Epidemiology History Research Articles

Preisolation measures and clinical features for pediatric patients with suspicious COVID-19.

In December 2019, many cases of COVID-19 were reported in Wuhan City, Hubei Province, China. In the following 3 months, the disease out broke in China. Preisolation measures was used to screen out COVID-19 patients in the pediatric respiratory ward of our hospital. To investigate the new measures for screening COVID-19 patients and to analyze the clinical features of children with suspicious COVID-19. A total of 50 preisolated children with suspicious COVID-19 who were admitted to our hospital in Mianyang, China, between January 28 and March 5, 2020, were included. Patients presented with fever and cough or fever accompanied by vomiting and diarrhea. A detailed epidemiological history screening was performed. A real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was used to detect SARS-COV-2 nucleic acid. Low-dose chest computed tomography (CT) was applied when pneumonia was suspicious. Routine blood tests were performed to rule out COVID-19. Patients' data were collected, and the basic clinical features, epidemiological history, clinical manifestations, auxiliary examination results, and outcomes were analyzed and summarized. No definite cases were detected, while two patients were suspected of having COVID-19. The pathogenic results of the 50 patients mainly included Mycoplasma pneumoniae, followed by Epstein-Barr virus, and rotavirus. Thirty-five patients suffered from bronchopneumonia. The preisolated patients had similar clinical and epidemiological characteristics as patients with fever, cough, vomiting, and diarrhea. Preisolation measures combined with pathogen screening can minimize the risk of hospital-acquired infections by preventing patients with suspicious COVID-19 from contacting other patients before they are explicitly excluded. Clinical analysis of the patients was helpful for clinical nursing management.

Human Orf with Immune-Mediated Reactions: A Systematic Review

Background: Orf is a highly contagious zoonosis caused by Orf virus (ORFV), which is endemic in sheep and goats worldwide. Human Orf is usually a self-limiting disease, but potential complications, including immune-mediated reactions, may occur. Methods: We included all articles regarding Orf-associated immunological complications published in peer-reviewed medical journals. We conducted a literature search of the United States National Library of Medicine, PubMed, MEDLINE, PubMed Central, PMC, and the Cochrane Controlled Trials. Results: A total of 16 articles and 44 patients were included, prevalently Caucasian (22, 95.7%) and female (22, 57.9%). The prevailing immunological reaction was erythema multiforme (26, 59.1%), followed by bullous pemphigoid (7, 15.9%). In most cases, the diagnosis was made on the basis of clinical and epidemiological history (29, 65.9%), while a biopsy of secondary lesions was performed in 15 patients (34.1%). A total of 12 (27.3%) patients received a local or systemic treatment for primary lesions. Surgical removal of primary lesion was described in two cases (4.5%). Orf-immune-mediated reactions were treated in 22 cases (50.0%), mostly with topical corticosteroids (12, 70.6%). Clinical improvement was reported for all cases. Conclusions: Orf-related immune reactions can have a varied clinical presentation, and it is important for clinicians to be aware of this in order to make a prompt diagnosis. The main highlight of our work is the presentation of complicated Orf from an infectious diseases specialist’s point of view. A better understanding of the disease and its complications is essential to achieve the correct management of cases.

Visceral leishmaniasis in Xinjiang Uygur Autonomous Region during the COVID-19 pandemic: a case report

To perform an epidemiological investigation on a case of visceral leishmaniasis reported from Shule County, Kashi Prefecture, Xinjiang Uygur Autonomous Region in 2021, so as to provide insights into differential diagnosis of visceral leishmaniasis during the COVID-19 pandemic. The epidemiological history of this case was collected, and the case was diagnosed for Leishmania infection with the immunochromatographic (rK39) strip test, bone marrow smear microscopy and PCR assay. The patient had typical clinical symptoms of leishmaniasis, including irregular fever, hepatosplenomeg- aly, low serum albumin and elevated globulin. Bone marrow smear microscopy identified L. donovani amastigotes, and both rK39 strip test and PCR assay were positive, while the case was tested negative for SARS-CoV-2. COVID-19 was therefore excluded and visceral leishmaniasis was diagnosed. Standard full-dose treatment with sodium stibogluconate was given, and no Leishmania was found on blood smears during the reexamination. No recurrence was found during the followup after discharge for hospital. During the COVID-19 pandemic, it is recommended to increase the perception of differential diagnosis of visceral leishmaniasis among first-contact doctors, and reinforce the capability of differential diagnosis and health education of visceral leishmaniasis among medical and healthcare institutions at all levels, to prevent missed diagnosis and misdiagnosis of visceral leishmaniasis.

