Evolution Of Disease Severity Research Articles

The Prognostic Value of Olfactory Dysfunction in Patients with COVID-19: The COVIDORA Study.

Among all studies describing COVID-19 clinical features during the first wave of the pandemic, only a few retrospective studies have assessed the correlation between olfac-tory dysfunction (OD) and the evolution of disease severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity based on the patient's medical management (outpa-tient care, standard hospital admission, and ICU admission). A national, prospective, mul-ticenter cohort study was conducted in 20 public hospitals and a public center for COVID-19 screen-ing. During the first wave of the pandemic, from 6 April to 11 May 2020, all patients tested positive for COVID-19 confirmed by RT-PCR underwent two follow-up ENT consultations within 10 days of symptom onset. The main outcome measures were the evolution of medical management (out-patient care, standard hospital admission, and ICU admission) at diagnosis and along the clinical course of COVID-19 disease. Among 481 patients included, the prevalence of OD was 60.7%, and it affected mostly female patients (74.3%) under 65 years old (92.5%), with fewer comor-bidities than patients with normal olfactory function. Here, 99.3% (290/292) of patients with OD presented with non-severe COVID-19 disease. Patients reporting OD were significantly less hospi-talized than the ones managed as outpatients, in either a standard medical unit or an ICU. Conclu-sions: As regards the clinical course of COVID-19 disease, OD could predict a decreased risk of hospitalization during the first wave of the pandemic.

Evolution of Disease Severity and Susceptibility in the Asteraceae to the Powdery Mildew Golovinomyces latisporus: Major Phylogenetic Structure Coupled With Highly Variable Disease Severity at Fine Scales.

Pathogen host range and pathogen severity are dependent on interactions with their hosts and are hypothesized to have evolved as products of a coevolutionary arms race. An understanding of the factors that affect host range and pathogen severity is especially crucial in introduced pathogens that infect evolutionarily naïve hosts and cause substantial damage to ecosystems. Powdery mildews are detrimental pathogens found worldwide in managed and natural systems. Golovinomyces latisporus is a powdery mildew species that is especially damaging to plants within Asteraceae and to plants within the genus Helianthus in particular. In this study, we evaluated 126 species within Asteraceae to measure the role of host plant morphophysiological traits and evolutionary history on susceptibility to G. latisporus and disease severity. We observed phylogenetic signal in both susceptibility and severity within and among major clades of the Asteraceae. In general, there was a major phylogenetic structure of host severity to G. latisporus; however, there was some fine-scale phylogenetic variability. Phylogenetic statistical methods showed that chlorophyll content, biomass, stomatal index, and trichome density were not associated with disease severity, thus providing evidence that phylogenetic structure, rather than observed plant morphophysiological traits, is the most reliable predictor of pathogen severity. This work sheds light on the role that evolutionary history plays in plant susceptibility and severity to disease and underscores the relative unimportance of commonly assessed host plant traits in powdery mildew severity.

Mepolizumab in a population with severe eosinophilic asthma and corticosteroid dependence: results from a French early access programme.

BackgroundMepolizumab was available in France as part of an early access programme for patients with severe eosinophilic asthma (nominative autorisation temporaire d'utilisation [temporary use authorisation] (nATU)) before its commercialisation. This study aimed to characterise patients who received mepolizumab in the nATU.MethodsThis retrospective, observational study analysed data from the hospital medical records of patients up to 24 months after treatment initiation. Study objectives were to describe patient baseline characteristics, the evolution of disease severity and treatment modifications during follow-up; safety was also investigated.FindingsOverall, 146 patients who received ≥1 dose of mepolizumab were included. At inclusion, patients had a mean age of 58.2 years with a mean severe asthma duration of 13.4 years, and 37.0% had respiratory allergies. Patients experienced, on average, 5.8 exacerbations per patient per year at baseline, 0.6 and 0.5 of which required hospitalisation and emergency department visits, respectively. These values improved to 0.6, 0.1 and 0.1 exacerbations per patient per year, respectively, at 24 months of follow-up. Most patients (92.8%) were using oral corticosteroids at baseline, compared with 34.7% by 24 months of follow-up. Moreover, mean blood eosinophil counts improved from 722 cells·µL−1 at baseline to 92 cells·µL−1 at 24 months of follow-up; lung function and asthma control followed a similar trend.InterpretationResults confirm findings from clinical trials, demonstrating that mepolizumab is associated with important improvements in several clinically meaningful outcomes and has a favourable safety profile in a population with severe eosinophilic asthma, outside of the controlled environment of a clinical trial.

The attributable mortality of delirium in critically ill patients: prospective cohort study

Objective To determine the attributable mortality caused by delirium in critically ill patients.Design Prospective cohort study.Setting 32 mixed bed intensive care unit in the Netherlands, January 2011 to July 2013.Participants...

