Multiple Comorbid Conditions Research Articles

2194. Epidemiology, Clinical Features and Outcomes of Hospitalized Adult Patients with Respiratory Syncytial Virus Infections

Abstract Background Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infection (RTI) in all age groups. In general, RSV causes more severe disease in the elderly and adults with underlying comorbidities. There are limited studies evaluating RSV disease among inpatient adults. Our study objective was to assess the epidemiology, clinical features and outcomes of RSV RTIs among hospitalized adults. Methods A multicenter retrospective cohort study was conducted on adult patients hospitalized for RSV RTIs in southeast Michigan from 1/1/19-12/31/21. Hospitalized patients were identified using ICD 10 codes for RSV related diseases. Electronic medical records were reviewed. We collected the following data: demographics, comorbid conditions, laboratory and radiology results, treatment received and outcomes (death, discharge, 30 day readmission). Results A total of 102 patients were identified and included for analysis. The mean (SD) age of the cohort was 68.8 ± 14.2 yrs, 61 (60%) were female and 60 (59%) were white. The mean body mass index of the cohort was 31 ± 9.5 kg/m2. The common comorbidities were chronic lung disease (75%), hypertension (69%), obesity (38%) and congestive heart failure (30%). The mean Charlson weighted index of comorbidity was 2.28 ± 2. Fever and hypotension were noted in 13% and 15% on admission respectively. Admission CXR were abnormal in 47% cases. RSV upper and lower RTI were present in 23 (22.5%) and 79 (77.5%) respectively. Antibiotics were given in 63% of patients. Infectious diseases consultation was obtained in 41% cases. Mechanical ventilation was required in 11%, intensive care in 23.5% patients and length of stay was 6.5 + 5.6 days. Other complications were encephalopathy in 17%, acute kidney injury in 21% and liver injury in 5%. Seven (6.8%) patients died. Conclusion Our study found that adults admitted with RSV tended to be elderly, have multiple comorbid conditions and a high incidence of lower RTIs. Admissions were frequently complicated by need for ICU stay, mechanical ventilation and death. Our study supports a need for RSV immunizations once available for this high risk population. Disclosures All Authors: No reported disclosures.

COVID-19 and monkeypox co-infection: A rapid systematic review.

In this paper we aimed to study the characteristics, laboratory data and outcomes of monkeypox virus (MPV) and COVID-19 co-infection. On 2nd October 2022, we used the search term "("monkeypox virus" OR "MPV" OR "monkey pox" OR "monkeypox") AND ("COVID-19" OR "COVID 19" OR "novel coronavirus" OR "SARS-CoV-2")" in five databases to collect the relevant articles. We found three male patients, who had sex with men prior to the infection, had multiple comorbid conditions, were diagnosed with PCR, and were admitted to the hospital. The length of hospital stay was 4, 6, and 9 days. On admission, two cases had multiple vesicular lesions on various sites of the body associated with tonsillar inflammation, while the third case had genital ulcers and inguinal lymph node enlargement. All cases were managed in the hospital and recovered well. It might still be too early to establish solid evidence about the exact cause-effect association between SARS-CoV-2 and MPV co-infection and patient's outcomes because of the current low sample size. Accordingly, future relevant investigations, estimating the risk ratio of this association are needed to formulate definite evidence.

Factors associated with COVID-19 vaccination for patients in an inpatient forensic psychiatric hospital.

The aim of this study was to assess factors associated with SARS-CoV-2 (COVID-19) vaccination in patients in 2 inpatient forensic psychiatric hospitals. This was a retrospective chart review evaluating factors associated with COVID-19 vaccination for patients residing in two inpatient forensic psychiatric hospitals between January 1, 2021 and February 28, 2022. Data was collected through electronic medical records utilizing MetaCare Enterprise™ and secure facility computer drives, individual patient paper charts, and Missouri's vaccination records database, ShowMeVax. Several variables were collected to assess factors associated with COVID-19 vaccination. Additionally, COVID-19 vaccination rates were compared to the influenza vaccination rates at these hospitals. Overall, 229 patients (84.5%) were vaccinated against COVID-19 during or before the study period and 42 (15.5%) were unvaccinated. Patients who were deemed incompetent to stand trial were less likely to receive the COVID-19 vaccine. Those that had a higher body mass index (BMI), were diagnosed with multiple comorbid conditions, not prescribed involuntary medications, were offered incentives, and received the influenza vaccine were more likely to receive the COVID-19 vaccine. Education level, race, sex, age, and being prescribed psychiatric medications did not affect vaccination status. Patient specific factors should be used when educating and offering COVID-19 vaccines to patients in an inpatient forensic psychiatric unit. Awareness of these results can facilitate targeted interventions for optimal care in a psychiatric population.

