Epidemiological and clinical features of severe imported Plasmodium falciparum malaria among travelers upon hospital admission

BackgroundFor rapid initiation of anti-malarial treatment and prevention of complications, early diagnosis and risk stratification is important in patients with Plasmodium falciparum malaria. Routine laboratory values do not correlate well with disease severity. The aim of this study was to determine the diagnostic and prognostic value of several biomarkers related to inflammation; endothelial and cardiac dysfunction; coagulation, and haemolysis in imported P. falciparum malaria.MethodsIn a prospective case-control study, 79 adult travellers with both uncomplicated and complicated P. falciparum malaria were included between 2007 and 2011. Forty-one healthy subjects were included as controls. Blood samples were obtained within 24 hours after first consultation to assess routine laboratory values as well as markers related to inflammation (PAPP-A, copeptin, CRP), endothelial activation (MPO, elastase-2, endothelin-1, sICAM-1, sVCAM-1), cardiac function (NT-proBNP, MR-proANP), coagulation (fibrinogen, D-dimers, platelet count), and haemolysis (LDH). Prognostic performance was assessed using the receiver operating characteristic curve (area under the curve = AUROC).ResultsTwelve (15.2%) patients had severe P. falciparum malaria. In the patient group, significant thrombocytopaenia was found, all other markers but PAPP-A were significantly elevated. Diagnostic performance was best for CRP with an AUROC of 1.00, followed by MPO (0.99), D-dimers (0.98), elastase-2 (0.98), and sICAM-1 (0.98). Biomarker levels did not correlate well with disease severity.ConclusionThe combination of travel history, fever prior to blood sampling, and CRP serum levels above or below 10.8 mg/l upon hospital admission, best discriminated between malaria patients and control persons. None of the biomarkers studied predicted the presence or the development of malaria complications, neither at the time of admission, nor during hospitalization.

Since 1990 a clone of gentamicin and methicillin-resistant Staphylococcus aureus (MRSA) has remained endemic in our hospital, but since January 1996 a gentamicin-sensitive strain has progressively replaced the previous clone. We characterized the phenotypic and molecular pattern of the MRSA strains isolated in our hospital in 1996 and compared prospectively the epidemiological, clinical and evolutionary characteristics of ninety patients infected or colonized by gentamicin-sensitive MRSA (GS-MRSA) (49) and by gentamicin-resistant MRSA (GR-MRSA) (41). Finally we studied the variation of aminoglycoside consumption in our hospital from 1989 to 1996. We observed two antibiotypes (GS-MRSA and GR-MRSA) corresponding to two major chromosomal patterns. Patients with GS-MRSA usually acquired the infection 72 hours after hospital admission. No significant differences were observed in epidemiological characteristics, clinical presentation and evolution between patients with GS-MRSA and GR-MRSA. Since 1989 aminoglycoside intake in our hospital has decreased by 46%.

BACKGROUNDPrevious studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019 (COVID-19) patients. Very few studies have assessed it at intensive care unit (ICU) admission and compared it with the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There are no studies comparing its accuracy with APACHE III score.AIMTo describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODSWe conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney. We included all adult patients (age > 16 years) admitted to ICU with COVID-19 infection over a 5-month period (July 1, 2021 to November 30, 2021). We collected the data on demographics, clinical characteristics, interventions and outcomes for all patients. We calculated the 4C Mortality Score for each patient using eight variables as described previously. We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve (AUROC). We determined the optimal cut-off value for each of these scores using the ‘nearest’ method and its 95% confidence interval by bootstrapping.RESULTSA total of 140 patients (62% males, mean age 56 ± 17 years, mean APACHE II score 13 ± 57) were included in the study. Nineteen (13.6%) of 140 patients died in the hospital. Compared to survivors, the non-survivors were older, males, had more comorbidities, higher rate of mechanical ventilation and vasopressor use. The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75, 0.80. 0.75 and 0.79 respectively. The optimal cut-off value for these four scores was 9, 10, 14 and 56 respectively. The cut-point for all the scores had higher sensitivity than specificity.CONCLUSIONThe 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission. The predictive accuracy was similar to that for APACHE III score. The 4C score at ICU admission needs to be validated in future studies.

A Multi-Center Retrospective Review of COVID-19 Outcomes in Patients with Lymphoid Malignancy

Clinical impact of disease-related malnutrition and fluid overload assessment via bioimpedance vector analysis in hospitalized patients.

