Requiring Hospital Treatment Research Articles

LCHAD chorioretinopathy case series long‐time follow up

Aims/Purpose: The aim of this study is the present a long‐time follow up of patients with LCHAD deficiency – ocular findings and it's evolution.Methods: The study included a group of 8 patients diagnosed with LCHAD deficiency, confirmed by genotyping as a mutation in HADHA gene c.1528 G > C. Patients were evaluated yearly, since 2013 to 2024. Examination included slit‐lamp examination, best corrected vision acuity, sOCT, fundus imaging and visual field – if possible to obtain. Patients were questioned about events of metabolic decompensation that required hospital treatment in the period of time since previous ophthalmological evaluation.Results: Progressive deterioration of BCVA along with progressive myopia were observed. The loss of vision usually progressed rapidly and was unsymmetrical, thus usually unnoticed by the patient if the fellow eye maintained good vision acuity. The deterioration of the vision acuity was accompanied by presence of central scotoma, progression of myopia, chorioretinal thinning and in some cases forming of staphyloma. Pigment accumulation in the foveal area and in the central area was not associated with the vision deterioration or visual field loss. In 2 cases MNV occurred, followed by macular scarring in one patient. MNV if treated by anti‐VEGF injections without a delay responded very well, 2‐3 injections were needed to maintain the deasease inactive. Positive scotomas were associated with macular hemorhage. Bad metabolic status recognized by repeated necessity of in ward treatment due to metabolic decompensations was associated with progressive chorioretinopathy and it's complications.Conclusions: Presence of the metabolic decompensations requires ophthalmological vigilance as it is a main factor for visual deterioration. The chorioretinal thinning is followed by staphyloma and progressive myopia. MNV can be successfully treated in those patients but evaluation should be done monthly afterwards.

The Risk of Hospital Admission for an Acute-Onset Psychiatric Disorder in Adolescents and Adults Treated with Isotretinoin: A French, Nationwide, Population-Based, Case-Time-Control Study.

Oral isotretinoin is the only effective treatment for severe acne without an alternative. Isotretinoin has been linked to the occurrence of acute psychiatric disorders outside suicidal behaviors. There are few large-scale epidemiological studies in this area, and the putative associations are unclear. Our objective was to determine whether adolescents and young adults have an elevated risk of acute-onset psychiatric disorder requiring hospital treatment within 2 months of starting isotretinoin treatment. Our data source was the French national health insurance database (Système National des Données de Santé, SNDS), 2010-2015. We performed a case-time-control study nested in an exhaustive, nationwide cohort of all French adolescents and young adults aged 10-25 years treated with isotretinoin. The outcome was an acute-onset psychiatric disorder requiring hospitalization (including anxiety, depressive, mood, adjustment, and psychotic disorders). A conditional logistic model was used to estimate odds ratios (ORs) with their 95% confidence interval (CI) for acute psychiatric events. 2,284 acute-onset psychiatric disorder requiring hospitalization were recorded for the study population of 262,786 patients. Among the patients with at least one psychiatric event, 88 had started taking isotretinoin in the risk period (0-2 months before the date of the event), versus 81 in the reference period (2-4 months before the event). A comparison with the 383 and 355 time-trend matched controls who started taking isotretinoin in the risk and reference periods, respectively, yielded a case-time-control OR (95% CI) of 1.01 (0.72-1.41). Psychiatric events managed outside the hospital system were not recorded. Our findings are reassuring for clinicians concerning the risk of severe acute-onset psychiatric events after isotretinoin initiation.

Twin home birth: Outcomes of 100 sets of twins in the care of a single practitioner.

Research on community (home or birth center) twin birth is scarce. This study evaluates outcomes of twin pregnancies entering care with a single community practitioner. This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during a 12-year period. Outcomes measured included mode of birth; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; birth interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity. 31 women (31%) transferred to a hospital-based clinician prior to labor. Of the 69 pregnancies still under the obstetrician's care when labor began, 79.7% (n = 55) were Dichorionic Diamniotic and 21.3% (n = 14) were Monochorionic Diamniotic. The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35-42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment. A community birth can lead to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section-especially when there is no option of a hospital vaginal birth. Training all practitioners in vaginal twin and breech birth skills remains an imperative.