Older Adults with Acute Myeloid Leukemia (AML) Treated in a Pragmatic Trial: How Do Patients’ Function and Health-Related Quality of Life Change with Treatment?

Background: Over one-third of older adults with AML do not receive chemotherapy because of fear of toxicities and functional decline. This highlights the critical and urgent need to generate knowledge of functional changes following newer treatments. Methods: As a part of a pragmatic single-center phase II investigator-initiated trial (ClinicalTrials.gov ID: NCT03226418), we enrolled older adults (≥60 years) with a new diagnosis of AML. We repeated geriatric assessment (GA) and health-related quality of life (HRQOL) before and 3 months after chemotherapy initiation. GA included measures of physical function (e.g. short physical performance battery or SPPB), Montreal Cognitive Assessment (MoCA), Hematopoietic Cell Transplantation Comorbidity Index, Patient Health Questionnaire-9 (PHQ-9), Mini Nutritional Assessment-Short Form. Frailty was defined as impairment in 2 or more domains on geriatric assessment (excluding MoCA). HRQOL was measured using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (v 3.0). Established cutoffs were used to determine a clinically meaningful change in various measures from baseline to 3 months. Results: 59 eligible patients were enrolled and had median age of 69 years and median KPS of 80. Patients received treatment with predominantly low-intensity chemotherapy (hypomethylating agent +/-venetoclax or midostaurin); six patients received intensive chemotherapy. 56% of patients had ≥2 comorbid conditions, and 69% each had impaired MoCA scores and impaired objective physical function at baseline. Whereas 29% had an established diagnosis of depression or anxiety, 66% had abnormal PHQ-9 with a score of 5 or more. 61% had impaired nutritional screen. A total of 43 patients completed some or all of the optional follow-up assessments at 3 months. Cognitive function or MoCA scores improved (64.5%) or stabilized (9.6%) from baseline to 3 months after treatment (Figure 1). We also noted improvement (51.6%) or stabilization (22.6%) in objective physical function (Figure 2). PHQ-9 scores showed improvement or stabilization in about 90% of patients. Nutritional scores showed variable changes with 40% demonstrating improvement. On HRQOL assessment, global health status score, and role functioning moderately improved from baseline to three-month after enrollment. Longitudinal cognitive function over 3 months differed based on the presence of frailty and multimorbidity (≥2 comorbid conditions) at baseline. Improvement in MoCA scores was noted in 31.8% (95% CI 16.4-52.7%) and 50.0% (95% CI 23.7-76.3%) of patients with versus without baseline frailty. The risk of worsening of cognitive function was 31.5% (95% CI 15.4-54.0%) for patients with multimorbidity at baseline versus 16.7% (95% CI 4.7-44.8%) for those without. Conclusion: We demonstrated an overall improvement or stabilization of functional status and HRQOL in a high proportion of older adults with AML, despite high prevalence of functional impairments and significant comorbidity burden at baseline. These results should encourage oncologists to offer chemotherapy even to older adults with multiple comorbid conditions or poor functional status at the time of diagnosis of AML. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Defining Ferritin Clinical Decision Limits to Improve Diagnosis and Treatment of Iron Deficiency: A Modified Delphi Study