Influence of meteorological and seasonal parameters on the activity of Culicoides paraensis (Diptera: Ceratopogonidae), an annoying anthropophilic biting midge and putative vector of Oropouche Virus in Rondônia, Brazilian Amazon

Biting midges of the genus Culicoides are insects of proven medical and veterinary importance, because of their role in the transmission of viruses, bacteria, protozoa and nematodes. Culicoides paraensis has been considered the main vector of the Oropouche Virus (OROV) in the urban cycle of the disease in the neotropics. Due to the great abundance of Culicoides spp. in the State of Rondônia and its epidemiological history of OROV, we investigated the biting activity in humans, the abundance as a function of meteorological parameters and seasonality, and the detection of OROV. Entomological collections occurred in three municipalities from Brazilian State of Rondônia: Porto Velho, Ariquemes, and Ouro Preto do Oeste. GLMM's were used to determine if Culicoides spp. abundance was predicted by seasonal, diurnal, and meteorological factors. Total RNA was extracted from insects and viral RNA detection was performed using the S segment as the target region of OROV via RT-qPCR. In total, 7315 individuals were captured and identified as C. paraensis. In the dry season, 1488 individuals (24.5%) were recorded, 4591 (75.5%) in the rainy season, with peaks of biting activity between 4pm and 6pm. All variables showed a significative effect on the midge abundance. The rainy season, temperature between 30 °C and 32 °C and relative air humidity between 75% and 85% were the main predictive parameters for capturing the highest average number of insects. Our results confirm diurnal activity of C. paraensis and its greatest abundance in rainy periods. No sample was positive for the OROV, which could be explained by the virus absence in local human populations, C. paraensis as a minor vector species in the sampled localities, and probable low rate of infection of biting midges. Our findings on hourly and seasonal biting activities can provide support to intervention actions regarding vector control and surveillance of this species. This was the first study to collect and analyze biting midges in a region where human OROV cases had already been detected, but without previous information on entomovirological surveillance.

Rare clinical cases of tularemia

The most common clinical form of tularemia in Europe is ulcerative bubonic , which has a summer-autumn seasonality . When infected with water and food , the development of oropharyngeal and abdominal forms is possible . The rarity of registration of such forms is associated not only with the low frequency of such cases of infection , but also with the complexity of diagnosing diseases with an atypical clinic . Important for the correct diagnosis are the results of specific laboratory diagnostics and a qualitatively collected epidemiological history . The results of zooparasitological monitoring allow assessing the risk of infection in certain territories . The article provides descriptions of two cases of severe abdominal tularemia , registered in autumn 2021 – winter 2022 in the Republic of Karelia , which has been one of the most disadvantaged regions of Russia in recent years . In the first case , in a 15-year-old boy , the disease began acutely , the main symptoms were high fever , abdominal pain , vomiting , loose stools , foci of skin hyperemia with clear uneven edges without infiltration in the left knee joint and right inguinal region , hepatomegaly , mesoadenitis . In indirect gemagglutination reaction with tularemia diagnosticum on the third day from the onset of the disease antibodies in titer 1:640. Infection probably occurred when eating food during a trip to the forest zone of the city , where infected rodents were previously detected . In the second case , a 17-year-old girl living in a village was diagnosed with a peritonsillar abscess 3 weeks before a sharp rise in temperature , abdominal pain , vomiting and loose stools . Later he developed renal and hepatic insufficiency , polyserositis . The antibodies titer was 1:320 after 3 weeks and 1:2650 after 5 weeks . Infection probably occurred through consumption of rodent-contaminated v egetables .

