Beginning Of Hospitalization Research Articles

The role of transforming growth factor-β in lung damage in COVID-19: clinical and diagnostic parallels

BACKGROUND: Coronavirus 2 (SARS-CoV-2), which causes severe acute respiratory syndrome in COVID-19, leads to complex immune reactions, hyperactivation of immunocompetent cells, including increased degranulation activity of mast cells and the release of their secretome products. The SARS-CoV-2 virus and the subsequent strong immune and inflammatory response, as well as a violation of the regulation of coagulation and fibrinolytic pathways, cause massive activation of latent TGF-β in the lungs, as well as the latent pool of TGF-β in the blood of patients with COVID-19. AIMS: To assume the participation of transforming growth factor-β (TGF-β) in lung damage in patients with COVID-19 by determining its quantitative level in autopsy lung samples in patients with COVID-19 and to conduct a correlation analysis with clinical and laboratory parameters. MATERIALS AND METHODS: The study included samples of lung autopsy material obtained from patients who died from severe COVID-19. A correlation analysis of TGF-β-positive cells and clinical and laboratory parameters was also performed. RESULTS: Extensive representation of TGF-β-positive cells was found in lung tissues of patients who died from COVID-19.A negative correlation was revealed: between TGF-β and the content of nucleated neutrophils in the blood (r = - 0,617; p = 0,033); between TGF-β and the level of C-reactive protein (CRP) according to the results of blood biochemistry (r = - 0,491; p = 0,013). A positive correlation was revealed between TGF-β and the content of blood platelets (r = 0,384; p =0,012);TGF-β with the level of erythrocyte sedimentation rate (ESR) (r = 0,409; p = 0,025). A positive correlation was also found between TGF-β and the presence of cough in the patient at the beginning of hospitalization (r = 0,367; p = 0,046). CONCLUSIONS: Activation of TGF-β in the lungs of patients who died from severe COVID-19 correlates with the level of neutrophils, platelets, ESR, CRP and the presence of cough in the patient. Further research is needed on the activation, release of TGF-β and its interactions in larger cohorts of patients. These correlations suggest the negative involvement of the transforming growth factor and consider the therapeutic possibilities of regulatory influence on its activation.

Actual situation of nutritional management and factors related to activities of daily living ability at discharge in convalescent rehabilitation ward.

In this study, we aimed to investigate changes in the Geriatric Nutritional Risk Index (GNRI), a nutrition-related prognostic indicator, in our convalescent rehabilitation ward and determine how this index relates to activities of daily living (ADL) ability at discharge. We retrospectively analyzed data of 107 patients admitted to our convalescent rehabilitation ward between April and September 2023. We used the GNRI as the nutritional risk index and Functional Independence Measure (FIM) as the ADL index. The patients' mean age was 80.0 ± 10.3 years; 38 were males and 69 females. The patients' mean body weight at admission was 51.2 ± 10.2 kg, which significantly decreased to 50.2 ± 9.4 kg at discharge (p = 0.0006). Their mean body mass index (BMI) also significantly decreased from 21.4 ± 3.4 at admission to 20.0 ± 8.2 at discharge (p = 0.002). The mean GNRI significantly decreased from 93.1 ± 8.6 at admission to 91.7 ± 8.4 at discharge (p = 0.023). The mean body weight decreased until the fourth month after admission; however, no decreasing trend after the fifth month was observed. The mean monthly energy intake gradually increased after admission and reached the calculated energy requirement of 1,415 ± 22 kcal at the fifth month. Multivariate analysis demonstrated that at discharge, the GNRI score was positively associated with the FIM score (β = 0.21, p = 0.0008). Body weight and GNRI scores decreased after admission but stopped decreasing after the fifth month due to a gradual increase in energy intake. At discharge, the FIM score was positively associated with the GNRI score. We expected that active nutritional therapy from the beginning of hospitalization would increase the GNRI by the time of discharge and eventually improve ADL ability at discharge.

Can simple biomarkers of inflammation guide the diagnosis of psychiatric disorders?