Introduction: Iron is an essential nutrient, required for various physiological processes. However, iron deficiency is highly prevalent worldwide and is an issue of health inequity. Iron deficiency can result in iron deficiency anemia (IDA) as it greatly influences the synthesis of hemoglobin. IDA can result in significant morbidities such as delayed motor and cognitive development in children, mood disorders, impaired immunity, heart failure, and decreased health-related quality of life. Despite its high prevalence, there remains uncertainty on the clinical applicability and evidence-base of iron-related lab test cut-offs. Routine diagnostic tests for assessing iron stores include serum or plasma ferritin and iron studies such as transferrin saturation (TSAT). While these tests are widely utilized, they are highly influenced by various confounding factors and may not always be an accurate reflection of true iron levels. Therefore, the current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. Objective: Given the complexity of determining appropriate clinical decision limits for ferritin, there is a role for consensus-driven clinical decision making. A Delphi method is one such process for achieving consensus between experts. We performed a modified (electronic) Delphi study to determine clinical decision limits for serum ferritin in commonly encountered patient populations with the goal of facilitating proper identification and management of iron deficiency. Methods: A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee and then distributed to the expert panel to vote on the agreement with the aim of achieving consensus and acquiring feedback on the presented statements. The steering committee determined a priori criteria for how responses would be managed. Using a 7-point Likert scale, statements with at least 70% of experts rating agreement as a 5 or higher were retained in the final consensus statements. Statements with 50-69% of participants rating agreement as 5 or higher were revised based on qualitative feedback provided by the experts; the revised statements were reviewed by the expert panelists in the subsequent round. Statements with fewer than 50% of experts rating agreement as 5 or higher were discarded as planned a priori. Results: Twenty-six clinical experts across 10 different specialties such as Clinical Biochemistry, Family Medicine, Pediatric Hematology, General Internal Medicine, and Hematology took part in the study. During the first round, 22 statements were reviewed by experts: 18 achieved consensus, 4 statements were revised with qualitative feedback for the second round, and 9 new statements were added based on qualitative feedback from the first round. During the second round, 13 statements were reviewed of which 10 achieved consensus, for a total of 28 statements (see table 1) and 3 statements were removed. Statements that achieved consensus addressed ferritin decision limits in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients), ferritin testing frequency, and iron replacement therapy. Conclusion: Using a modified Delphi process, the consensus statements generated by the expert panel corresponded with current evidence-based literature. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 14196: Methamphetamine Use is Associated With Increased In-Hospital Mortality After Aortic Dissection: The National Inpatient Sample Perspective

Introduction: Aortic dissection is a rare complication associated with methamphetamine abuse. Mortality in aortic dissection is high, however outcomes in methamphetamine associated aortic dissection have not been investigated. In this study, we describe the impact of methamphetamine use on in-hospital mortality in patient who presented with an acute aortic dissection using a large inpatient database. Methods: We queried the 2017 National Inpatient Sample database to identify all admissions age 18 years or older with a discharge diagnosis of aortic dissection. We accounted for survey design and built a multivariable logistic regression model to evaluate the impact of methamphetamine use on in-hospital mortality after an acute aortic dissection, while controlling for patient demographics, hospital characteristics and multiple co-morbid conditions. Results: A total of 30,060 cases of acute aortic dissection were identified, of which 395 had a history of methamphetamine use disorder. Patients with aortic dissection and history of methamphetamine use disorder were younger, male with higher incidence of co-morbid smoking and history hypertension compared to those without history of methamphetamine use disorder (Table 1). We found that in-hospital mortality for aortic dissection was significantly higher among methamphetamine users despite controlling for multiple co-morbid conditions and patient demographics, OR 3.52 (95% CI 1.73 - 7.13); p - value 0.001. Conclusions: To our knowledge, this is the first population study to demonstrate that patients with a history of methamphetamine use disorder are at increased risk of death in the hospital after acute aortic dissection. Factors contributing to these findings necessitates further prospective investigations to prevent morbidity. Special attention should be paid to young patients presenting with aortic dissection and methamphetamine use disorder should be suspected.

Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study.

