High Case Fatality Rate Research Articles

Research Advances on the Pathogenesis and Treatment of Hemolytic Uremic Syndrome --Review

Hemolytic uremic syndrome (HUS) is clinically rare, with high mortality and case fatality rates. In recent years, the research on HUS has been intensified and the pathophysiological mechanism has been continuously improved. At present, the main mechanism of pathogenesis is the excessive activation of complement alternative pathways mediated by complement-related gene mutations or the existence of antibodies. The treatment methods and strategies are also constantly updated, mainly including complement-blocking drugs such as Eculizumab, Lavalizumab, and Ravulizumab. In this review, the new developments in the pathogenesis and treatment of HUS is summarized, and provide references for the clinical treatment of HUS.

Growth and Control of Catheter-related Bloodstream Infection Causing Bacteria in Nutrient Solutions

Among healthcare-associated infections, catheter-related bloodstream infection (CRBSI) shows a high case fatality rate and is serious threat. CRBSI are a problem to be eradicated. This study was conducted to reveal the growth characteristics of the causative microorganisms of CRBSI and investigate relevant control methods. The effects of biotin on growth of Candida albicans (C. albicans) in the nutrient solutions were investigated. Upon comparing general solutions and biotin-containing solutions, C. albicans showed auxotrophy against biotin, resulting in significant proliferative potential. CRBSI is caused by biofilm formation in the catheter lumen and subsequent proliferation. The effect of biotin on the colonization of C. albicans in the catheter lumen was evaluated. Candida albicans colonization in the catheter lumen and subsequent proliferation were significantly higher than those in control solutions. To investigate methods for CRBSI control, effects on pathogenic microorganisms were examined by screening for nutrient solutions with antimicrobial activity, using a catheter-lumen contamination model. A commercially available solution (PLAS-AMINO® injection; PA) containing the highest amount of sodium bisulfite was selected. Gram-positive or negative bacteria and C. albicans were used as the causative microorganisms of CRBSI in the study. Dripping PA into each catheter-lumen contamination model demonstrated bactericidal effects against all bacteria tested and strong growth-inhibitory effects on C. albicans. By using PA for contamination inside the catheter, sterilization and suppression of bacterial growth can be expected without having to remove central venous catheters and/or central venous access devices. This review provides valuable findings for the development of novel control methods for CRBSI.

Community-acquired bacterial meningitis in patients of 80 years and older.

BackgroundAdvanced age is a risk factor for unfavorable outcome in community‐acquired bacterial meningitis, but clinical characteristics and outcome in meningitis patients of 80 years or older have not been defined.MethodsWe compared clinical characteristics and outcome of community‐acquired bacterial meningitis patients aged 80 years or older and adults under 80 years old within a prospective nationwide cohort study.ResultsOut of 2140 episodes identified between March 2006 and July 2018, 149 occurred in patients aged 80 years or older (7%). Common predisposing factors other than age were diabetes mellitus (25 of 148 [17%]), otitis or sinusitis (30 of 136 [22%]), and pneumonia (23 of 141 [16%]). The triad of fever, neck stiffness and altered consciousness was present in 60 of 139 (43%). The most common causative pathogen was Streptococcus pneumoniae (99 of 149 [66%]). Atypical causative pathogens, such as Listeria monocytogenes, Staphylococcus aureus, and Escherichia coli, occurred more often compared to younger patients (49 of 149 [33%] vs 362 of 1991 [18%]; p < 0.001). Patients of 80 years and older had high case fatality rate (75 of 149 [50%]), but 45 of 149 (30%) had a favorable outcome. Characteristics associated with an unfavorable outcome were absence of otitis or sinusitis, presence of aphasia, mono‐ or hemiparesis, a lower score on the Glasgow Coma Scale, a higher heart rate, a higher blood C‐reactive protein concentration and CSF leukocytes <100 per mm3.ConclusionsBacterial meningitis in patients of 80 years of older is associated with high rates of unfavorable outcome and death. Atypical causative pathogens such as L. monocytogenes, S. aureus, and E. coli occur commonly and should be considered when starting empirical antimicrobial therapy in this age group.