Objective In this study, we wanted to investigate the usability of routine blood samples taken at the beginning of hospitalisation in inpatients to predict the presence of psychotic symptoms in patients. Methods We divided the hospitalised patients into two groups those with and without psychotic symptoms according to their ICD-10 diagnosis codes. Then, we compared the complete blood count, c-reactive protein (CRP), and fasting glucose levels, which can be used as simple markers of inflammation. Results In this retrospective study, which included 349 patients, we found that blood leukocytes, neutrophils, CRP, and fasting glucose levels were higher in patients with psychotic symptoms than in patients without psychotic symptoms (p = 0.015; p = 0.013; p = 0.002; and p = 0.001, respectively). According to regression analysis, patients with high glucose levels were 4.9 times more likely to have psychotic symptoms than those with low glucose levels. In addition, according to the ROC analysis results; when we used 87 mg/dl as the cut-off value for fasting glucose, it was observed that it predicted psychotic symptoms with approximately 69% sensitivity and 71% specificity. Conclusion Although our results still have some limitations, they are promising for the future use of simple biomarkers of inflammation for the differential diagnosis of psychiatric disorders.

The Effects of Music Therapy on Self-Management, Depression, and Stress in Patients with Type 2 Diabetes Mellitus

Background: Among type 2 diabetes patients hospitalized for blood sugar control, stress and depression are high and have a negative effect on blood sugar control. Therefore, this study sought to determine whether listening to music helps reduce stress and depression and affects blood sugar control.Methods: This is a randomized, controlled, pre- and post-design study conducted from April 2017 to September 2019 in patients with type 2 diabetes hospitalized for blood glucose control at Kyung Hee University Hospital at Gangdong. After diabetes education was provided to both the control and experimental groups, the experimental group listened to music for 30 minutes a day with a tablet PC and the control group was prohibited from listening to music during the study period. Stress was evaluated using the PAID (Problem Areas in Diabetes) scores, depression using the CES-D (Center for Epidemiologic Studies Depression) scale, and self-management using the SDSCA (Summary of Diabetes Self-Care Activities) questionnaire.Results: A total of 59 patients (41.5 ± 12.6 years, 75.0% male) were enrolled and randomized into the control group (n = 28) and experimental group (n = 31). Music therapy had no statistically significant relationship with blood sugar (<i>P</i> = 0.887), depression (<i>P</i> = 0.248), stress (<i>P</i> = 0.994), or self-management (<i>P</i> = 0.959). However, in both groups, blood glucose control, stress, and self-management were all significantly improved at discharge compared to at the beginning of hospitalization (<i>P</i> = 0.031).Conclusion: It was confirmed that intensive medical treatment and diabetes education for hospitalized patients with type 2 diabetes improved not only blood glucose control but also depression, stress, and self-management, regardless of listening to music.

Very early and early nutrition in children with pancreatitis-A randomised trial.

The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines. This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1β [IL-1β], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation. A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1β on the third day of hospitalisation (p = 0.01). The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1β, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.

Assessing biomarkers of remission in female patients with anorexia nervosa (REMANO): a protocol for a prospective cohort study with a nested case–control study using clinical, neurocognitive, biological, genetic, epigenetic and neuroimaging markers in a French specialised inpatient unit

BackgroundAnorexia nervosa (AN) is a severe psychiatric disorder associated with frequent relapses and variability in treatment responses. Previous literature suggested that such variability is influenced by premorbid vulnerabilities such as...

Enhanced liver fibrosis score is stable after withdrawal in patients with heavy alcohol consumption: A pilot study.

Enhanced liver fibrosis (ELF) score is an accurate, noninvasive test for assessing the severity of liver fibrosis in chronic liver disease, including alcohol-related liver disease. However, whether the ELF score changes during alcohol withdrawal is unknown. This pilot study assessed changes in the ELF score during withdrawal in patients with a history of excessive alcohol intake. In this prospective study, ELF was performed on day 0 (D0, at the beginning of hospitalization), at day 7 (D7, on discharge from hospital), and at follow-up visits on days 30 (D30) and 90 (D90). Transient elastography (TE) was also assessed on days 4 (D4) and D30. The study included 35 patients (71% male) with a mean alcohol intake of 139 g/day. On D30 and D90, 8 and 13 patients had resumed alcohol consumption (mean intake of 90 and 80 g/day, respectively). In patients who remained abstinent, the mean ELF score was 8.93 on D0, 9.14 on D30 (p = 0.32), and 9.27 on D90 (p = 0.14). In patients who resumed alcohol, mean ELF score was 9.7 on D0, 10.05 on D30 (p = 0.09), and 9.71 on D90 (p = 0.12). ELF score was comparable over the first months after withdrawal, although there was a slight increase in the first week (mean ELF score increased from 9.24 on D0 to 9.74 on D7, p < 0.001). Mean TE value was 7.9 kPa on D4 and 8.1 kPa on D30 (p = 0.84) in patients who resumed alcohol consumption, and 8.3 and 7.5 kPa (p = 0.03) on D4 and D30, respectively, in abstinent patients. The ELF score is stable during the first months after withdrawal and thus appears to be a useful tool to assess liver fibrosis or cirrhosis in this setting. Nevertheless, because in the first week there is a transient increase in ELF score, caution in interpretation is warranted.