The association between cardiovascular disease (CVD) and selected psychiatric disorders has frequently been suggested while the potential role of familial factors and comorbidities in such association has rarely been investigated. We identified 869,056 patients newly diagnosed with CVD from 1987 to 2016 in Sweden with no history of psychiatric disorders, and 910,178 full siblings of these patients as well as 10 individually age- and sex-matched unrelated population controls (N = 8,690,560). Adjusting for multiple comorbid conditions, we used flexible parametric models and Cox models to estimate the association of CVD with risk of all subsequent psychiatric disorders, comparing rates of first incident psychiatric disorder among CVD patients with rates among unaffected full siblings and population controls. The median age at diagnosis was 60 years for patients with CVD and 59.2% were male. During up to 30 years of follow-up, the crude incidence rates of psychiatric disorder were 7.1, 4.6, and 4.0 per 1000 person-years for patients with CVD, their siblings and population controls. In the sibling comparison, we observed an increased risk of psychiatric disorder during the first year after CVD diagnosis (hazard ratio [HR], 2.74; 95% confidence interval [CI], 2.62-2.87) and thereafter (1.45; 95% CI, 1.42-1.48). Increased risks were observed for all types of psychiatric disorders and among all diagnoses of CVD. We observed similar associations in the population comparison. CVD patients who developed a comorbid psychiatric disorder during the first year after diagnosis were at elevated risk of subsequent CVD death compared to patients without such comorbidity (HR, 1.55; 95% CI, 1.44-1.67). Patients diagnosed with CVD are at an elevated risk for subsequent psychiatric disorders independent of shared familial factors and comorbid conditions. Comorbid psychiatric disorders in patients with CVD are associated with higher risk of cardiovascular mortality suggesting that surveillance and treatment of psychiatric comorbidities should be considered as an integral part of clinical management of newly diagnosed CVD patients. This work was supported by the EU Horizon 2020 Research and Innovation Action Grant (CoMorMent, grant no. 847776 to UV, PFS, and FF), Grant of Excellence, Icelandic Research Fund (grant no. 163362-051 to UV), ERC Consolidator Grant (StressGene, grant no. 726413 to UV), Swedish Research Council (grant no. D0886501 to PFS), and US NIMH R01 MH123724 (to PFS).

Palliative Care Utilization in Burn Patients.

Background: Burn injuries are a common cause for hospitalization, and severe burns have an increased risk of death in patients with advanced age, inhalational injury, comorbid conditions. Very little is known about the utilization of palliative care consultation in burn patients. Objective: The aim of this study was to evaluate the factors influencing the utilization of inpatient palliative care consultation for patients with severe burn injuries. Methods: This was a retrospective chart review study at a single burn center. Results: Seventeen out of 191 patients (8.9%) received a palliative care consultation with the average time for consultation of 10.3 days. Factors that appear to impact consultation were age, presence of inhalational injury, and multiple comorbid conditions. Conclusion: Inpatient palliative care consultation was underutilized in patients with severe burn injurie. Further research into the outcomes of palliative care consultation could help further support the utility of early involvement in burn patients.

General Comorbidity Indicators Contribute to Fracture Risk Independent of FRAX: Registry-Based Cohort Study.

FRAX® estimates 10-year fracture probability from osteoporosis-specific risk factors. Medical comorbidity indicators are associated with fracture risk but whether these are independent from those in FRAX is uncertain. We hypothesized Johns Hopkins Aggregated Diagnosis Groups (ADG®) score or recent hospitalization number may be independently associated with increased risk for fractures. This retrospective cohort study included women and men age ≥ 40 in the Manitoba BMD Registry (1996-2016) with at least 3 years prior health care data and used linked administrative databases to construct ADG scores along with number of hospitalizations for each individual. Incident Major Osteoporotic Fracture and Hip Fracture was ascertained during average follow-up of 9 years; Cox regression analysis determined the association between increasing ADG score or number of hospitalizations and fractures. Separately, hospitalizations and ADG score independently increased the hazard ratio for fracture at all levels of comorbidity (hazard range 1.2-1.8, all P < 0.05), irrespective of adjustment for FRAX, BMD, and competing mortality. Taken together, there was still a higher than predicted rate of fracture at all levels of increased comorbidity, independent of FRAX and BMD but attenuated by competing mortality. Using an intervention threshold of major fracture risk >20%, application of the comorbidity hazard ratio multiplier to the patient population FRAX scores would increase the number of treatment candidates from 8.6% to 14.4%. Both complex and simple measures of medical comorbidity may be used to modify FRAX-based risk estimates to capture the increased fracture risk associated with multiple comorbid conditions in older patients.