Zur falschen Zeit am falschen Ort – Eine Kasuistik

Purpose. The case report describes the consequences of a fireworks injury to the left eye of a 63-year-old man and is also dealing with the whole complex of fireworks injuries in Germany. Material and Methods. A comprehensive examination of the anterior and posterior segment of the eye including various surgical procedures were performed due to the severity of the injury. This included immediate ocular ultrasonography, radiological diagnostics and surgery under local anesthesia to rule out a bulbar rupture. The surgical procedures included a pars plana vitrectomy, pars plana vitrectomy revision, removal of the silicone oil tamponade and, due to the pain symptoms, several cyclodestructive procedures and enucleation of the eye. Results. Despite all treatment efforts, 4 months after the injury there was still permanent pain that could hardly be reduced with medication in conjunction with an eye that was completely blind due to total optic atrophy, which is why a prosthetic fitting was carried out. Conclusion. Firework injuries are a serious social problem. A quarter of all patients with a firework-related eye injury usually require hospital treatment and around 5% of patients suffer a bulbar rupture. From an ophthalmological point of view, a discussion regarding private fireworks is necessary.

Severe hypoglycaemia and diabetic ketoacidosis in adults presenting to a hospital emergency department: Adverse prognostic markers for survival in type 2 diabetes and the role of SGLT2 inhibitors.

To determine the prognosis associated with severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in adults presenting to a hospital emergency department (ED). Medical records of adults with type 1 (T1D) and type 2 (T2D) diabetes who attended the ED with SH and DKA between 1 January 2019 and 30 June 2023, were reviewed for comorbidities, long-term survival, mortality and causes of death. A total of 429 episodes of DKA occurred in 293 people and 643 episodes of SH in 515 people. DKA predominated in T1D (77.6%) and SH in T2D (54.3%). In T2D, 32.3% of DKA events were associated with sodium-glucose cotransporter-2 inhibitor (SGLT2-i) medication. In both SH and DKA, patients with T2D were older and had more comorbidities than T1D, particularly cardiorenal disease, heart failure, cognitive impairment and cancer (all p < 0.005). Compared with T1D, mortality was higher in T2D after SH (48.4% vs. 19.9%, p < 0.005) and after DKA (30.8% vs. 13.4%, p = 0.001) with shorter median times to fatal outcome (SH: 134 vs. 511 days; DKA: 43 vs. 266 days, both p < 0.005). Long-term survival was lower (p < 0.005) and mortality risk was higher in T2D after index presentation with SH (HR 3.43 [95% CI: 2.43-4.84], p < 0.005) and DKA (HR 3.00 [95% CI: 1.77-5.10], p < 0.005). Irrespective of diabetes type, most causes of death in SH and DKA were non-cardiovascular. SH and DKA events requiring hospital treatment herald a poor prognosis with greater mortality in T2D adults with multimorbidity. A significant number of DKA episodes in T2D occurred in people receiving SGLT2-i medication.

Acute abdominal pain in general practice

Acute abdominal pain (AAP) represents the 9th most common complaint in general practice. The etiologies are multiple: a third are non-specific, but around 10% require hospital treatment. An accurate history enables a correct diagnosis in 76% of cases, and abdominal palpation can detect a possible surgical abdomen. This article summarizes the intra- and extra-abdominal causes of AAP, the diagnostic strategies, and the most appropriate complementary examinations. It lists the most common causes in general practice, as well as their management and reviews the warning signs not to be missed.

Characteristics and outcomes of inpatients aged 85 and older with thoracolumbar vertebral fractures: impact on hospital stay and mortality

BackgroundThere is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on “short-term” hospital outcomes.MethodsAll patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed.ResultsA total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as “Osteoporotic Fracture” (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%.ConclusionVFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.

Impact of respiratory tract infections on spinal muscular atrophy with focus on respiratory syncytial virus infections: a single-centre cohort study.

