequently representative of a complex ongoing disease process requiring very close monitoring in a critical care setting. A clear diagnostic pathway may improve decision making following a diagnosis of UnCoTBAD. Choice of treatment still predominantly depends on when an equilibrium might be reached where the risks of TEVAR outweigh the natural history of the dissection in both the short- and long-term.

Objectives: Female sex is considered a risk factor for mortality and morbidity following cardiac surgery. This study is the first to review the UK adult cardiac surgery national database to compare outcomes following surgical coronary revascularisation and valvular procedures between females and males. Methods: Using data from National Adult Cardiac Surgery Audit (NACSA), we identified all elective and urgent, isolated coronary artery by-pass grafting (CABG), aortic valve replacement (AVR) and mitral valve replacement/repair (MVR) procedures from 2010-2018. We compared baseline data, operative data and outcomes of mortality, stroke, renal failure, deep sternal wound infection, return to theatre for bleeding and length of hospital stay. Multivariable mixed-effect logistical/linear regression models were used to assess relationships between sex and outcomes, adjusting for baseline characteristics. Results: Females, compared to males, had greater odds of experiencing 30-day mortality (CABG OR 1.76, CI 1.47-2.09, p<0.001; AVR OR 1.59, CI 1.27-1.99, p<0.001; MVR OR 1.37, CI 1.09-1.71, p=0.006). After CABG, females also had higher rates of post-operative dialysis (OR 1.31, CI 1.12-1.52, p<0.001), deep sternal wound infections (OR 1.43, CI 1.11-1.83, p=0.005) and longer length of hospital stay (Beta 1.2, CI 1.0-1.4, p<0.001) compared to males. Female sex was protective against returning to theatre for post-operative bleeding following CABG (OR 0.76, CI 0.65-0.87, p<0.001) and AVR (OR 0.72, CI 0.61-0.84, p<0.001). Conclusion: Females in the UK have an increased risk of short-term mortality after cardiac surgery compared to males. This highlights the need to focus on the understanding of the causes behind these disparities and implementation of strategies to improve outcomes in females.

Recently, in Pakistan, several cases of mysterious dengue-like illness are being reported. We present a case of a 52-year-old female presenting with a history of continuous fever, documented up to 104 F, for five days. The symptoms were associated with headache, nausea, retro-orbital headache, arthralgia, and myalgia.

This report introduces a patient with end-stage haemophilia arthropathy. He had a unique background and presentation, with challenges such as joint stiffness, muscular atrophy, severe pain, decrease in cardiopulmonary and vestibular function. Finally, he achieved the basic self-care of daily life through comprehensive physical therapy.

Background: Humoral and cellular immune responses to SARS-CoV-2 vaccines wane with time. In the COV‑ADAPT cohort, we recently studied both immunological components and their interdependencies following different vaccine combinations before (T1) and up to three months after second immunization (T2). This follow-up investigated the stability of long-term immune responses and aimed to identify predictive markers. Methods: We assessed humoral (anti-spike-RBD-IgG, neutralization capacity, avidity) and cellular (spike-induced T-cell interferon‑γ release) immune responses three-seven months after secondary vaccination (T3) in blood samples of 318 healthcare workers with previous homologous ChAdOx1 nCoV-19 (ChAdOx1), homologous BNT162b2 or heterologous ChAdOx1/BNT162b2 vaccinations. Results: At T3, homologous ChAdOx1 vaccination resulted in significantly lower anti-spike-RBD-IgG (152±151 BAU/ml) as compared to heterologous ChAdOx1/BNT162b2 (388±300 BAU/ml) and homologous BNT162b2 (435±327 BAU/ml). In all groups, anti-spike-RBD-IgG (T3) exceeded antibody levels before second vaccination (T1). T-cell interferon-γ release following heterologous ChAdOx1/BNT162b2 vaccination was significantly higher at T3 (1062±2083 mIU/ml) vs. T1 (680±1691 mIU/ml), yet did not differ significantly between the three groups at T3. Associations between humoral and cellular responses were found at T3 (all groups combined). Additionally, the early cellular response (at T1) was significantly associated with late (T3) humoral (ChAdOx1/BNT162b2, BNT162b2/BNT162b2) and cellular responses (all groups). In contrast to T2, neutralization capacity at T3 was significantly higher for ChAdOx1/BNT162b2 and BNT162b2/BNT162b2 vs. ChAdOx1/ChAdOx1. Conclusions: We identified (i) long-term interdependencies between the humoral and the cellular immune system, (ii) observed distinct waning dynamics following different vaccination regimes, and (iii) uncovered early T-cell responses as a useful predictor of long-term immune responses.