Raman spectroscopy of lymphocytes from patients with the Epstein–Barr virus infection

In this study, Raman spectroscopy is applied to trace lymphocytes activation following contact with the Epstein–Barr virus (EBV) of the herpesvirus family. The biomarker of cell activation is found to be the 520 cm−1 band, indicating formation of immunoglobulins. The blood samples are obtained from patients diagnosed with infectious mononucleosis and treated at the University Hospital in Kraków. The lymphocytes’ Raman spectra are collected using a mapping technique, exciting samples with a 514.5 nm line of Ar + laser. Measurements are performed on the 1st, 4th, 6th, 12th and 30th day of hospitalization, until the patient has recovered. The highest intensity of the immunoglobulin marker is observed on the 4th day of hospitalization, while the results of the blood count of patients show the greatest increase in the number of lymphocytes at the beginning of hospitalization. No activated lymphocytes were observed in the blood of healthy volunteers. Some information is provided by the evaluation of B-cell activation by estimating the activated areas in the cells, which are determined by the presence of the Ig marker. The 900 cm−1 band and band around 1450 cm−1 are also analyzed as markers of the presence of the latent membrane protein, LMP2A (and 2B), of the EBV viral protein. The anomalous degree of depolarization observed in B-cells in the course of EBV infection appears to be due to the influence of a virus protein, disrupting BCR signal transduction.

Managing Hepatotoxicity Caused by Anti-tuberculosis Drugs: A Comparative Study of Approaches.

Tuberculosis (TB) is one of the oldest and most well-known diseases that has been associated with humans for many years and remains a global health challenge today. Timely diagnosis and proper treatment are crucial for controlling and preventing the spread of the disease. While anti-TB drugs offer many benefits, inadequate monitoring can lead to a range of side effects, including hepatotoxicity, which is a major concern and can cause treatment discontinuation. The aim of this study was to determine the approach to the hepatotoxicity of anti-TB drugs and to investigate potential relationships between demographic factors, underlying medical conditions, and successful retreatment outcomes for hepatotoxicity induced by anti-TB drugs. For this study, we reviewed the medical records of patients who experienced hepatotoxicity due to anti-TB treatment and were admitted to the infectious ward of Imam Khomeini Hospital between April 2015 and February 2019. The data were collected using a questionnaire. The findings indicated that the female gender, weight loss at the beginning of hospitalization, hepatitis C virus, hepatitis B virus (HBV), heart disease, and high levels of aspartate aminotransferase (AST) and alanine transaminase (ALT) at the beginning of hepatotoxicity are risk factors for failure to the retreatment of hepatotoxicity. There were two different approaches to the anti-TB retreatment regimen. The first approach involved gradually starting the drugs in full dose, while the second approach encompassed starting the drugs in the minimum dose and then increasing to the maximum dose. The results demonstrated no significant difference between the two approaches to managing hepatotoxicity induced by anti-TB drugs. Drug-induced hepatotoxicity is a common occurrence that often results in treatment discontinuation. Understanding the prevalence of this complication and identifying appropriate methods of rechallenge treatment is crucial to reducing complications and mortality rates.

Use of opioids in geriatric palliative care

Introduction: Patients in Geriatric Palliative Care (GPC) complain of pain and opioids are the drugs used to manage it. This study aims to understand the sociodemographic, clinical and opioid use characteristics of GPC patients in a public hospital in the Federal District of Brazil.Methods: This is a cross-sectional approach based on analysis of prescriptions. The results are shown in tables after descriptive and bivariate analysis. Fisher’s exact test, Bonferroni’s post hoc for categorical variables and Kendall’s tau correlation coefficient for continuous variables were used.Results: Four hundred and forty-four prescriptions for 49 patients were analyzed. Data showed a mean age of 80.4 years, a prevalence of women (57.1 %), the main diagnoses being Alzheimer’s disease and neoplasia, and prevalent length of up to 7 days. Morphine was the most used medication (15.8 mg to 20.8 mg). The oral route was predominant at the beginning of hospitalization and the subcutaneous route at the end. There was a greater dose variation in degenerative disease of the nervous system and statistical significance between length of stay (1 to 7 days) and clinical diagnosis.Discussion: The sociodemographic and clinical characteristics are in line with the Brazilian epidemiological profile. The use of opioids was equivalent to that recommended and is more associated with dyspnea control. Dose variation in degenerative nervous system disease probably occurred due to the variability of diseases included in this group. The statistical significance between length of hospitalization and diagnosis can be justified by the clinical severity of the patients hospitalized.