Infectious endocarditis caused by Bartonella henselae associated with infected pets: two case reports

BackgroundBlood culture-negative infective endocarditis is a potentially severe disease that can be associated with infectious agents such as Bartonella spp., Coxiella burnetti, Tropheryma whipplei, and some fungi.Case presentationReported here are two cases of blood culture-negative infective endocarditis in patients with severe aortic and mitral regurgitation in Brazil; the first case is a 47-year-old white man and the second is a 62-year-old white woman. Bartonella henselae deoxyribonucleic acid was detectable in the blood samples and cardiac valve with vegetation paraffin-fixed tissue samples. Additionally, an investigation was carried out on patients’ pets, within the context of One Health, and serum samples collected from cats and dogs were reactive by indirect immunofluorescence assay.ConclusionsEven though the frequency of bartonellosis in Brazil is unknown, physicians should be aware of the possibility of blood culture-negative infective endocarditis caused by Bartonella, particularly in patients with weight loss, kidney changes, and epidemiological history for domestic animals.

Multiple rib and vertebral fractures associated with Bordetella pertussis infection: a case report

BackgroundPertussis is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis, characterized by paroxysms of severe coughing, and predominantly affects children. We report the first case of multiple fractures in the ribs, lumbar spine, and sacrum associated with severe coughing caused by Bordetella pertussis infection in an adult.Case presentationA 49-year-old female presented with acute-onset chest wall pain for 3 weeks. Imaging results revealed multiple fractures in the ribs and vertebrae, as well as bilateral pleural effusion, pericardial effusion, right pneumothorax, and enlargement of the left parapharyngeal and subclavian lymph nodes. The patient’s bone density scan, autoimmune antibodies, bone marrow biopsy, and sacral bone biopsy all came back normal. Imaging test results found no evidence of solid tumors or active TB infection. The patient later recalled having violent coughing prior to the onset of chest pain and several family members having similar symptoms. Her blood sample was sent to the CDC, revealing Bordetella pertussis toxin (PT) IgG titer of 110.68 IU/mL. The patient was diagnosed with pertussis and multiple stress fractures from violent coughing. Symptomatic treatments were administered, and the patient’s symptoms improved. The patient was followed up 8 weeks later, she reported no more coughing or chest pain.ConclusionsPertussis is not just a pediatric disease, but diagnosis in adults is challenging as patients may present with a myriad of confusing symptoms, such as multiple stress fractures due to violent coughing. Medical and epidemiological histories are key to reaching the correct diagnosis, which is essential for appropriate treatments to avoid further complications. Adult immunization should be suggested both for the protection of the adult population and to prevent transmission to children.

Clinical case of imported tropical malaria in a teenager

The article presents a case of imported tropical malaria in a 15-year-old girl who returned from the United Republic of Tanzania 5 days before the onset of the disease. The disease began with an increase in body temperature to 38—40°С, catarrhal phenomena. From the 3rd day of illness, abdominal pains, vomiting, loose stools joined. Despite an earlier request for medical help (the 2nd day of illness) and a timely epidemiological history, the patient was diagnosed with tropical malaria on the 6th day of illness, when complications of the disease developed. Late initiation of adequate therapy led to death from multiple organ failure on the 7th day of illness.

Prostate Cancer: Epidemiology & Natural History II (MP77)

You have accessJournal of UrologyCME1 Apr 2023Prostate Cancer: Epidemiology & Natural History II (MP77) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Hepatitis D virus infection: Progress on the path toward disease control and cure.