Background Nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) are two widely used ways of noninvasive ventilation. Whether or not early NIPPV simultaneously reducing the incidences of invasive ventilation(IV) and BPD as compared with NCPAP in preterm infants with RDS remains unclear. The present study aims to systematically assess the beneficial effects between NIPPV and NCPAP. Methods: A search of Medline, Embase, Web of Science and the Cochrane Central Register of Controlled Trials(from 1980 to Feb 2022) was performed, and randomized controlled trials(RCTs) comparing early NIPPV with NCPAP in preterm infants with RDS were included. The primary outcome was simultaneous incidences of IV and BPD. Results: Meta-analysis of 13 RCTs (n = 1681) demonstrated that, compared with NCPAP, early NIPPV concurrently reduced the incidences of IV [relative risk (RR):0.52, 95% confidence interval (CI) 0.43, 0.63, P < 0.00001] and BPD (RR: 0.51, 95%CI 0.37, 0.71, P < 0.0001). Similarities were also shown in the subgroups receiving surfactant [IV (RR:0.59, 95%CI 0.45, 0.77, P = 0.0001) and BPD (RR: 0.57, 95%CI 0.37, 0.87, P = 0.009) ], birth weight(BW) ≤ 1,500g [IV (P < 0.0001) and BPD (P = 0.004) ] and excluding RCTs with significant difference referring to IV (P = 0.0004) and BPD (P = 0.02) . Conclusions: Early NIPPV could be superior to NCPAP in concurrently decreasing the incidences of IV and BPD in preterm infants with RDS, especially in the infants receiving surfactant and whose BW ≤ 1,500g.

We are devoted to the study of a non-local nonhomogeneous time fractional timoshenko system with frictional and viscoelastic damping terms. We are concerned with the well-posedness of the given problem. The approach relies on some functional analysis tools, operator theory, a prori estimates, and density arguments.

The forced vibrations of thermodiffusive elastic circular plate in the framework of a mathematical model of fractional thermoelastic diffusion employing hyperbolic two-temperature theory with temperature-dependent material properties are studied. Governing equations are simplified by introducing potential functions and solved by applying Laplace \& Hankel transform technique. Mechanical, thermal and mass concentration loads are applied on the boundary surfaces. The expression for field quantities in closed form are obtained analytically. The numerical study is carried out for copper material. The resulting field quantities in the original domain are converted by employing a numerical inversion technique and displayed graphically to present the different physical effects. The significant impacts of hyperbolic two temperature, fractional parameter and temperature dependent properties are observed on temperature fields, stress and chemical potential. Obtained analytical results are validated with existing literature.

Square loop and square slot are the simplest and commonly used elements of frequency selective surfaces (FSSs) providing bandstop and bandpass responses, respectively. Despite it is already known that employment of a double square slot structure presents a tunable stopband between two passbands, it is not clear which parameters of the structure are crucial for tunning the inbetween stopband. We propose an analysis of a double square slot FSS considering its element as a parallel connection of square slot and square loop predicting two geometrical parameters of the constituent square loop are crucial for tunning the inbetween stopband. The stopband is tunable by changing geometrical parameters of the constituent square loop and does not depend on geometries of the constituent square slot. The validity of this analytical prediction is verified by full wave EM simulation results.

To validate the experimental results of Part-1, we conducted a two-phase flow simulation of imbibition of a wetting liquid through 2D microstructures made of ellipses of varying aspect ratios. The flow simulation in the particulate microstructures, characterized by low (ellipse) aspect ratio, produced somewhat even micro-fronts, thus replicating the sharp fronts at the visual (macroscopic) scale observed in Part-1. Whereas simulations in the fibrous microstructures produced highly uneven micro-fronts, suggesting the formation of semi-sharp or diffuse visual fronts. Increasing the porosity from 50% to 70% resulted in solid-phase clustering and led to further increase in the unevenness of micro-fronts, pointing to purely diffuse visual fronts. The evolution of the saturation plots along the flow direction, obtained from area-averaging of fluid-distribution plots, pointed to diffusing of sharp fronts with time. The predictions matched our previous experimental observations, i.e., the particulate media create sharp fronts while the fibrous media create semi-sharp/diffuse fronts.