Acute gastroenteritis is one of the most common causes of hospital admission in children. Treatment regimens differ depending on the pathogen. In our study, we aimed to evaluate the epidemiological and clinical features of pediatric patients whose gastrointestinal agents were detected by multiplex PCR. The study included 131 pediatric patients who were followed up at Eskişehir Osmangazi University, Pediatric Department between January 2018 and December 2021.Gastrointestinal pathogens were detected in stool samples by multiplex PCR. The epidemiological and clinical features were reviewed retrospectively. A total of 203 gastrointestinal pathogens were detected from the stool samples of 131 cases. Of these cases, 56% were male and 44% were female. The mean age was 66 (2-204) months. The most common symptoms were diarrhea, fever, vomiting and abdominal pain. The pathogen detection rate was 69% by multiplex PCR. A single pathogen was detected in 85 (65%) cases and multiple pathogens were detected in 46 (35%) cases. The most common pathogens were enteropathogenic Escherichia coli (EPEC, 23%), Clostridium difficile (21%), norovirus (17%), rotavirus (15%), salmonella (12%) and enterotoxigenic E. coli (ETEC, 11%). Stool culture was positive in 16 (12%) cases and microscopic examination positive in 17 (13%) cases. Probiotic treatment was given to 119 (92%) cases and antimicrobial treatment (metroinidazole, ceftriaxone, azithromycin and oral vancomycin) to 34 (26%) cases. Of the cases, 56 (42%) had chronic disease, 40 (30%) had a history of previous antibiotic use and 17 (13%) had a history of hospitalization in the intensive care unit. The sensitivity of the multiplex PCR in the detection of acute gastroenteritis agents is higher than stool microscopy, stool culture and stool antigen tests. However, due to the inability to distinguish between colonization, carrier state and pathogenicity, it should be evaluated together with other diagnostic tests and clinical findings in order to determine whether the determined agent is pathogenic or not and in the regulation of antimicrobial therapy.

Incarceration Rates of Persons With First-Admission Psychosis

Nowcasting towards sustainable SARS-CoV-2 endemicity

To describe the features and treatment of macrophage activation syndrome (MAS) in a single-center cohort of patients with childhood-onset systemic lupus erythematosus (SLE), and to compare childhood-onset SLE manifestations and outcomes between those with and those without MAS. We included all patients with childhood-onset SLE followed up at The Hospital for Sick Children from 2002 to 2012, and identified those also diagnosed as having MAS. Demographic, clinical, and laboratory features of MAS and SLE, medication use, hospital and pediatric intensive care unit (PICU) admissions, as well as damage indices and mortality data were extracted from the Lupus database. Student's t-tests and Fisher's exact tests were used to compare continuous and categorical variables, respectively. We calculated incidence rate ratios of hospital and PICU admissions comparing patients with and those without MAS, using Poisson models. Kaplan-Meier survival analysis was used to examine the time to disease damage accrual. Of the 403 patients with childhood-onset SLE, 38 (9%) had MAS. The majority (68%) had concomitant MAS and SLE diagnoses. Fever was the most common MAS clinical feature. The frequency of renal and central nervous system disease, hospital admissions, the average daily dose of steroids, and time to disease damage were similar between those with and those without MAS. We observed a higher mortality rate among those with MAS (5%) than those without MAS (0.2%) (P = 0.02). MAS was most likely to develop concomitantly with childhood-onset SLE diagnosis. The majority of the MAS patients were successfully treated with corticosteroids with no MAS relapses. Although the numbers were small, there was a higher risk of death associated with MAS compared to SLE without MAS.

Introduction: Since their emergence, SARS-CoV-2 variants of concern (VOC) B.1.1.7 and B.1.351 have spread worldwide. We estimated the risk of hospitalisation and admission to an intensive care unit (ICU) for infections with B.1.1.7 and B.1.351 in Norway, compared to infections with non-VOC. Methods: Using linked individual-level data from national registries, we conducted a cohort study on laboratory-confirmed cases of SARS-CoV-2 in Norway diagnosed between 28 December 2020 and 2 May 2021. Variants were identified based on whole genome sequencing, partial sequencing by Sanger sequencing or PCR screening for selected targets. The outcome was hospitalisation or ICU admission. We calculated adjusted risk ratios (aRR) with 95% confidence intervals (CIs) using multivariable binomial regression to examine the association between SARS-CoV-2 variants B.1.1.7 and B.1.351 with i) hospital admission and ii) ICU admission compared to non-VOC. Results: We included 23,169 cases of B.1.1.7, 548 B.1.351 and 4,584 non-VOC. Overall 1,017 cases were hospitalised (3·6%) and 206 admitted to ICU (0·7%). B.1.1.7 was associated with a 1·9-fold increased risk of hospitalisation (aRR 95%CI 1·6–2·3) and a 1·8-fold increased risk of ICU admission (aRR 95%CI 1·2–2·8) compared to non-VOC. Among hospitalised cases, no difference was found in the risk of ICU admission between B.1.1.7 and non-VOC. B.1.351 was associated with a 2·4-fold increased risk of hospitalisation (aRR 95%CI 1·7–3·3) and a 2·7-fold increased risk of ICU admission (aRR 95%CI 1·2–6·5) compared to non-VOC. Interpretation: Our findings add to the growing evidence of a higher risk of severe disease among persons infected with B.1.1.7 or B.1.351. Control measures to reduce transmission of these VOC in society, and preparedness plans for hospital surge capacity are essential. Further studies on differences in patient trajectories and clinical characteristics among hospitalised patients infected with VOC are needed. Funding Information: The authors received no specific funding for this work. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approval for this study was granted by Regional Committees for Medical Research Ethics - South East Norway, reference number 249509.