DIEULAFOY LESION CAUSING LOWER GI BLEEDING: A CASE OF COVID-19 CRITICAL ILLNESS PROMPTING UNUSUAL PRESENTATION OF A MORE RARE CONDITION

DIEULAFOY LESION CAUSING LOWER GI BLEEDING: A CASE OF COVID-19 CRITICAL ILLNESS PROMPTING UNUSUAL PRESENTATION OF A MORE RARE CONDITION

Comparable Outcomes for Bebtelovimab and Ritonavir-Boosted Nirmatrelvir Treatment in High-Risk Patients With Coronavirus Disease-2019 During Severe Acute Respiratory Syndrome Coronavirus 2 BA.2 Omicron Epoch.

The effectiveness of bebtelovimab in real-world settings has not been assessed. In this retrospective cohort study of 3607 high-risk patients, bebtelovimab was used more commonly than nirmatrelvir-ritonavir for treatment of coronavirus disease 2019 (COVID-19) among older patients, immunosuppressed patients, and those with multiple comorbid conditions. Despite its use in patients with multiple comorbid conditions, the rate of progression to severe disease after bebtelovimab (1.4% [95% confidence interval, 1.2%–1.7%]) was not significantly different from that for nirmatrelvir-ritonavir treatment (1.2% [.8%–1.5%]). Our findings support the emergency use authorization of bebtelovimab for treatment of COVID-19 during the Omicron epoch dominated by BA.2 and subvariants.

Risks of paxlovid in a heart transplant recipient.

The burden of morbidity and mortality from SARS-CoV-2 infection is especially significant in heart transplant patients who are at higher risk for poor outcomes owing to immunosuppression, blunted response to vaccination, and multiple comorbid conditions. Over the last 3 years the therapeutic landscape for COVID-19 has evolved and our drug armamentaria continues to expand. With these advancements comes a time of great hope to mitigate significant illness from SARS - CoV - 2 infection. However, as with many emerging frontiers, the administration of novel therapeutics to a complex patient population remains challenging. We present a patient case encountered at our institution that highlights the need for increased awareness of nuances while managing COVID-19 infection in a heart transplant recipient.

33251 Exploring temporal disease progression and comorbidities in psoriatic disease

Psoriasis is associated with multiple systemic comorbid conditions. Most registry studies fail to recapitulate correlations between psoriasis and the temporal progression of broader diseases. Here, a holistic overview of the correlations of disease characteristics with temporal disease progression and long-term disease trajectories of psoriatic patients is explored. This observational, retrospective, noninterventional study identified psoriatic patients in the Danish National Patient Registry with an International Statistical Classification of Diseases and Related Health Problems-10th edition (ICD-10) code for psoriasis (L40.0 or L40.9) from 1999–2013.

A nationwide population-based cohort study of the incidence of severe and rare infections among adults with psoriasis in Denmark