This article discusses the impact of Hepatitis D virus (HDV) infection as a major cause of liver-related morbidity and mortality in people with Hepatitis B virus (HBV) infection. The article reviews the current knowledge and unanswered questions about the epidemiology, pathogenesis, and natural history of HDV infection. Although effective treatments for HDV infection have been elusive, interferon alfa is recommended for at least 48 weeks. However, response rates with standard-of-care peginterferon alfa are suboptimal, leading to few patients with a sustained virologic response. The article proposes novel approaches to treating HDV and HBV, including targeting reduction or loss of hepatitis B surface antigen (HBsAg) reduction, and discusses potential strategies for achieving HBsAg loss in patients with chronic HBV infection. Finally, the article discusses the landmark decision of accepting viral and biochemical surrogates by regulatory authorities, opening the door for the clinical development of drugs for patients with HDV infection.

Prostate Cancer: Epidemiology & Natural History I (PD21)

You have accessJournal of UrologyCME1 Apr 2023Prostate Cancer: Epidemiology & Natural History I (PD21) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003287AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Long-term management of children with tracheo-oesophageal fistula

Tracheoesophageal fistula with or without oesophageal atresia (TOF/OA) is a common congenital anomaly of the aero-digestive system. Timely diagnosis of the primary structural defect and later identification of complications are key to ensuring good outcomes. This short article outlines the epidemiology and natural history of TOF and offers practical advice to healthcare professionals to assist them in diagnosis, initial and longer-term management. The structural and functional features of TOF/OA are discussed alongside the associated conditions (including tracheomalacia and gastro-oesophageal reflux) and attendant clinical features. Following surgical correction post-operative and longer-term complications and sequelae are relatively common and include stricture, recurrent respiratory infections, cough, wheeze, dysphagia and gastroesophageal reflux disease. We highlight the importance of taking a multidisciplinary approach to managing children with TOF.

Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine.

Jim Downs has written an ambitious book that traces the unique ways imperial medicine shaped modern medicine, particularly epidemiology. The book has two main aims. First, Downs shows that colonialism created specific environments, particularly confined spaces such as military hospitals, ships, and plantations, which provided ideal conditions for the detailed observation of the spread of diseases and the conduct of controlled medical experiments and vaccinations. In doing so, he challenges the conventional approaches to the social history of medicine that focus mainly on Europe and maintain an uneasy relationship with its colonial counterpart. Its second aim is to shift the focus of the history of medicine “from medical authorities to the people who made their theories visible” (200). Downs seeks to recover the lost voices of slaves and colonized people subjected to medical experiments. The book is evidently successful in refocusing the history of epidemiology on empire, but less so in uncovering lost voices. We do not hear the voices of the slaves, hajj pilgrims, or those confined to army barracks or ships. The narrative is based primarily on the familiar study of white colonial actors such as Arthur Holroyd, James O. McWilliam, and Florence Nightingale.

Genetic diversity and epidemic histories of rice yellow mottle virus in Ghana

Rice yellow mottle virus (RYMV) has persisted as a major biotic constraint to rice production in Africa. However, no data on RYMV epidemics were available in Ghana, although it is an intensive rice-producing country. Surveys were performed from 2010 to 2020 in eleven rice-growing regions of Ghana. Symptom observations and serological detections confirmed that RYMV is circulating in most of these regions. Coat protein gene and complete genome sequencings revealed that RYMV in Ghana almost exclusively belongs to the strain S2, one of the strains covering the largest area in West Africa. We also detected the presence of the S1ca strain which is being reported for the first time outside its area of origin. These results suggested a complex epidemiological history of RYMV in Ghana and a recent expansion of S1ca to West Africa. Phylogeographic analyses reconstructed at least five independent RYMV introductions in Ghana for the last 40 years, probably due to rice cultivation intensification in West Africa leading to a better circulation of RYMV. In addition to identifying some routes of RYMV dispersion in Ghana, this study contributes to the epidemiological surveillance of RYMV and helps to design disease management strategies, especially through breeding for rice disease resistance.