Short-acting β2 -agonists are the mainstay of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED). It is still unclear whether the addition of short-acting anticholinergics is clinically more effective care compared to treatment with β2 -agonists alone in patients with hypercapnic AECOPD. The objective was to evaluate whether combining ipratropium bromide (IB) to terbutaline reduces hospital and intensive care unit (ICU) admission rates compared to terbutaline alone in AECOPD hypercapnic patients. In this double-blind controlled trial, patients who were admitted to the ED for AECOPD requiring noninvasive ventilation (NIV) were randomized to receive either 5 mg of nebulized terbutaline combined to 0.5 mg of IB (terbutaline/IB group, n = 115) or 5 mg of terbutaline sulfate (terbutaline group, n = 117). Nebulization was repeated every 20 minutes for the first hour and every 4 hours within the first day. Primary outcomes were the rate of hospital admission and need for endotracheal intubation within the first 24 hours of the start of the experimental treatment. Secondary outcomes included changes from baseline of dyspnea, physiologic variables, length of hospital stay, ICU admission rate, and 7-day mortality. The two groups were similar regarding baseline demographic and clinical characteristics. Hospital admission was observed in 70 patients (59.8%) in the terbutaline/IB group and in 75 patients (65.2%) in the terbutaline group (respiratory rate [RR] = 1.09, 95% confidence interval [CI] = 0.93 to 1.27, p = 0.39). ICU admission was required in 37 (32.2%) patients in the terbutaline/IB group and 30 patients (25.6%) in terbutaline group (RR = 1.25, 95% CI = 1.02 to 1.54, p = 0.27). There were no significant differences in dyspnea score, blood gas parameters changes, vital signs improvement, and 7-day death rate between both groups. In patients admitted to the ED for AECOPD requiring NIV, combination of nebulized IB and terbutaline did not reduce hospital admission and need to ICU care.

Video capsule endoscopy for triage of patients with acute upper GI hemorrhage: Is seeing believing?

Utilization of Emergency Medical Transports and Hospital Admissions Among Persons With Behavioral Health Conditions

Objective: To describe the clinical–epidemiological characteristics and the survival time of deceased COVID-19 patients treated at hospitals belonging to Red Sabogal–Callao in 2020. Materials and methods: An observational, descriptive and retrospective study conducted in a population of 23 patients who died of COVID-19 from the beginning of the state of emergency (March 11, 2020) to April 15 at two hospitals belonging to Red Sabogal–Callao. The data was analyzed using the Stata Statistical Software: Release 16. The survival time was assessed by means of the Kaplan-Meier survival analysis and the log-rank test, with a 95 % confidence interval. Results: The predominant epidemiological characteristics were male sex, 60 to 79 years of age and comorbidities (hypertension and obesity). The main signs and symptoms at hospital admission were dyspnea, fever, cough and increased respiratory rate. Laboratory tests showed abnormal values: PaO₂/FiO₂ ratio < 300, leukocytosis, lymphopenia and increased lactate levels. Ground-glass opacities with bilateral pulmonary involvement prevailed in the radiological reports. During the hospital stay, 60.87 % of the patients were treated in the Intensive Care Unit (ICU), 69.57 % were on mechanical ventilation, 39.13 % received a therapeutic scheme consisting of hydroxychloroquine plus azithromycin, and 39.13 % received corticosteroids additionally to the aforementioned treatment. The patients died before reaching 20 days of hospital stay; on day five, the general survival probability was 43.48 %; and the survival probability was higher, although without statistical significance (p = 0.17), in those on mechanical ventilation. Conclusions: Deceased patients were mainly males, older adults, those with underlying health conditions such as hypertension and obesity, and those classified as having moderate to severe COVID-19 infection at hospital admission. The longest survival time was observed among those on mechanical ventilation.

Background and Aims: In Korea, IPF is registered as a rare and incurable disease on the medical care system. This study aimed to analyze the epidemiology and the current situation of medical resource utilization in IPF. Methods: We analyzed nationwide data between 2009 to 2013 from the Korean Health Insurance Review and Assessment (HIRA) Service which covers almost the entire Korean population (97%) and provide details of all medical services for claims made. Patients with IPF were defined by using the International Classification of Diseases-10 code. Results: The prevalence and annual incidence of IPF was 30.0-37.5 and 13.8-13.9 per 100,000 populations, respectively, with 61.9% predominance of males. The total direct health care costs were mean $ 2, 839, 4000 per year and the highest portion was the cost related to hospital admission (86.6%-88.8% of the total cost).The proportion of patients who experienced hospital admission per year was 27.3% and the average length of stay was 12.7 days. 5.7% of the patients had a history of intensive care unit (ICU) admission. ICU admission and emergency room visit rates exhibit significant seasonal variation, with the highest rates in the spring (from March to May), respectively (P <0.001 & P=0.0193). Conclusion: This is the first nationwide study based on Korean HIRA data. The prevalence and annual incidence of IPF showed increasing patterns during the recent years. A significant number of patients needed a medical care of high cost such as hospital admission. The seasonal variation in hospitalization suggests that there may be a seasonal factor in clinical presentation of IPF patients (for example: acute exacerbation).