Prevalence of Cardiovascular Involvement in Patients With COVID-19 Disease

Background: Coronaviruses are a huge family of viruses that lead to various diseases from a common cold to more unadorned illnesses for example SARS-CoV and MERS-CoV. Common symptoms of this infection include respiratory symptoms. In addition, this disease can also manifest with an acute cardiovascular (CV) syndrome. The aim of this study was to determine the frequency of CV involvement in patients with COVID-19 disease admitted to Afzalipour Hospital in Kerman. Methods: In this study, all patients who were diagnosed with COVID-19 disease and were hospitalized and monitored due to disease conditions were eligible to enter the study. At the beginning of the patient’s hospitalization, the patients’ vital signs were recorded and the first 12-lead electrocardiography was taken. Then, patients underwent cardiac monitoring and echocardiography at the beginning of hospitalization and afterwards during the course of disease. Preliminary tests including biochemistry, blood cell count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and troponin were also performed for patients. Results: The mean age of patients with COVID-19 was 55.63 years and 20.2% of them had a history of heart disease. More than half of these patients were men. Ejection fraction was normal in 87.8% of patients. There was a significant relationship between diastolic dysfunction grade and the history of heart disease (P=0.02). Conclusion: Since the incidence of underlying diseases such as diabetes, hypertension and cardiac disorders can raise the risk of corona viruses’ disease and also increase the mortality rate of this disease in these people, it is suggested that more attention be paid to the observance of health protocols for people with underlying diseases, and that people with underlying diseases be given priority in vaccinating against this disease.

The role of the neutrophil-lymphocyte ratio in predicting poor outcomes in COVID-19 patients.

This study examines how the neutrophil-lymphocyte ratio (NLR) predicts coronavirus disease 2019 (COVID-19) hospitalization, severity, length, and mortality in adult patients. A study was done using a retrospective, single-center, observational design. A total of 400 patients who were admitted to the Ziv Medical Center (Safed, Israel) from April 2020 to December 2021 with a confirmed diagnosis of COVID-19 through RT-PCR testing were included in the analysis. Two complete blood count laboratory tests were conducted for each patient. The first test was administered upon admission to the hospital, while the second test was conducted prior to the patient's discharge from the hospital or a few days before their death. Four hundred patients were included in the study, 206 males (51.5%) and 194 females (48.5%). The mean age was 64.5 ± 17.1 years. In the group of cases, there were 102 deaths, and 296 survivors were recorded, with a fatality rate of 25.5%. The median NLR was 6.9 ± 5.8 at the beginning of hospitalization and 15.1 ± 32.9 at the end of hospitalization (p < 0.001). The median length of hospital stay was 9.4 ± 8.8 days. NLR in the fatality group was 34.0 ± 49.9 compared to 8.4 ± 20.4 in the survivor group (p < 0.001). Comparison between the NLR at the time of admission of the patient and before discharge/death was 6.9 ± 5.8 vs. 15.1 ± 32.9 (p < 0.001). The analyses conducted revealed a statistically significant correlation between the NLR and the severity, mortality rates, and the duration of hospitalization. The consideration of NLR should commence during the initial phases of the disease when assessing individuals afflicted with COVID-19.

Analysis of Platelet Lymphocyte Ratio on Severe COVID-19 and Dengue Hemorrhagic Fever Grade IV