Predicting Factors of Brucella melitensis Bacteremia in Children Admitted with Brucellosis

Abstract Objective Brucellosis is the most common zoonotic disease. Isolation of Brucella melitensis in blood culture is accepted as the gold standard for diagnosis. This study aims to determine the predictive factors of B. melitensis bacteremia in pediatric patients followed up with brucellosis. Methods Two-hundred twenty pediatric brucellosis patients were included in the study. The epidemiological, clinical, and laboratory data were recorded. Results The patients comprised 63.2% males and 36.8% females with a mean age of 10.45 ± 4.36 years (range, 1–18 years), and 70.5% were younger than 14 years old. B. melitensis was isolated in the blood culture in 33.6% of patients. In the epidemiological history of pediatric patients with bacteremic brucellosis, there was a history of dealing with, owning, or working with livestock. In patients with brucellosis, fever and weight loss, hepatomegaly, and arthritis were more common in patients with bacteremia than in those without bacteremia. Among laboratory findings, leukopenia, low albumin value, and high C-reactive protein were calculated as predictors of Brucella bacteremia in patients with brucellosis. Conclusion In regions where brucellosis is endemic, serum agglutination tests may be positive without clinical findings. Brucellosis can mimic many other diseases, so the definitive diagnosis is demonstrated by bacteremia. Blood cultures should be taken in patients with predictive factors suggestive of brucellosis.

Plagues upon the Earth: Disease and the Course of Human History by Kyle Harper

Reviewed by: Plagues upon the Earth: Disease and the Course of Human History by Kyle Harper Brandon T. McDonald Plagues upon the Earth: Disease and the Course of Human History Kyle Harper Princeton, NJ: Princeton University Press, 2021. Pp. x + 686. ISBN: 9780691192123 Presses are encouraged to submit books dealing with Late Antiquity for consideration for review to any of JLA's three Book Review Editors: Maria Doerfler (maria.doerfler@yale.edu); John Weisweiler (j.weisweiler@lmu.de); and Damián Fernández (dfernandez@niu.edu). We are inseparable from pathogens (at least, for much of our history). With good reason, this theme reverberates through the chapters of Kyle Harper's recent book, Plagues upon the Earth, a global history of disease stretching back to before our emergence as a species. We will call it a work of historical epidemiology. An ancient economic historian, Harper follows up his previous monograph, The Fate of Rome: Climate, Disease, and the End of an Empire (Princeton, 2017)—a considerable portion of which dealt with infectious disease—by expanding from Roman epidemiological events to a full history of humans' experience with pathogens. He delivers this history—a massive undertaking at nearly 700 pages—with a strong grasp of the science (particularly microbiology and phylogenetics) and an adeptness at making it accessible that is rarely reached in historical scholarship. A struggle to contend with the challenges in writing a global history of disease is somewhat apparent, given that our evidence (whether it be demographic or genomic) is unsurprisingly biased towards Europe. Harper, keenly aware of the difficulties, accepts them and provides as close to an aerial perspective of the human world's exposure to pathogens as possible, with caveats and without firmly extrapolating "Western" evidence. Plagues upon the Earth has four parts, each taking on a crucial aspect of our evolving relationship with germs, and these parts are divided into three chapters. Part One, "Fire," gives the reader an overview of the microbes that have afflicted Homo sapiens and our predecessors for hundreds to thousands of millennia. Harper familiarizes us with humans' most deadly and notorious disease culprits, such as species of bacteria and viruses, as well as less villainized microbes like protozoa and helminths, elucidating that those infecting early chimpanzees (our closest living ape relative) and Homo erectus (an ancestor of modern humans) in some cases evolved to adapt to us. He explains how our understanding of the emergence and evolution of pathogens has improved immensely with the advance of paleogenomics (ancient DNA analysis) and phylogenetics (the study of evolutionary development and the diversification of species), which he labels and continually refers to as "time travel" and "tree thinking," respectively—terms that are a bit playful but nonetheless descriptively effective for reaching a wider audience. These scientific methods, Harper rightly argues, afford us better comprehension of the germs that affected our ancestors and today allow us to write a better-informed history of disease. Early [End Page 238] on, the reader realizes that the improvements in science are a partial basis behind Plagues upon the Earth; perhaps a successor, or an enlightened reply, to works like William McNeil's Plagues and Peoples (Harmondsworth, 1976) or Jared Diamond's Gun, Germs, and Steel (New York, 1997), both of which are cited and referenced in the text multiple times. Ultimately, Part One serves to illustrate not only the ubiquity of microbes, both harmful and not, but also that they were already an age-old fixture on this planet long before Homo sapiens arose. Part Two, "Farms," delves into the diverse ecological settings our ancestors explored and settled into, as well as the significance of these migrations to pathogenic adaptation. Harper begins Part Two with an intriguing story about William Black, an eighteenth-century London doctor who embarked on the huge research task of attempting to understand the main reasons humans die (A Comparative View of the Mortality of the Human Species at All Ages; and the Diseases and Casualties by which They Are Destroyed or Annoyed, London, 1788). These anecdotes are sprinkled throughout the book, usually at the beginning of sections. In the Fate of Rome, Harper strayed from his place as a strictly...