BackgroundPatients with psoriasis have a high risk for multiple comorbid conditions. However, few studies have examined the association between psoriasis and severe and rare infections. This study reports the incidence of severe and rare infections (considered as rare in Denmark) among Danish patients with psoriasis, compared with the general population.ObjectivesThe objectives of this study were to assess the incidence and risk of severe and rare infections in Danish patients with psoriasis and the matched general population, and to compare this risk for patients with severe or mild psoriasis with that of the general population.MethodsData for individuals aged ≥18 years who were alive and resident in the source population were collected from the Danish National Patient Register between 1 January 1997 and 31 December 2018. Individuals with any of the investigated chronic infections prior to inclusion were excluded. Patients with psoriasis were matched (1 : 6) for age and sex with general population controls. Severe infections were defined as infections requiring treatment in a hospital setting and rare infections included HIV, hepatitis B and C, and tuberculosis infections. Incidence rates (IRs) were reported per 100 000 person‐years of exposure. Severe psoriasis was defined according to previous or active use of systemic or biological treatment. Patients who never received biological and/or systemic treatment were categorized as having mild psoriasis.ResultsA total of 94 450 patients with psoriasis were matched with 566 700 controls. The respective IRs were higher for patients with any psoriasis compared with controls; IR 3104·9 [95% confidence interval (CI) 3066·6 to 3143·7] and IR 2381·1 (95% CI 2367·6 to 2394·6) for any infection, IR 3080·6 (95% CI 3042·5 to 3119·3) and IR 2364·4 (95% CI 2350·9 to 2377·9) for severe infections, and IR 42·9 (95% CI 38·89 to 47·4) and IR 31·8 (95% CI 30·34 to 33·3) for rare infections, respectively. Patients with severe psoriasis had higher IRs of severe or rare infections (IR 3847·7, 95% CI 3754·3 to 3943·4) compared with patients with mild psoriasis and controls.ConclusionsAs the severity of psoriasis increases, so does the risk of severe and rare infections. Therefore, clinicians should be aware of the increased risk of severe and rare infections in patients with severe psoriasis so that early investigation and treatment can be initiated. What is already known about this topic? Few studies have looked at the incidence and prevalence of serious infections (associated with hospitalization) and rare infections including tuberculosis, hepatitis B and C, and HIV among patients with different severities of psoriasis. What does this study add? Patients with psoriasis have an increased risk of severe and rare infections.Clinicians should be aware of the increased risk of severe and rare infections in patients with severe psoriasis so that early investigation and treatment can be initiated.

33659 Incidence of severe and rare infections among adult patients with psoriasis in Denmark

Patients with psoriasis have a high risk for multiple comorbid conditions. However, few studies have examined the association between psoriasis and severe and rare infections. This nationwide population-based cohort study reports the incidence of severe and rare infections among Danish patients with psoriasis compared with the general population. Data was collected from the Danish National Patient Register on individuals ≥18 years between 1st January 1997–31st December 2018. Patients with psoriasis were matched 1:6 on age and sex with general population controls.

COVID-19 – GLOBAL CHALLENGE OF OUR TIME

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. The first diagnosed case of COVID 19 in Macedonia with a PCR diagnostic test was on February 27, 2020. The first diagnosed case of COVID 19 in Bitola with a PCR diagnostic test was on April 03, 2020. The purpose of this paper is to present our experiences in the fight against the new unknown disease, with special reference to clinical expressions and post-covid conditions. A great problem and challenge for the infectologists in Clinical Hospital, Bitola, were the therapeutic possibilities, especially in treatment of patients with multiple comorbid conditions. This paper covers patients who were treated in the Infectious Diseases department’s COVID-19 center at the Clinical Hospital, over a period of 2 years.The fight against the SARS-CoV 2 continues and we are already facing the new - seventh wave of the pandemic.

Seronegative immunity to SARS-CoV-2: a case study

BackgroundCOVID-19 presents with a variable clinical course from asymptomatic to severe respiratory distress with nearly 25% mortality in mechanically-ventilated patients. As such, there is uncertainty regarding how host factors modulate the disease course.Case PresentationThis report examines these factors in two geriatric patients with multiple comorbid conditions who were residents of the long-term care facility in West Virginia that was the epicenter of COVID-19 in the state. Each patient had substantial, unprotected exposure to SARS-CoV-2 with subsequent negative PCR and antibody testing.ConclusionsThese cases could represent an important step in understanding host factors that modulate the disease course and susceptibility of patients exposed to SARS-CoV-2, and illustrate the need for further research into host resistance relating to this pandemic.

Effectiveness of Corticosteroid Therapy for Non-Severe COVID-19 in Patients Not Requiring Supplemental Oxygen Who Have Risk Factors for Severe Disease.