Thrombocytopenia can occur in severe COVID-19 or grade IV DHF. In COVID-19, lymphopenia occurs gradually due to Angiotensin Converting Enzyme-2 as the primary response to SARS-CoV-2 and cytokines that can damage lymphocytes. Contrastingly, lymphocytosis occurs in dengue virus infection. Platelet-to-lymphocyte ratio (PLR) is a new inflammatory marker in predicting the severity of both diseases. This study aimed to analyze differences in PLR values in severe COVID-19 and grade IV DHF and determine the cut-off values. Retrospective research of a cross-sectional approach was carried out using medical record data of patients diagnosed with severe COVID-19 and grade IV DHF by clinicians at Dr. Wahidin Sudirohusodo Hospital from January 2017 to October 2021. The platelet-to-lymphocyte ratio was obtained from the complete blood count results using the flow cytometry method at the beginning of hospitalization. Mann-Whitney test and Receiver Operating Characteristics (ROC) curve were used for statistical analysis. A total of 74 severe COVID-19 and 33 grade IV DHF patients were involved; PRL of severe COVID-19 in dead patients was higher than in recovered patients (p&gt;0.05). The platelet-to-lymphocyte ratio value was significantly lower in grade IV DHF patients who died compared to those who recovered (p&lt;0.001). Platelet to-lymphocyte ratio cut-off of 48.30 for severe COVID-19 was obtained with an Area Under the Curve (AUC) of 0.631 (sensitivity of 54.3%, specificity of 78.6%) and cut-off of 0.715 for grade IV DHF with an AUC of 0.989 (sensitivity of 94.4%, specificity of 100%). There was a difference in PLR value in severe COVID-19 and grade IV DHF. Severe COVID-19 patients who died had higher PLR, whereas grade IV DHF patients had lower PLR values. Values above the PLR cut-off of 48.30 for severe COVID-19 and 0.715 for grade IV DHF can predict the severity of the disease.

Efficacy of Vitamin D as Adjuvant Therapy for Treatment of Hospitalized Children with COVID-19: A Randomized Clinical Trial

Background: Vitamin D is a multifunctional hormone essential in the immune system. Vitamin D deficiency may increase the disease burden in patients with COVID-19. Objectives: We investigated the effect of vitamin D administration as an adjunctive therapy on treating children with COVID-19. Methods: Children with confirmed or probable COVID-19 who were admitted to 17th Shahrivar Hospital in Rasht from October 2022 to April 2023 were selected by random sampling method. They were divided into two groups by random blocks: the intervention group with vitamin D administration and the placebo-controlled group. The patient data were recorded and analyzed, including age, sex, and the required clinical and laboratory information, including the time required to recover from fever and respiratory distress and the length of hospitalization. Results: In this study, 60 patients (30 in each group) were evaluated. At the beginning of hospitalization, fever was significantly more observed in the intervention group (90% vs. 53.3%, P = 0.002). The average time required to recover from fever and respiratory distress was less in the intervention group, although this difference was not significant between the two groups (P = 0.591 and P = 0.192, respectively). The hospitalization duration was also similar in both groups, and no complications or death were observed in the two groups. Conclusions: Administering vitamin D at a dose of 1000 IU daily showed no significant efficacy for recovering children with COVID-19. Further studies are suggested to investigate the high dose of vitamin D supplementation in treating children with COVID-19.

Effect of High-dose Vitamin D on IL-1β Blood Level in Patients with Moderate Stroke: A Randomized Clinical Trial.

Vitamin D has neuroprotective and anti-inflammatory effects in stroke patients, but its effect on pro-inflammatory and inflammatory cytokines, especially IL-1, has been investigated in a few trials. This study aimed to determine the effect of prescribing a high dose of vitamin D on the anti-inflammatory parameters, short-term and long-term prognosis of patients with ischemic stroke. This randomized clinical trial was performed on 42 patients randomly divided into two equal groups of 21 in Imam Hussein Hospital. The patients were allocated through block randomization methods to receive 300,000 units of vitamin D (intramuscularly) or not receive it as a control group. Age, gender, and clinical and laboratory information were recorded. The stroke severity was calculated according to the National Institute of Health Stroke Scale (NIHSS) at the beginning of hospitalization and upon hospital discharge. The 3-month prognosis of the patients was recorded according to the Barthel criteria three months after the stroke. Vitamin D3 levels were recorded before and after injection, while the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were assessed on the first day and for 7 consecutive days after hospitalization. All statistical analyses were performed using STATA version 14. A P-value < 0.05 was considered significant. The mean age of the patients was 61.45 ± 4.74 years. There were 18 female (42.86%) and 24 male patients (57.14%). In the vitamin D group, the mean IL-1 decreased compared to before the intervention (-23.60 ± 103.83), but this decrease was not statistically significant (P = 0.070). In addition, the changes in IL-1 after the intervention were statistically different between the two groups (mean difference of -23.60 ± 103.83 in the vitamin D group vs. 15.96 ± 9.64 in the control group). The mean IL-6 decreased in both groups after the intervention compared to before, although these changes were not statistically significant (P > 0.05). In the group receiving vitamin D compared to the control group, the mean NLR decreased by about 2 units, the PLR decreased by about 10 units, and the NIHSS score decreased by about one unit during the study. However, these changes were not statistically significant (P > 0.05). A high dose of vitamin D can improve the NIHSS score and decrease IL-1 and IL-6, although these changes were not statistically significant. The mean NLR and PLR decreased after using high-dose vitamin D.