Porcine reproductive and respiratory syndrome virus (PRRSV) is an important pathogen that endangers the swine industry worldwide. Recently, lineage 1 PRRSVs, especially NADC30-like PRRSV, have become the major endemic strains in many pig-breeding countries. Since 2016, NADC30-like PRRSV has become the predominant strain in China. Unfortunately, current commercial vaccines cannot provide sufficient protection against this strain. Here, an attenuated lineage 1 PRRSV strain, named SD-R, was obtained by passaging NADC30-like PRRSV strain SD in Marc-145 cells for 125 passages. Four-week-old PRRSV-free piglets were vaccinated intramuscularly with 10 5.0TCID 50 SD-R and then challenged intramuscularly (2 ml) and intranasally (2 ml) with homologous NADC30-like PRRSV SD (1×10 5.0TCID 50/ml) and heterologous NADC30-like PRRSV HLJWK108-1711 (1×10 5.0TCID 50/ml). The results showed that 5 of 5 immunized piglets had a perceptible humoral immune response to vaccination and did not develop fever or clinical diseases after NADC30-like PRRSV challenge. Additionally, compared to challenge control piglets, vaccinated piglets gained significantly more weight and showed much milder pathological lesions. Furthermore, the viral replication levels of the immunized group were significantly lower than those of the challenge control group. These results demonstrate, for the first time, that lineage 1 PRRSV SD-R is a good candidate for an efficacious vaccine against NADC30-like PRRSVs.

Background: Umbilical cord prolapse is an obstetric emergency that warrants urgent intervention. Although the incidence is low, it carries a high rate of fetal morbidity and mortality. Quality appraisal of well- developed practice guidelines provides clinicians with a framework for good clinical practice. Objective: To assess the quality of clinical practice guidelines on umbilical cord prolapse using AGREE II instrument-2010. Search strategy: A systematic review employing the principles of PRISMA 2020 was done to identify suitable practice guidelines available in digital databases from inception till 2021. Selection criteria: Practice guidelines on management of umbilical cord prolapse in English which have rigorous methodology of development and is between 2010-2021 were selected for the appraisal. Data collection and analysis: Selected guidelines were appraised utilizing the AGREE-II - 2010 instrument Results: Three practice guidelines were fulfilled the selection criteria. Two of the three guidelines were assigned sufficient scores based on the domains for quality appraisal, though they require further modifications. Conclusions: Practice guidelines on management of umbilical cord prolapse developed by the RCOG and RCPI achieved sufficient scores to be recommended for use in clinical practice. Professionals should provide patient care based on practice points tailored to patients’ characteristics and resource availability. Keywords: umbilical cord prolapse, guidelines, clinical practice guidelines, quality appraisal Tweetable abstract: AGREE II was used to assess the quality of CPGs on umbilical CP, of which RCOG and RCPI guidelines were recommended.

A document by Markus Gonser. Click on the document to view its contents.

[Abstract] Objective To explore the MRI assistance in diagnosing of vasa previa when inconclusive ultrasonography results come. Methods From January 2018 to December 2021, 12 patients with suspected vasa previa but inconclusive ultrasonography diagnoses at 23-25w or 31-33w were enrolled into the study group. 51 patients diagnosed by ultrasonography as mild ventriculomegaly with no vasa previa were enrolled into the control group. Both groups had taken MRI scanning during the 3rd trimester to check the existence of vasa previa. Placentas from both groups were checked to confirm the existences of vasa previa immediately at delivery, and postoperatively by pathology. Results In the 12 patients from the study group, MRI demonstrated vasa previa in 11 patients. The rest one was excluded of vasa previa by MRI. In all the 51 patients from the control group, MRI had excluded vasa previa. Pathology examination after delivery had confirmed these MRI diagnoses. Conclusion When inconclusive ultrasonography interpretations on vasa previa come, MRI may offer some assistance in diagnosis.