Mo1965 Factors Determining Therapeutic Strategy at Diagnosis and Evolution of Disease Severity in a Cohort of Belgian Pediatric Crohn's Disease Patients (BELCRO)

Mo1965 Factors Determining Therapeutic Strategy at Diagnosis and Evolution of Disease Severity in a Cohort of Belgian Pediatric Crohn's Disease Patients (BELCRO)

P320 Factors determining therapeutic strategy at diagnosis and evolution of disease severity in a cohort of Belgian pediatric Crohn's disease patients (BELCRO)

Background: The effect of biological therapy on surgical rates in Crohn’s disease (CD) is unclear. Our objective is to describe the post-biologic surgical incidence and identify prognostic factors. Methods: A CD cohort (n = 104) prescribed infliximab or adalimumab between 1/7/2000 and 29/6/2011 was identified. The primary outcome was post-biologic CD-related surgery. The primary exposure of interest was disease behavior at onset of first biologic: inflammatory (B1), fibrostenotic (B2) or penetrating disease (B3). Secondary factors collected were: age at diagnosis; sex; time from diagnosis to onset of first biologic; and pre-biologic surgical history. The surgical rate following the start of the first biologic was calculated assuming a Poisson distribution. Kaplan Meier (KM) survival curves of post-biologic surgery, stratified by disease behavior at onset of biologics, were compared using the log rank test. Cox proportional regression model evaluated the effect of prebiologic disease behavior (B1 referent versus B2 and B3) on the post-biologic surgical risk after adjusting for confounders. Risk estimates were presented as hazard rate ratios (HR) with 95% confidence intervals (CI). Results: 26.0% of CD patients underwent post-biologic surgery (0.09 per person-year; 95% CI 0.06 0.13). B2 (mean time to surgery = 1.6±0.17 years; figure 1) and B3 (mean time to surgery = 1.4±0.08 years) disease behavior showed a significant (p = 0.002) increase in surgical rates when compared to B1 (mean time to surgery = 7.3±0.48 years). B2 (HR = 10.7; 95% CI: 3.3 37.5; p = 0.0001) and B3 (HR = 4.2; 95% CI: 1.2 15.4; p = 0.027) disease behavior at onset of the first biologic showed a significantly increased risk for surgery as compared to B1 after adjusting for age at the onset of biologic (HR = 1.0; 95% CI: 0.97 1.03), pre-biologic surgical status (HR = 0.48; 95% CI: 0.18 1.3), time from diagnosis to onset of biologic (HR = 0.97; 95% CI: 0.91 1.03), and pre-biologic perianal disease (HR = 1.9; 95% CI: 0.75 5.1). Conclusions: Complicated CD behavior at the start of biological therapy is a significant predictor of surgery. Treating CD at the inflammatory stage may improve disease outcomes.

Attributable Mortality of Ventilator-Associated Pneumonia

Measuring the attributable mortality of ventilator-associated pneumonia (VAP) is challenging and prone to different forms of bias. Studies addressing this issue have produced variable and controversial results. We estimate the attributable mortality of VAP in a large multicenter cohort using statistical methods from the field of causal inference. Patients (n = 4,479) from the longitudinal prospective (1997-2008) French multicenter Outcomerea database were included if they stayed in the intensive care unit (ICU) for at least 2 days and received mechanical ventilation (MV) within 48 hours after ICU admission. A competing risk survival analysis, treating ICU discharge as a competing risk for ICU mortality, was conducted using a marginal structural modeling approach to adjust for time-varying confounding by disease severity. Six hundred eighty-five (15.3%) patients acquired at least one episode of VAP. We estimated that 4.4% (95% confidence interval, 1.6-7.0%) of the deaths in the ICU on Day 30 and 5.9% (95% confidence interval, 2.5-9.1%) on Day 60 are attributable to VAP. With an observed ICU mortality of 23.3% on Day 30 and 25.6% on Day 60, this corresponds to an ICU mortality attributable to VAP of about 1% on Day 30 and 1.5% on Day 60. Our study on the attributable mortality of VAP is the first that simultaneously accounts for the time of acquiring VAP, informative loss to follow-up after ICU discharge, and the existence of complex feedback relations between VAP and the evolution of disease severity. In contrast to the majority of previous reports, we detected a relatively limited attributable ICU mortality of VAP.

Dementing disorders in the elderly: evolution of disease severity over 7 years.

The goal of this study was to describe the evolution of dementia severity in a very old dementia population. We investigated a representative group of demented subjects gathered from a population-based study (n = 223). Changes in cognition, functioning, and performance on global scales were followed over a period of 7 years. At baseline, 19% of the demented subjects were found to be severely impaired according to the Clinical Dementia Rating scale, 41% according to the Mini-Mental State Examination score, and 31% according to Katz activities of daily living scale. After 7 years these proportions were 78%, 93%, and 68%, respectively. The probability of surviving 3 years, 5 years, and 7 years after baseline examination was 48%, 28%, and 15%, respectively. Over a 7-year follow-up period, subjects suffering from questionable-mild dementia had a mean survival of 3.9 years (95% confidence interval 3.3-4.5), whereas subjects with severe dementia survived on average 2.9 years (95% confidence interval 2.5-3.2). Male gender, lower education, and poor cognitive and functional status were associated with shorter survival in milder cases, whereas the only factors that predicted shorter survival in more severe cases were older age and poor functional status. Long-term survivors in dementia are not rare, and as the absolute number of demented people is increasing, expanding our knowledge of these persons is of high public health importance.

Host-Parasite Relations, Vectors, and the Evolution of Disease Severity

A widespread contention in the parasitological and medical literature is that severe disease represents a lack of coadaption between host and parasite2 because species that do not harm their hosts have the best chance of long-term survival. This view has been proposed throughout this century (89, 91, 97) and was extensively developed by Dubos, who concluded: Given enough time a state of peaceful coexistence eventually becomes established between any host and parasite (33, p. 190). In other words, commensalism was believed to be the ideal evolutionary end point for both host and parasite. Although several authors have suggested that evolution may sometimes result in increased virulence (6, 7, 14, 27, 28, 61), the former view is often accepted as fact in current texts and. reviews (e.g. 4, 48). One of the major problems with this view, however, is that disease severity is analyzed in terms of the survival of the species or of a large subgroup of the species rather than in terms of the effects on gene frequencies within the species. Evolutionary theory, on the other hand, emphasizes that it is the effects on gene frequencies that yield the evolutionary changes within a species (10 1).