Because they suppress cytokine production, corticosteroids are a candidate therapy for coronavirus disease 2019 (COVID-19). However, the effectiveness of corticosteroids is unclear for non-severe COVID-19 that does not require supplemental oxygen. This study investigated the effectiveness of corticosteroid therapy for patients with non-severe COVID-19. This retrospective observational study analyzed data from 10 patients with non-severe COVID-19 who received corticosteroid therapy at our center between July 1, 2020 and January 31, 2021. The median age of the 10 patients was 60 years, and nine were male. Nine of the 10 patients had multiple comorbid conditions (e.g., hypertension, diabetes, and obesity). Although blood oxygen saturation was maintained above 95%, all patients had persistent fever and deterioration in chest imaging findings, which led to initiation of corticosteroid treatment. The median duration symptom onset to initiation of corticosteroid therapy was 8 days. All patients received dexamethasone 6 mg/day as corticosteroid therapy, and the median period was 7.5 days. After the start of corticosteroid therapy, clinical improvement was rapid in all patients, and no patient developed severe disease. The latest World Health Organization guidance recommends against corticosteroid treatment for patients with non-severe COVID-19. In this report, early administration of corticosteroids during the non-critical phase, when oxygen supplementation was not required, was associated with early improvement and prevention of severe disease in patients with risk factors for severe COVID-19 and worsening clinical symptoms.

Prediction of Asthma Risk Using Family Health Histories identified from Population-based Electronic Healthcare Records.

ObjectivesPrediction of asthma risk can potentially be improved by including family history of asthma and related diagnoses, which reflect both genetics and shared environments. We tested the improvements in offspring asthma risk prediction using objectively-measured maternal, paternal, and offspring histories of comorbid conditions from administrative healthcare databases. ApproachA population-based cohort study was conducted using data from Manitoba, Canada. Children born from 1974 to 2000 with linkages to at least one parent using family identification numbers were included. Asthma diagnosis and comorbidities were identified from hospital and outpatient physician visit records. Lasso regression models were used to assess performance and identify important predictors. The base model included offspring demographics, diagnosed allergic conditions and respiratory infections, and diagnosed parental asthma. Subsequent models included multiple comorbid chronic health conditions for offspring and parents. ResultsThe cohort included 195,666 offspring; 51% were males, 13.6% had a parental asthma diagnosis, and 17.7% had an asthma diagnosis (median age at diagnosis: 6.0 years; interquartile range 3.0-11.0 years). The base model achieved a modest prediction performance with an area under the receiver operating characteristic curve of 0.60, sensitivity of 0.46 and a specificity of 0.67 using a threshold of 0.20. Sensitivity significantly improved when we included offspring chronic health conditions (sensitivity= 0.69; specificity = 0.66); both measures further improved when we additionally included parents’ chronic health conditions (sensitivity= 0.72; specificity = 0.70). Chronic obstructive pulmonary disease, noninfectious gastroenteritis and otitis media were among the variables that added incremental predictive value of asthma risk with odd ratios of 1.36, 1.25 and 1.18, respectively. ConclusionsIncluding offspring and parents’ chronic health conditions, identified objectively from administrative healthcare databases, improved the performance of asthma risk prediction models in children. Health histories of comorbid conditions provide important factors to improve risk prediction models of chronic health conditions, which will facilitate disease prevention and treatment strategies.

Management of late implantable cardiac device infection in the elderly patient: a case report

Introduction: Currently, the use of Cardiac Implantable Electronic Devices (CIED) is widely used, but in line with the increase in the use of CIEDs, there has also been an increase in the rate of complications. Infection accounts for about 1% of them. All of these were seen in chronically ill patients with multiple comorbid conditions within a few years of implantation. It has not become a standard treatment for infection in the pacemaker bag until now. This study aims to report an immunocompetent patient who developed a pacemaker pocket infection with Escherichia coli bacteria after more than 10 years post-implantation who was successfully treated by moving the bag more medial to sterilization on a pacemaker battery. Case Report: We report an 89 year-old, elderly patient with sick sinus syndrome with a pacemaker pocket infection. The method we used was to explant the battery from the pacemaker and sterilize it with gas, the next day it was reassembled by moving the bag more medially. Loading of the vancomycin antibiotic was carried out for 14 days while still controlling the renal function Conclusion: Staphylococcus aureus causes the majority of CIED infections, especially in immunocompromised elderly patients. Proper treatment of infected pacemaker pouches is necessary with minimal improvement on antibiotics. If left untreated, it can develop into endocarditis which has a high mortality rate.