Little is known about dispersal in deep-sea sponges, yet understanding patterns of gene flow and connectivity is essential for their effective management. Given rising pressure from harmful anthropogenic activities, schemes that manage resource extraction whilst conserving species diversity are increasingly necessary. Here, we used ddRADseq derived SNPs to investigate the genetic diversity and connectivity for the deep-sea sponge Phakellia ventilabrum across the northeast Atlantic Ocean (from the Cantabrian Sea to Norway). The analysis of 166 individuals collected from 57 sampling stations were grouped into 17 different areas, including two MPAs, one SAC and other areas with different levels of protection. The 4,017 neutral SNPs we uncovered indicated high connectivity and panmixis amongst the majority of areas, spanning a ca. 2,500-kilometre range and depths of 99–900 m. This was likely due to the presence of strong ocean currents aiding larval transport, as supported by our migration analysis and also by 3D particle tracking modelling using information on the reproductive cycle of P. ventilabrum. We also observed significant genetic similarity between samples from the Cantabrian Sea and Roscoff (France) as compared to the remainder of the collection areas, likely arising from physical drivers such as prevailing current circulation patterns and topographic features, acting as barriers for gene flow. Despite this, our results suggest that all protected areas studied are well connected with each other. The relatively low genetic diversity observed in all areas, though, highlights the potential fragility of this species to changing climates, which might compromise resilience to future threats.

Background Fatigue is a burden for a substantial proportion of women in the postpartum period. A wide array of patient-reported outcome measures (PROMs) are used for assessment, which makes comparison of data difficult. Objective To identify the best PROM for postpartum fatigue using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Search strategy We searched Web of Science, Embase, PubMed and CINAHL, with no date limiters, in July 2020 for validated PROMs used to assess fatigue in the postpartum period. Selection criteria Studies evaluating at least one author-defined domain of postpartum fatigue and one psychometric measurement property of a PROM. Data collection and analysis An overall rating was assigned based upon COSMIN criteria and the quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Main results We identified 49 validation studies using 18 PROMs in 21 209 women that evaluated postpartum fatigue. All three fatigue domains (Physical, Mental, Interference) were assessed by four PROMs: Fatigue Assessment Scale (FAS), Brief Fatigue Inventory (BFI), Checklist Individual Strength (CIS) and Fatigue Severity Scale (FSS). The FAS, which is freely available online, was the only PROM to demonstrate adequate content validity and at least a low level evidence of sufficient internal consistency, resulting in a Class A recommendation. Conclusion The FAS is the best available PROM to assess postpartum fatigue. However, it fails to assess important areas of postpartum recovery. Future studies should aim to develop a more specific PROM for postpartum fatigue.

Aim: To explore the evolution of antipsychotic polypharmacy (APP) and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns. Methods: Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals. Results: Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (ORadmission=2.53, CI=1.1-5.84, ORdischarge=11.01, CI=4.45-27.28), treatment with a first-generation antipsychotic (ORadmission=26.79, CI=13.08-54.86, ORdischarge=25.2, CI=12.2-52.04), increased antipsychotic exposure (ORadmission=8.93, CI=5.13-15.56, ORdischarge=19.89, CI=10-39.54), and a greater number of hypno-sedatives (ORadmission=1.88, CI=1.23-2.88, ORdischarge=4.18, CI=2.53-6.91), and negatively associated with involuntary admission (ORadmission=0.31, CI=0.14-0.7, ORdischarge=0.3, CI=0.13-0.68). When using an alternative definition of monotherapy (i.e., including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (ORadmission=0.26, CI=0.13-0.54) and higher age (ORdischarge=0.53, CI=0.29-0.95) were negatively associated with APP, and living in a residential facility (ORdischarge=2.39, CI=1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (ORdischarge=1.32, CI=1.03-1.69) increased the odds of being discharged on APP. Although 28.1% of patients were eligible for clozapine treatment, only 9.3% were being treated with clozapine on admission, and 11% at discharge. Seven of the ten patients with a new clozapine prescription were directly being prescribed a combination of antipsychotics, without a prior trial of clozapine monotherapy. Conclusion: Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.