Spinal muscular atrophy (SMA) is a degenerative neuromuscular disorder leading to muscle hypotonia, weakness, and respiratory and bulbar impairment. Infants with SMA have an increased risk of respiratory tract infections (RTI) including severe respiratory syncytial virus (RSV) infections. Therefore, guidelines for the treatment of SMA recommend RSV prophylaxis with palivizumab for patients aged below two years who have compromised motor functions ("non-sitters"). Since palivizumab is not approved for RSV prophylaxis in SMA patients in Switzerland, payers usually do not grant cost approvals for this indication. Therefore, this study aimed to investigate the frequency of severe RTI among SMA patients focusing on RSV infections requiring hospital treatment and to determine the long-term impact of RSV infections on the natural history of SMA. A single-centre cohort study at the tertiary paediatric Neuromuscular Centre Zurich, Switzerland, including data of SMA patients with a genetic-based therapy initiated below two years of age between May 2019 and December 2022. All hospitalisations were analysed with a focus on severe RTI and especially RSV infections, and their impact on nutritional and respiratory function. The costs of inpatient treatment of RSV infections were determined and compared with estimated expenses for RSV prophylaxis with palivizumab. 12 SMA patients (median age at treatment initiation: 3.5 months, range: 0-17 months) were followed for a cumulative period of 25.75 years (7 SMA type 1; 5 SMA type 2 including one presymptomatic individual). With an incidence rate of 2.34 per patient-year, the risk of severe RTI was especially high in SMA type 1 (versus 0.1 in SMA type 2, p = 0.044). A total of 37 hospitalisations (279 hospital days) was necessary for the treatment of RTI in general; 9 of them were attributed to RSV infections (in 5 SMA type 1 patients; 84 hospital days). Only 3/12 SMA patients had received seasonal RSV prophylaxis with palivizumab. No RSV infections requiring hospital treatment occurred in patients while receiving seasonal RSV prophylaxis. During RTI, nutritional support had to be commonly initiated and continued after discharge. In 3/7 SMA type 1 patients, non-invasive ventilation was started during acute treatment for RTI and continued to the end of follow-up. We observed a high risk of RTI, especially RSV infections, among young SMA patients. Failure to adhere to established care protocols, for example by omitting RSV prophylaxis, may be linked to a heightened risk of morbidity in these children.

A brief description of the epidemiology of dengue in Dili, Timor-Leste, 2018-2022.

Dengue virus (DENV) infection causes 390 million infections per year and 40,000 deaths globally. It is endemic in many countries in Asia, Africa, the Americas, the Caribbean, and Oceania. Dengue is endemic in Timor-Leste year-round, but peak transmission occurs during the rainy season. We briefly describe the epidemiology of DENV in the Municipality of Dili between 2018 and 2022. There were 6,234 cases notified, with a mean annual incidence rate of 330 cases per 100,000 population. There were 55 deaths (case fatality rate 0.9%). The peak annual incidence (3,904 cases) occurred in 2022 after an outbreak was declared in January of that year; this outbreak included 760 cases of dengue haemorrhagic fever and 35 deaths. The number of outbreak cases requiring hospital treatment exceeded the usual capacity, but facilities established for coronavirus disease 2019 (COVID-19) isolation and treatment were repurposed to meet this demand. Existing strategies of vector control, minimising breeding sites and promoting early presentation for treatment should continue, as should the utilisation of surveillance systems and treatment facilities established during the COVID-19 pandemic. However, dengue incidence remains high, and other dengue control strategies-including the deployment of Wolbachia-infected mosquitoes-should be considered in Timor-Leste.

Impact of physical and sexual abuse on risk of hospitalisations for physical and mental illnesses: insights from two large prospective cohort studies