Osuntokun Award Lecture 2021: Challenges of Measuring the Burden of Stroke in Africa

BackgroundOver recent years non-communicable diseases have dramatically increased in low- and middle-income countries, including those of sub-Saharan Africa. With continuing high levels of infectious disease, these countries now face the double burden of disease. Stroke has emerged as a major cause of hospital admission, disability, and mortality for which the major modifiable risk factor is hypertension, which is often not diagnosed and, even if diagnosed, not treated and, even if treated, not controlled. MethodsIn this award lecture paper I outline my personal experience of measuring the burden of, and risk factors for, stroke in sub-Saharan Africa, along with the challenges faced. I will specifically describe the measurement of mortality and case fatality, prevalence and incidence as well as commenting on aetiology and risk factors and reflect on future initiatives and directions. ResultsOver the past 5 decades there has been a dramatic increase in numbers of stroke patients admitted to hospital throughout sub-Saharan Africa, with high in hospital mortality rates, also reflected in high case fatality rates in those cohorts followed up following discharge from hospital. Community-based surveys assessing mortality from stroke using verbal autopsy have demonstrated very high age-adjusted rates. Age adjusted prevalence rates assessed by door-to-door surveys have generally shown lower prevalence than high income countries. The Tanzanian stroke incidence study, which incorporated verbal autopsy for those patients dying before reaching hospital, demonstrated some of the highest age-adjusted stroke incidence rates in the world. There were high rates of stroke in younger ages and high rates of intracranial haemorrhage though not as high as previously shown in hospital-based studies. Hypertension is the main modifiable risk factor but other risk factors such as HIV are important while, certainly in rural populations, raised cholesterol remains rare as does carotid artery stenosis and history of transient ischemic attack. Other vascular disease such as ischemic heart disease and peripheral vascular disease is also less common. ConclusionsThere is already a large burden relating to stroke in sub-Saharan Africa and this will only escalate further as the population ages. Hypertension is the biggest risk factor for mortality worldwide and in sub-Saharan Africa prevalence rates are very high with the majority of people suffering with stroke not being diagnosed with their hypertension prior to their stroke. The most important challenge is to improve primary prevention for which improving diagnosis and control rates for hypertension is the number one priority. For those who do have stroke there is a need to increase the number of suitably staffed stroke units as these have been shown to have a very large impact on improving both mortality and morbidity in high income countries. There are still many unanswered questions and a need for more research throughout sub-Saharan Africa on risk factors, and treatment, for stroke.

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 \u2013 a secondary database analysis

BackgroundInvasive meningococcal disease (IMD) causes high fatality in untreated patients alongside long-term sequelae in 20% survivors. For a comprehensive assessment of epidemiology, an analysis of these sequelae is required. This study aims to investigate the epidemiology of disease between 2008 and 2017 including a description of the sequelae, through the analysis of data collected from the UK Clinical Practice Research Datalink (CPRD) linked with data from the Hospital Episode Statistics (HES), and Office for National Statistics (ONS) mortality registry data.MethodsThis was a 10-year retrospective observational cohort study designed to describe the incidence, case-fatality rate (CFR) and occurrence of sequelae due to meningococcal disease, in the UK between 2007 and 2017 using data from the UK CPRD-HES-ONS. Cases were identified and matched on age, gender, date of diagnosis of IMD and followed-up-time with a control group without IMD. Demographics, clinical characteristics, mortality, and IMD-related sequelae were examined for IMD cases and compared with matched controls for a more comprehensive assessment.ResultsThe study analysed 640 IMD patients with majority of the cases diagnosed (76.9%) in a hospital setting. Age-group analysis showed a decrease in the incidence rate of IMD in patients aged <1 year (30.4 – 7.5%) and an increase in those >50 years (10.4 – 27.8%). CFR was slightly higher among females, toddlers, and adults >50 years. No significant change in CFR was observed over study period. Case-control study showed a higher number of IMD sequelae among cases compared to age- and gender-matched controls, especially in those ≥ 50 years.ConclusionThe study showed that, despite a relatively low incidence rate, IMD is responsible for a high CFR, namely in older age groups and by a high number of IMD sequelae. The study showed that leveraging data from existing databases can be used to complement surveillance data in truly assessing the epidemiology of IMD. Despite the availability of routine vaccination programs, IMD still poses a significant burden in the healthcare system of the UK. Optimization of vaccination programs may be required to reduce the disease burden.