Anti- N-MethyL-D-Aspartate Receptor Encephalitis in Children Infected with Herpes Simplex

Herpes Simplex Virus (HSV) is a common cause of infectious encephalitis in children, which can lead to severe neurological sequels. There is a new perspective suggesting that herpes simplex encephalitis plays an important role in triggering the synthesis of NMDA receptor antibodies. There have been no data on the incidence of anti-NMDA receptor encephalitis in Indonesia. Herpes simplex encephalitis was found in these patients as a risk factor for anti-NMDA receptor encephalitis. A 9-year-old male patient complained of seizures such as jerking of the right hand and smacking of the lips along with fever for 4 days before being admitted to the hospital. Complaints began with slurred speech and t inability of fingers to hold objects for the previous 8 days. From the physical examination, it was reported that the patient looked seriously ill, blood pressure was 110/80 mmHg, pulse was 117 beats per minute, the temperature was 38.5 C, and respiratory rate was 24 times per minute. Another physical examination was within normal limits. The results of a complete blood count at the time of initial treatment of patients showed mild leukocytosis due to a mild increase in monocytes, whereas blood gas and electrolyte analysis showed hypoventilation at the beginning of hospitalization in which mixed acid-base disturbance, respiratory acidosis, and metabolic alkalosis occurred. Analysis of cerebrospinal fluid in these patients showed mononuclear pleocytosis and the results of immunoserological test in serum indicated HSV1 and HSV2 infection and detected anti-NMDA receptor. Both clinical and laboratory findings in this study supported encephalitis. Herpes simplex virus infection can be a risk factor for patients suffering from anti-NMDA receptor encephalitis.

Contribution of Pharmaceutical Care to Person-centered Health Care and the Safety of Pharmacotherapy for Hospitalized Older Individuals in Brazil: An Investigative Single-arm Intervention Trial.

Adverse drug events (ADE) and medication errors (ME) provide large numbers of victims. Older people are more susceptible to these events, due to the continuing search for several chronic degenerative disease treatments. The Third Global Patient Safety Challenge announced the objective of reducing unnecessary polypharmacy, encouraging deprescription, and aiming to ensure the prescription of medications in an appropriate manner, based on the best evidence and taking into account the individual factors of people. To evaluate whether Pharmaceutical Care (PC), when inserted in a geriatric ward and the context of person-centered health care, cooperates with the safety of pharmacotherapy in older individuals in Brazil. This is an investigative, single-arm, preliminary study. individuals aged ≥60 years and admitted to the geriatric ward between August 2019 to January 2020. The PC (with the practice of pharmacotherapeutic follow-up, medication reconciliation, and pharmacotherapy review) was made available to identify ADE and ME, as well as the associated factors and clinical outcomes, were analyzed. 60 participants were included. It was found that, on hospital admission, 93.3% of them were polymedicated and 86.7% had a history of using potentially inappropriate medications (PIM). ADE and ME were detected in 43 individuals (71.7%) and, in total, 115 incidents were identified, with drugs that act on the nervous system associated with them (31.9%). Acceptance of the PC's recommendations reached the rate of 85.2%. Polypharmacy (p=0.03) and the presence of multiple diseases (p=0.03) had an effect on the presentation of ADE and ME. The number of medications in use decreased in the comparison between admission and hospital discharge (p<0.0001). This investigative study indicated that ADE and ME are linked to the polypharmacy in use at the beginning of hospitalization. On the other hand, we showed that the PC (inserted in the multidisciplinary team) contributed to the deprescribing of medications at hospital discharge. Therefore, the PC can provide improvements in this scenario.

Role of Lipid Profile and Its Relative Ratios (Cholesterol/HDL-C, Triglyceride/HDL-C, LDL-C/HDL-C, WBC/HDL-C, and FBG/HDL-C) on Admission Predicts In-Hospital Mortality COVID-19.