Emergence, continuity, and evolution of Yersinia pestis throughout medieval and early modern Denmark

The historical epidemiology of plague is controversial due to the scarcity and ambiguity of available data.1,2 A common source of debate is the extent and pattern of plague re-emergence and local continuity in Europe during the 14th-18th century CE.3 Despite having a uniquely long history of plague (∼5,000 years), Scandinavia is relatively underrepresented in the historical archives.4,5 To better understand the historical epidemiology and evolutionary history of plague in this region, we performed in-depth (n= 298) longitudinal screening (800 years) for the plague bacterium Yersinia pestis (Y.pestis) across 13 archaeological sites in Denmark from 1000 to 1800 CE. Our genomic and phylogenetic data captured the emergence, continuity, and evolution of Y.pestis in this region over a period of 300 years (14th-17th century CE), for which the plague-positivity rate was 8.3% (3.3%-14.3% by site). Our phylogenetic analysis revealed that the Danish Y.pestis sequences were interspersed with those from other European countries, rather than forming a single cluster, indicative of the generation, spread, and replacement of bacterial variants through communities rather than their long-term local persistence. These results provide an epidemiological link between Y.pestis and the unknown pestilence that afflicted medieval and early modern Europe. They also demonstrate how population-scale genomic evidence can be used to test hypotheses on disease mortality and epidemiology and help pave the way for the next generation of historical disease research.

Determinants of Acquisition, Persistence, and Clearance of Oncogenic Cervical Human Papillomavirus Infection in the Philippines Using a Multi-Omics Approach: DEFEAT HPV Study Protocol

HPV infection is one of the most studied risk factors in cervical cancer-the second most common cancer site and cause of death due to cancer in the Philippines. However, there is a lack of population-based epidemiological data on cervical HPV infection in the Philippines. Local reports on co-infections with other lower genital tract pathogens, commonly reported globally, are also lacking, which emphasizes the need to increase efforts in targeting HPV prevalence, genotype, and distribution. Hence, we aim to determine the molecular epidemiology and natural history of HPV infection among reproductive-age Filipino women using a community-based prospective cohort design. Women from rural and urban centers will be screened until the target sample size of 110 HPV-positive women (55 from rural sites and 55 from urban sites) is reached. Cervical and vaginal swabs will be collected from all screened participants. For HPV-positive patients, HPV genotypes will be determined. One hundred ten healthy controls will be selected from previously screened volunteers. The cases and controls will comprise the multi-omics subset of participants and will be followed up after 6 and 12 months for repeat HPV screening. Metagenomic and metabolomic analyses of the vaginal swabs will also be performed at baseline, after 6 months, and after 12 months. The results of this study will update the prevalence and genotypic distribution of cervical HPV infection among Filipino women, determine whether the current vaccines used for HPV vaccination programs capture the most prevalent high-risk HPV genotypes in the country, and identify vaginal community state types and bacterial taxa associated with the natural history of cervical HPV infection. The results of this study will be used as the basis for developing a biomarker that can help predict the risk of developing persistent cervical HPV infection in Filipino women.