Pneumomediastinum: An Early Predictor of Mortality in Paraquat Poisoning: A Rare Case Presentation

Paraquat is a broad spectrum liquid herbicide (1,1'- dimethyl-4,4'- dipyridylium) associated with both accidental and intentional ingestion. It has a very high case fatality rate assuming to be due to inherent toxicity and lack of effective treatments. Poisoning by Paraquat herbicide has been a major medical problem in parts of Asia. Despite widespread availability, reports of Paraquat poisoning is not common due to very high case fatality rate might be due to not reaching to tertiary care centres and non specific clinical features with absence of proper history. Case Presentation: We report a case of previously healthy 19 years old male who was brought to the emergency department 3 days after intentional ingestion of approximately 100ml of 24% Paraquat herbicide with complaints of retrosternal chest pain while breathing &amp; dysphagia followed by several episodes of vomiting followed by the development of pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence. Conclusion: Though Pneumomediastinum being an early predictor of 100% mortality in Paraquat poisoning but an emergency physician should establish the diagnosis early and to pursue aggressive decontamination and prevention of further absorption. Increased awareness of the clinician and availability of the laboratory diagnostic methods will definitely help in successful management of paraquat poisoning and to decrease the case fatality rate. What we already know? There are quite a few case reports that already mentioned about possibilities of occurrence of spontaneous pneumomediastinum, pneumothorax or lung fibrosis along with acute renal failure, liver toxicity and mucosal injury. What this paper adds? This is rare case report of spontaneous pneumomediastinum in Paraquat poisoning presenting to our tertiary care centre. A chest radiograph or a CT chest should be performed which may be useful in early detection of pneumomediastinum, pneumothorax or lung fibrosis for assessing long term damage in survivors. We specifically point towards the fact that no obvious clinical guideline can decrease the case fatality rates in these kind of cases.

Global Threat of Carbapenem-Resistant Gram-Negative Bacteria.

Infections caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), including carbapenem-resistant (CR) Enterobacterales (CRE; harboring mainly bla KPC, bla NDM, and bla OXA-48-like genes), CR- or MDR/XDR-Pseudomonas aeruginosa (production of VIM, IMP, or NDM carbapenemases combined with porin alteration), and Acinetobacter baumannii complex (producing mainly OXA-23, OXA-58-like carbapenemases), have gradually worsened and become a major challenge to public health because of limited antibiotic choice and high case-fatality rates. Diverse MDR/XDR-GNB isolates have been predominantly cultured from inpatients and hospital equipment/settings, but CRE has also been identified in community settings and long-term care facilities. Several CRE outbreaks cost hospitals and healthcare institutions huge economic burdens for disinfection and containment of their disseminations. Parenteral polymyxin B/E has been observed to have a poor pharmacokinetic profile for the treatment of CR- and XDR-GNB. It has been determined that tigecycline is suitable for the treatment of bloodstream infections owing to GNB, with a minimum inhibitory concentration of ≤ 0.5 mg/L. Ceftazidime-avibactam is a last-resort antibiotic against GNB of Ambler class A/C/D enzyme-producers and a majority of CR-P. aeruginosa isolates. Furthermore, ceftolozane-tazobactam is shown to exhibit excellent in vitro activity against CR- and XDR-P. aeruginosa isolates. Several pharmaceuticals have devoted to exploring novel antibiotics to combat these troublesome XDR-GNBs. Nevertheless, only few antibiotics are shown to be effective in vitro against CR/XDR-A. baumannii complex isolates. In this era of antibiotic pipelines, strict implementation of antibiotic stewardship is as important as in-time isolation cohorts in limiting the spread of CR/XDR-GNB and alleviating the worsening trends of resistance.

Effectiveness of Human Mobility Change in Reducing the Spread of COVID-19: Ecological Study of Kingdom of Saudi Arabia

Non-pharmacological interventions including mobility restriction have been developed to curb transmission of SARS-CoV-2. We provided precise estimates of disease burden and examined the impact of mobility restriction on reducing the COVID-19 effective reproduction number in the Kingdom of Saudi Arabia. This study involved secondary analysis of open-access COVID-19 data obtained from different sources between 2 March and 26 December 2020. The dependent and main independent variables of interest were the effective reproduction number and anonymized mobility indices, respectively. Multiple linear regression was used to investigate the relationship between the community mobility change and the effective reproduction number for COVID-19. By 26 December 2020, the total number of COVID-19 cases in Saudi Arabia reached 360,690, with a cumulative incidence rate of 105.41/10,000 population. Al Jouf, Northern Border, and Jazan regions were ≥2.5 times (OR = 2.93; 95% CI: 1.29–6.64), (OR = 2.50; 95% CI: 1.08–5.81), and (OR = 2.51; 95% CI: 1.09–5.79) more likely to have a higher case fatality rate than Riyadh, the capital. Mobility changes in public and residential areas were significant predictors of the COVID-19 effective reproduction number. This study demonstrated that community mobility restrictions effectively control transmission of the COVID-19 virus.