Physical abuse can lead to severe health consequences that extend beyond immediate harm. We explored the associations of physical abuse experienced during childhood and adulthood with a wide range of adult health conditions requiring hospital treatment. We utilised data from a sub-cohort of 157,366 UK Biobank participants (46.4% of the baseline population; age range 45-81; 89,101 women) and repeated analyses in an independent population of 85,929 adults from the Finnish Public Sector (FPS) study (age range 17-78; 68,544 women). Participants in both cohorts reported instances of physical and sexual abuse at study baseline. Follow-up included 77 common health conditions ascertained from linkage data to national hospital and mortality registries. Mean follow-up duration was 4.6 years (SD 0.14) in UK Biobank and 10.6 years (4.3) in FPS. Physical and sexual abuse was associated with 22 mental and physical health conditions. After multivariable adjustments, participants who experienced abuse during both early and later stages of life had a 2.12- (95% confidence interval 1.39-3.23) to 3.37-fold (1.52-7.45) increased risk of mental and behavioural disorders, a 1.46 (1.20-1.79) to 1.83 (1.05-3.20) times increased risk of metabolic, haematologic, and respiratory diseases, and a 1.24 (1.07-1.45) times higher risk of inflammatory diseases compared with non-exposed participants. The absolute risk difference between these groups was greatest for metabolic and haematologic conditions (rate 381 and risk difference 160 per 100,000 person-years). Frailty, comorbidities, and competing risk of death did not modify these associations, but the possibility of bias or residual confounding cannot be excluded. Repeated exposure to physical and sexual abuse amplifies the risk of hospitalisations from mental disorders and physical diseases spanning diverse organ systems. Addressing this issue may necessitate multifaceted strategies, including shifts in societal norms, legal measures, and increased healthcare provision for affected individuals and their families. Wellcome Trust, UK Medical Research Council, U.S. National Institute on Aging, Academy of Finland.

What is a ‘good enough’ prison? An empirical analysis of key thresholds using prison moral quality data

Performance thresholds and minimum standards in prison have preoccupied policy makers and practitioners alike for some time. These standards are based on widely accepted statements of principle, but benchmarks are rarely set or explored empirically. Nor has there been any attempt to describe or define higher-end thresholds; the point at which outcomes become positive, or stated principles are achieved. In this study, we provide an empirical demonstration of how quality of life thresholds may be determined using data from 518 Measuring the Quality of Prison Life (MQPL) surveys conducted in prisons in England and Wales (2009–2020) and examine their relationship to five violence outcomes: serious prisoner on prisoner assaults, serious assaults on staff, self-harm incidents requiring hospital treatment, self-inflicted deaths, and homicides. The results suggested that thresholds exist for most of the MQPL dimensions. A set of lower ‘unsafe’ and higher ‘minimally safe’ thresholds were produced. We found that the scores of prisons below the lower threshold had a very strong relationship with each of our five serious forms of violence in prison. Similarly, prisons that did not manage to cross the ‘minimally safe’ threshold also had strong relationships with incidents of violence in their prison but were at slightly lower risk of those incidents occurring. Striking differences in mean incidents rates were found when comparing prisons below the lower threshold to prisons above the ‘minimally safe’ threshold. Our findings suggest that to operate a safe enough (and therefore legitimate) prison, a combination of harmony, security and professionalism dimensions above a certain threshold should be achieved.

Near-term forecasting of Covid-19 cases and hospitalisations in Aotearoa New Zealand.

Near-term forecasting of infectious disease incidence and consequent demand for acute healthcare services can support capacity planning and public health responses. Despite well-developed scenario modelling to support the Covid-19 response, Aotearoa New Zealand lacks advanced infectious disease forecasting capacity. We develop a model using Aotearoa New Zealand's unique Covid-19 data streams to predict reported Covid-19 cases, hospital admissions and hospital occupancy. The method combines a semi-mechanistic model for disease transmission to predict cases with Gaussian process regression models to predict the fraction of reported cases that will require hospital treatment. We evaluate forecast performance against out-of-sample data over the period from 2 October 2022 to 23 July 2023. Our results show that forecast performance is reasonably good over a 1-3 week time horizon, although generally deteriorates as the time horizon is lengthened. The model has been operationalised to provide weekly national and regional forecasts in real-time. This study is an important step towards development of more sophisticated situational awareness and infectious disease forecasting tools in Aotearoa New Zealand.