Tridirectional association between probable depression, fear of falling and falls among middle-aged and older adults in Thailand

PurposeDepression is a major issue in the aging population, which may be related to fear of falling (FOF) and falls contributing to increased morbidity and mortality. The aim of the study was to assess the tridirectional associations between probable depression (PD), FOF and falls in a longitudinal study in Thailand. MethodsLongitudinal data of participants (≥45 years; N = 3708) from two consecutive waves (in 2015 and 2017) of the Health, Aging and Retirement in Thailand (HART) study were analysed. PD was assessed with the Center for Epidemiologic Studies Depression Scale, self-reported FOF and history of falls. ResultsHaving no PD in 2015 and PD in 2017 (aOR: 2.35, 95% CI: 1.67 to 3.30), and having both PD in 2015 and 2017 (aOR: 3.46, 95% CI: 1.92 to 6.23) were positively associated with incident FOF with activity avoidance, and no FOF in 2015 and FOF in 2017 (aOR: 2.29, 95% CI: 1.77 to 2.95), and both FOF in 2015 and 2017 (aOR: 2.38, 95% CI: 1.69 to 3.36) were positively associated with incident PD. Two or more falls in 2015 (aOR: 2.03, 95% CI: 1.29 to 3.19) was positively associated with incident PD, and both PD in 2015 and 2017 (aOR: 3.10, 95% CI: 1.40 to 6.48) were positively associated with incident multiple (≥2) falls. ConclusionsWe found tridirectional associations between PD, FOF and falls. It is suggested to screen and manage older adults for PD, FOF and fall history simultaneously.

Chlamydia psittaci pneumonia: a clinical analysis of 12 patients.

We conducted a retrospective analysis to explore the clinical characteristics, laboratory examination, imaging features, treatment outcomes, and prognosis of the Chlamydia psittaci (C. psittaci) pneumonia, aiming to improve early diagnosis and treatment. The clinical data of 12 patients with C. psittaci pneumonia diagnosed by metagenomic next-generation sequencing (mNGS) in our hospital were retrospectively analyzed. These data included baseline information, epidemiological history, clinical symptoms and signs, laboratory and chest computed tomography (CT) examination findings, treatment schemes, and prognosis. The average age of the 12 patients was 58.25±13.27 years, and there were 7 (58.3%) males and 5 (41.7%) females in this cohort. Five patients had clear exposure to poultry or birds. The main clinical manifestations included fever (12/12, 100.0%), cough (12/12, 100.0%), expectoration (10/12, 83.3%), and dyspnea (10/12, 83.3%). Laboratory examination showed marked elevation of the total white blood cell (WBC) count, neutrophil (NEUT) count, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine, and creatine kinase (CK) levels; as well as decreased hemoglobin (HGB), blood platelet (PLT), and albumin (ALB) levels. Arterial blood gas analysis showed that the average value of the oxygenation index (PO2/FiO2) was 290.9±83.1, which was less than 300 in 6 cases (50.0%). The main chest CT features were patchy or consolidation in the bilateral or unilateral lungs, and the boundary was not clear but showed a bronchial inflation sign. Also, some of the cases were accompanied by pleural effusion. Once the etiology was obtained, the patients were quickly treated with doxycycline combined with other antibiotics. All 12 patients improved and were discharged from the hospital. However, two severe patients were admitted to the intensive care unit (ICU) and received ventilation and monitoring treatment. There were no deaths. C. psittaci pneumonia is an atypical community-acquired pneumonia (CAP) caused by C. psittaci infection, with its own laboratory and imaging characteristics. In this study, diagnosis was established based on the application of mNGS owing to the absence of easily available conventional pathogenic evidence. In addition, an aggressive and precise treatment strategy can help achieve a favorable prognosis for patients.