COVID-19 vaccination challenge: what have we learned from the Brazilian process?

COVID-19 vaccination challenge: what have we learned from the Brazilian process?

Paraquat Poisoning – A Brief Overview

Paraquat poisoning in the modern era has become a major medical health problem, due to its high case fatality rate. The toxicological importance of this herbicide is due to its inherent toxicity and lack of specific antidote . It is one of the commonly used agents responsible for death among the reported pesticide poisonings in south east Asian countries. The high mortality rates associated has led to the withdrawal of this herbicide from the market by the European Union in 2007, but in developing countries like India it is widely marketed due to its low cost and high efficacy . Although several studies have been done globally, there are no extensive published human trials. In Asian pacific regions where pesticides are commonly used for suicidal or homicidal ingestion, it has become a subject of concern and there is a growing need to focus on prevention due lack of specific antidote .This article endeavors to revisit the profile of paraquat (PQ) and to investigate the impacts of this chemical on human health with a future direction to create awareness about this highly toxic nonselective herbicide and to consider it as a part of national strategy to lower suicidal mortality rates.

Factors associated with in-hospital mortality of adult tetanus patients-a multicenter study from Bangladesh.

Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh. This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26). A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07-15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05-10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications. Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.

COVID-19 Prevention Practices Among Prisoners, in Southern Ethiopia.

BackgroundCoronavirus disease-19 (COVID-19) is a highly contagious disease with high attack and case fatality rate. Since WHO’s declaration of disease as pandemic in March 2020, the unprecedented global crises have been happening. To curb and reduce such crises, multi-dimensional international efforts have been made, particularly, infection prevention measures has been developed. However, there was a wide gap of implementing COVID-19 prevention measures from rural to urban, from institution to institution and from person to person. Therefore, the aim of this study was to measure the level of prevention practice towards COVID 19 and associated factors in prison, in Sidama National Regional State, Ethiopia.MethodsA cross-sectional study using quantitative method of data collection was conducted in November, 2020 among 422 prisoners in two prisons. Data were collected by trained nurses using structured questionnaires. We analyzed data using SPSS version 24 software. Descriptive statistics and bivariable and multivariable logistic regression analyses were employed to identify factors associated with prevention practices of COVID-19.ResultsMore than one-fifth (22%; 95% CI: 19%, 26%) of respondents had good preventive practice. Participants who had a history of alcohol intake were 1.79 times less likely to implement good preventive practice for COVID-19 (AOR = 1.79; 95% CI; 1.09, 2.93). The respondents who had negative attitude towards COVID-19 infection were 1.69 times more likely to have poor prevention practice (AOR = 1.69; 95% CI: 1.02, 2.81).Conclusion and RecommendationIn this study, COVID-19 prevention practice among prisoners was very low. Negative attitude and previous alcohol taking history were factors associated with poor prevention practice. Accordingly, the researchers recommends to the concerned body to design educational intervention to change the attitude towards COVID-19 and other infectious diseases and behaviors of the prisoners.

Diagnostic accuracy of cytology for the detection of bacterial infection in fluid samples from veterinary patients.

Bacterial sepsis is a relatively common, life-threatening condition with a high case fatality rate. The current primary diagnostic tools for detecting bacterial infection in fluids are bacterial culture and fluid cytology. While culture is the gold standard, it can take up to several days for results to be made available to clinicians, which can delay recognition of bacterial sepsis and negatively impact patient outcomes. The aim of this study was to evaluate the diagnostic accuracy of cytology for detecting bacterial infection in body fluids. We retrospectively reviewed 10years of medical records at the Ohio State University's Veterinary Medical Center for mammalian patients with both cytology and bacterial culture of fluid samples, including body cavity fluids (abdominal and thoracic effusion), blood, joint fluid, and CSF. The overall sensitivity and specificity of cytology relative to the reference method of bacterial culture was recorded, as well as among the subcategories of fluid type. The overall sensitivity and specificity of cytology for the diagnosis of sepsis were 42.6% and 93.0%, respectively. Individual sensitivities and specificities were also calculated for each fluid type. Thoracic fluid cytology had relatively high sensitivity and low specificity, in contrast to the other fluid types analyzed. Overall, cytology is poorly sensitive but highly specific for the detection of bacterial infection in fluid samples. The results from this study will allow a better comparison between the diagnostic accuracy of cytology and emerging diagnostic tests for the detection of bacterial sepsis in mammalian patients.