Lipid profile and its related ratios such as total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio, white blood cell (WBC)/HDL-C ratio, and fasting blood glucose (FBG)/HDL-C ratio are valuable indicators that have been studied in various disorders to predict mortality. The present study was conducted with the aim of investigating the role of lipid profile ratios in predicting mortality in COVID-19 patients. At the beginning of hospitalization, laboratory tests were taken from all patients (n = 300). The ability of lipid profile ratios to determine the COVID-19 severity was evaluated using receiver-operating characteristic (ROC). In addition, survival probability was determined with the average of Kaplan-Meier curves, so that the end point was death. In deceased patients, TG, TC, LDL-C, HDL-C, TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C parameters were significantly lower than those of surviving patients, while WBC/HDL-C and FBG/HDL-C were significantly higher. TC (HR = 3.178, 95%CI = 1.064 to 9.491, P < 0.05), TG (HR = 3.276, 95%CI = 1.111 to 9.655, P < 0.05), LDL-C (HR = 3.207, 95%CI = 1.104 to 9.316, P < 0.05), and HDL-C (HR = 3.690, 95%CI = 1.290 to 10.554, P < 0.05), as well as TC/HDL-C (HR = 3.860, 95%CI = 1.289 to 11.558, P < 0.05), TG/HDL-C (HR = 3.860, 95%CI = 1.289 to 11.558, P < 0.05), LDL-C/HDL-C (HR = 3.915, 95%CI = 1.305 to 11.739, P < 0.05), WBC/HDL-C (HR = 3.232, 95%CI = 1.176 to 8.885, P < 0.05), and FBG/HDL-C ratios (HR = 4.474, 95%CI = 1.567 to 12.777, P < 0.01), were detectably related to survival. The multivariate Cox regression models showed that only FBG/HDL-C ratio (HR = 5.477, 95%CI = 1.488 to 20.153, P < 0.01) was significantly related to survival. The results suggested that FBG/HDL-C ratio in hospital-admitted COVID-19 patients was a reliable predictor of mortality.

Treatment of Acute Respiratory Distress Syndrome Caused by COVID-19 with Human Umbilical Cord Mesenchymal Stem Cells

This study aimed to identify the impact of mesenchymal stem cell transplantation on the safety and clinical outcomes of patients with severe COVID-19. This research focused on how lung functional status, miRNA, and cytokine levels changed following mesenchymal stem cell transplantation in patients with severe COVID-19 pneumonia and their correlation with fibrotic changes in the lung. This study involved 15 patients following conventional anti-viral treatment (Control group) and 13 patients after three consecutive doses of combined treatment with MSC transplantation (MCS group). ELISA was used to measure cytokine levels, real-time qPCR for miRNA expression, and lung computed tomography (CT) imaging to grade fibrosis. Data were collected on the day of patient admission (day 0) and on the 7th, 14th, and 28th days of follow-up. A lung CT assay was performed on weeks 2, 8, 24, and 48 after the beginning of hospitalization. The relationship between levels of biomarkers in peripheral blood and lung function parameters was investigated using correlation analysis. We confirmed that triple MSC transplantation in individuals with severe COVID-19 was safe and did not cause severe adverse reactions. The total score of lung CT between patients from the Control and MSC groups did not differ significantly on weeks 2, 8, and 24 after the beginning of hospitalization. However, on week 48, the CT total score was 12 times lower in patients in the MSC group (p ≤ 0.05) compared to the Control group. In the MSC group, this parameter gradually decreased from week 2 to week 48 of observation, whereas in the Control group, a significant drop was observed up to week 24 and remained unchanged afterward. In our study, MSC therapy improved lymphocyte recovery. The percentage of banded neutrophils in the MSC group was significantly lower in comparison with control patients on day 14. Inflammatory markers such as ESR and CRP decreased more rapidly in the MSC group in comparison to the Control group. The plasma levels of surfactant D, a marker of alveocyte type II damage, decreased after MSC transplantation for four weeks in contrast to patients in the Control group, in whom slight elevations were observed. We first showed that MSC transplantation in severe COVID-19 patients led to the elevation of the plasma levels of IP-10, MIP-1α, G-CSF, and IL-10. However, the plasma levels of inflammatory markers such as IL-6, MCP-1, and RAGE did not differ between groups. MSC transplantation had no impact on the relative expression levels of miR-146a, miR-27a, miR-126, miR-221, miR-21, miR-133, miR-92a-3p, miR-124, and miR-424. In vitro, UC-MSC exhibited an immunomodulatory impact on PBMC, increasing neutrophil activation, phagocytosis, and leukocyte movement, activating early T cell markers, and decreasing effector and senescent effector T cell maturation.