Ebola Entry Inhibitors Discovered from Maesa perlarius.

Ebola virus disease (EVD), a disease caused by infection with Ebola virus (EBOV), is characterized by hemorrhagic fever and a high case fatality rate. With limited options for the treatment of EVD, anti-Ebola viral therapeutics need to be urgently developed. In this study, over 500 extracts of medicinal plants collected in the Lingnan region were tested against infection with Ebola-virus-pseudotyped particles (EBOVpp), leading to the discovery of Maesa perlarius as an anti-EBOV plant lead. The methanol extract (MPBE) of the stems of this plant showed an inhibitory effect against EBOVpp, with an IC50 value of 0.52 µg/mL, which was confirmed by testing the extract against infectious EBOV in a biosafety level 4 laboratory. The bioassay-guided fractionation of MPBE resulted in three proanthocyanidins (procyanidin B2 (1), procyanidin C1 (2), and epicatechin-(4β→8)-epicatechin-(4β→8)-epicatechin-(4β→8)-epicatechin (3)), along with two flavan-3-ols ((+)-catechin (4) and (−)-epicatechin (5)). The IC50 values of the compounds against pseudovirion-bearing EBOV-GP ranged from 0.83 to 36.0 µM, with 1 as the most potent inhibitor. The anti-EBOV activities of five synthetic derivatives together with six commercially available analogues, including EGCG ((−)-epigallocatechin-3-O-gallate (8)), were further investigated. Molecular docking analysis and binding affinity measurement suggested the EBOV glycoprotein could be a potential molecular target for 1 and its related compounds.

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

BackgroundNeisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD.MethodsA comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.ResultsThere were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.ConclusionsThe use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities’ decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.

EQUAL Candida score, an effective tool for predicting the outcomes of Candida tropicalis candidaemia: A retrospective cohort study.

Candida tropicalis is the most common non-albicans Candida species found in Asia-Pacific countries, including Thailand. The pathogen is known for its great virulence, which causes a high case-fatality rate. Associations between case fatality and patient characteristics, infectious disease unit consultation and EQUAL Candida score were investigated. This retrospective cohort study was conducted with 160 cases of C.tropicalis bloodstream infection between 2015 and 2019 at a single, large, tertiary centre in Thailand. Clinical characteristics, clinical presentations, patient outcomes (30-day case-fatality rate) and independent predictive factors were analysed. The 30-day case-fatality rate was 68.1%. The median of the EQUAL Candida score was 8. Independent factors for the prediction of case fatality were septic shock (hazard ratio, 1.84), the use of mechanical ventilation (hazard ratio, 2.03) and the EQUAL Candida score (hazard ratio, 0.75). The predictive factors for 30-day case fatality were septic shock, mechanical ventilation use and the EQUAL Candida score. It is recommended that the EQUAL score be considered for patients infected with C.tropicalis candidaemia to reduce the case-fatality rate.

Activation of the Warburg Effect by Pyruvate Kinase M2 Promotes the Occurrence and Development of Liver Cancer

Liver cancer, which is one of the most common malignancies, has a high incidence and case fatality rate, and is the third most common cause of death attributed to cancer. Warburg effect is a form of modified cell metabolism by which tumor cells obtain energy by glycolysis instead of oxidative phosphorylation, whether in an aerobic or anaerobic environment. It plays an important role in tumor proliferation, growth, invasion, and treatment. Pyruvate kinase M2 (PKM2), an essential key enzyme in the glycolytic process, is significantly elevated in multiple tumor tissues and plays a crucial role in the Warburg effect. Recently, increasing attention has been devoted to the mechanism of action of PKM2 in tumors, and interference with the glycolysis pathway is one of the new strategies for cancer treatment. This paper provides a review of the Warburg effect of PKM2 activation and its relationship with tumorigenesis and development and the potential value of Warburg effect in clinical diagnosis, treatment, and prognostic evaluation of liver cancer.

Factors Associated with Mortality from Renal Failure in Brazil: A Descriptive Epidemiological Study

Background and aims: The incidence of renal failure (RF) is growing in Brazil, resulting in increased public spending and negatively affecting the public health, which can lead to patient death. Identifying factors associated with mortality from this condition can help to characterize susceptible populations; therefore, institutional and governmental measures can be adopted for prevention and treatment. Materials and Methods: Descriptive epidemiological study using secondary data from Brazilian database (DATASUS). Deaths from RF between 2009 and 2019 and characteristics such as color/race, gender, education, region, and age group of the individuals were analyzed. Results: Since 2016, there has been a reduction of approximately 2% per year in the RF case fatality rate. North, Northeast, and Southeast regions had the highest case fatality rate, 13.6%, 13.17%, and 12.84%, respectively, which may be associated with high prevalence of chronic-degenerative diseases. The elderly had the highest case fatality rates, ranging from 9.67% in individuals aged 50-59 years to 27.52% in the elderly over 80 years. Children under 1 year of age had a high case fatality rate of 15.03%. Moreover, the case fatality rate for individuals with education levels above 12 years of schooling was 0.50%, while the case fatality rate for individuals with 1 to 3 years of schooling was 3.52%, which is seven times higher. Case fatality rates of indigenous populations in the South and Southeast regions were 12.0% and 16.5%, approximately 20% higher than other populations. Conclusion: The presence of chronic-degenerative diseases, age above 50 and below 1 (elderly and preterm newborns), low level of education and being indigenous are factors associated with mortality from RF in Brazil.

Long-term case-fatality rate of nontuberculous mycobacterial disease in people living with HIV

BackgroundFew data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death.MethodsA retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1, 2012, to December 31, 2020, in Shanghai, China. We used Kaplan–Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM (DNTM) and localized NTM disease. Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR.ResultsThe cohort was followed up for a median of 26 months. The total CFR was 15.7% by one year and increased to 22.6% at 5 years after the diagnosis of NTM disease. The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM (26.7% vs 19.6% for DNTM and localized NTM disease, respectively). Older age [hazard ratio (HR) = 1.04, 95% confidence interval (CI): 1.02–1.06, P < 0.001], comorbidity (HR = 2.05, 95% CI: 1.21–3.49, P < 0.01), DNTM (HR = 2.08, 95% CI: 1.17–3.68, P < 0.05), and HIV viral load (HR = 1.32, 95% CI: 1.12–1.55, P < 0.001) were all independent risk factors for long-term CFR. In the subgroup analysis, time to culture positivity was negatively correlated with CFR in patients with DNTM (HR = 0.90, 95% CI: 0.82–0.98, P < 0.05).ConclusionsNTM was associated with a high long-term CFR in PLWH. Further approaches to prevent NTM disease in PLWH are urgently needed.Graphical

A dynamic model for individualized prognosis prediction in patients with avian influenza A H7N9.

BackgroundAvian influenza A H7N9 progresses rapidly and has a high case fatality rate. However, few models are available to predict the survival of individual patients with H7N9 infection in real-time. This study set out to construct a dynamic model for individual prognosis prediction based on multiple longitudinal measurements taken during hospitalization.MethodsThe clinical and laboratory characteristics of 96 patients with H7N9 who were admitted to hospitals in Jiangsu between January 2016 and May 2017 were retrospectively investigated. A random forest model was applied to longitudinal data to select the biomarkers associated with prognostic outcome. Finally, a multivariate joint model was used to describe the time-varying effects of the biomarkers and calculate individual survival probabilities.ResultsThe random forest selected a set of significant biomarkers that had the lowest classification error rates in the feature selection phase, including C-reactive protein (CRP), blood urea nitrogen (BUN), procalcitonin (PCT), base excess (BE), lymphocyte count (LYMPH), white blood cell count (WBC), and creatine phosphokinase (CPK). The multivariate joint model was used to describe the effects of these biomarkers and characterize the dynamic progression of the prognosis. Combined with the covariates, the joint model displayed a good performance in discriminating survival outcomes in patients within a fixed time window of 3 days. During hospitalization, the areas under the curve were stable at 0.75.ConclusionsOur study has established a novel model that is able to identify significant indicators associated with the prognostic outcomes of patients with H7N9, characterize the time-to-event process, and predict individual-level daily survival probabilities after admission.