488. Association between the Respiratory Microbiota and Response to Antibiotic Therapy in Children with Macrolide-resistant Mycoplasma pneumoniae Pneumonia

Abstract Background Along with the overuse of macrolides as the empirical treatment for M. pneumoniae infection, macrolide-resistant M. pneumoniae (MRMP) emerged up to 90 prevalence rate in Asian countries. We investigated whether respiratory microbiota at the beginning of hospitalization was associated with disease severity and response to antibiotic treatment in children with MRMP pneumonia. Methods Prospectively enrolled children aged &amp;lt; 18 years with community-acquired pneumonia caused by MRMP from 2017/4-2020/3 at Linkou Chang Gung Memorial Hospital. Oropharyngeal samplings were collected within 48 hours after admission. Total 66 children were included: 23 had not received macrolide or gave response to macrolide (defined as without effective treatment group); 43 needed doxycycline treatment (defined as doxycycline treatment group). Compared the oropharyngeal microbiota between groups using the 16S-rRNA-based sequencing. Patients who were administered antibiotics other than augmentin or Azithromax were excluded. The difference in microbial composition will be examined using microbial community analysis. Statistically significant species for each group were evaluated by the linear discriminant analysis of effect size analysis to identify differentially abundant biomarkers, comparing disease severity scores, CRP and febrile days lasting. Scheme of sample collection and analyses Augmentin with or without Azithromax was the most common antimicrobial agent used. If fever persisted under the impression of suspected MRMP infection, doxycycline was used following three days of Azithromax usage. Scheme of sample collection and analyses Correlation between microbiome and clinical feature. Results Doxycycline treatment group had longer duration of total febrile days (p&amp;lt; 0.001) and total hospitalization days (p=0.002). Without effective treatment group had higher microbial richness, different overall community composition (p&amp;lt; 0.01). The lowest respiratory alpha diversity had prolonged febrile days (p=0.032). Without effective treatment group had more abundant spices or genera. Classification of samples to detect patients with effective treatment or not based on these selected microbiota genera features achieved the ROC curve of 0.86. From the list of most relatively abundant species in MRMP patient without doxycycline, Fusobacterium periodonticum most negatively correlated with total febrile days and severity score. Clinical characteristics of patients enrolled in this study Data were shown as n (%) or mean ± standard deviation. N/A, not applicable. Taxonomic assignment of the all throat swab samples. Fraction of predominant microbiota with a relative abundance of at least 2% at the order level (A) and genus level (B) in all sample. Higher respiratory microbial diversity is associated with MRMP patients without effective treatment than MRMP patients who needed doxycycline treatment Microbial richness base on the different alpha-diversity index in MRMP patients without effective treatment (blue); MRMP patients with doxycycline treatment (red). (A)(B)The box represented the interquartile range (IQR, and the midline represented the median. Tukey’s honest significance test of ANOVA, p&amp;lt;0.05.) (C)Kaplan-Meier (KM) plot of febrile time by respiratory diversity. (D)Principal coordinates analysis (PCoA) for MRMP patients without effective treatment (blue), MRMP patients with doxycycline treatment (red) by Unweighted UniFrac distance. Significant differences were observed between MRMP patients without effective treatment and MRMP patients with doxycycline treatment. A PERMANOVA (α=0.05) with 999 random permutations, p = 0.001. Conclusion Respiratory dysbiosis was associated with persistent fever and disease severity in MRMP pneumonia. In our study, F. periodoticum negatively related to fever duration and disease severity. Compositional differences in the respiratory microbiome are associated with MRMP patients without effective treatment than MRMP patients who needed doxycycline treatment by LEfSE analysis LDA scores revealed differentially abundant bacteria in the respiratory microbiome of without effective treatment (blue) and doxycycline treatment (red) groups at genus level (A) and species level (B).The mean relative abundance of genera at right side. The mean relative abundance of genera at right side. (C) Receiver operating characteristic (ROC) curves of ASVs to predict MRMP patients without effective treatment or who needed doxycycline treatment. Pairwise Spearman rank correlation heat map of significantly different taxa in throat swabs at initial sampling and clinical severity score in MRMP patients without effective treatment/with doxycycline treatment The genus (A) and species (B) level. Genus and species were in rows; the correlation was indicated by color gradient. Disclosures All Authors: No reported disclosures.