EXTRACELLULAR VESICLE-FUNCTIONALIZED FIBRINOGEN AND MAGNESIUM SCAFFOLDS TO PROMOTE BONE REGENERATION

Bone defects and fractures, caused by injury, trauma or tumour resection require hospital treatment and temporary loss of mobility, representing an important burden for societies and health systems worldwide. Autografts are the gold standard for promoting new bone formation, but these may provide insufficient material and lead to donor site morbidity and pain. We previously showed that Fibrinogen (Fg) scaffolds promote bone regeneration in vivo (1), and that modifying them with 10mM of Magnesium (Mg) ions modulates macrophage response in vitro and in vivo (2). Also, we showed that Extracellular Vesicles (EV) secreted by Dendritic Cells (DC) recruit Mesenchymal Stem/Stromal Cells (MSC)(3).Herein, we aim to functionalize FgMg scaffolds with DC-EV, to promote recruitment and osteogenic differentiation of MSC.Scaffolds were produced by freeze-drying (2). Ethical permission was sought for all studies. Primary human peripheral blood monocyte-derived DC were cultured, their secreted EV were isolated by differential (ultra)-centrifugation and characterised by transmission electron microscopy and nanoparticle tracking analysis (3). Bone marrow MSC were used to determine the impact of EV-functionalized scaffolds through migration assays and their osteogenic differentiation was assessed by Alizarin Red staining.Fg and FgMg scaffolds functionalized with EV were characterized. Fg and FgMg scaffolds functionalized with DC-secreted EV were more efficient at recruiting MSC than scaffolds alone. MSC cultured on FgMg scaffolds showed significantly increased calcium deposits, in comparison with those cultured on Fg scaffolds.Fg scaffold modification by Mg promotes MSC osteogenic differentiation, while their functionalization with DC-secreted EV acts to promote MSC recruitment. This renders the FgMg-EV functionalized scaffolds an attractive material to promote new bone formation.Acknowledgments: Work funded by Orthoregeneration Network (ON Pilot Grant Spine 2021, EVS4Fusion). MCT supported by ERASMUS+ program.

Hospital services utilisation and cost before and after COVID-19 hospital treatment: Evidence from Indonesia.

To estimate hospital services utilisation and cost among the Indonesian population enrolled in the National Health Insurance (NHI) program before and after COVID-19 hospital treatment. 28,159 Indonesian NHI enrolees treated with laboratory-confirmed COVID-19 in hospitals between May and August 2020 were compared to 8,995 individuals never diagnosed with COVID-19 in 2020. A difference-in-difference approach is used to contrast the monthly all-cause utilisation rate and total claims of hospital services between these two groups. A period of nine months before and three to six months after hospital treatment were included in the analysis. A substantial short-term increase in hospital services utilisation and cost before and after COVID-19 treatment was observed. Using the fifth month before treatment as the reference period, we observed an increased outpatient visits rate in 1-3 calendar months before and up to 2-4 months after treatment (p<0.001) among the COVID-19 group compared to the comparison group. We also found a higher admissions rate in 1-2 months before and one month after treatment (p<0.001). Consequently, increased hospital costs were observed in 1-3 calendar months before and 1-4 calendar months after the treatment (p<0.001). The elevated hospital resource utilisation was more prominent among individuals older than 40. Overall, no substantial increase in hospital outpatient visits, admissions, and costs beyond four months after and five months before COVID-19 treatment. Individuals with COVID-19 who required hospital treatment had considerably higher healthcare resource utilisation in the short-term, before and after the treatment. These findings indicated that the total cost of treating COVID-19 patients might include the pre- and post-acute period.

Biologics Therapy in Paediatric Rheumatic Diseases in Hong Kong

Background: There is a substantial expansion in the number of biologics available for the treatment of JIA and childhood rheumatic disease over the past decades. However, there is no report on their use and safety profile in the local paediatric population. Method of study: This is a multi-centred retrospective cohort study, recruiting patients followed up in three Paediatric departments in Hong Kong. Subjects who were followed up for childhood-onset rheumatic diseases and was treated with any of the biologic DMARs on or before the 31st December 2022, were reviewed. Results: A total of 96 patients who received biologic DMARs in the studied period were reviewed. Sixty patients were diagnosed to have JIA, cSLE (10), uveitis (8), refractory KD (7), JDM (2), COVID-MISC (3), and others (6). Concerning the JIA group, male: female is 1.4:1. 38% of the patients had polyarticular JIA and 50% had ERA who failed conventional treatment with various cDMARS. Concerning the nature of biologics, 85% of JIA patients used different types of TNF-blockers, including etanercept (38.3%), adalimumab (40%), golimumab (5%) and infliximab (3.3%). Six JIA patients used tocilizumab and one used abatacept as second-line treatment after fail response to TNF-blockers. One JIA patient was on tofacitinib to avoid subcutaneous injection. For other biologics, infliximab for refractory KD (8), rituximab for cSLE and JDM (7 and 1), belimumab in cSLE (2) and anakinra in COVID-MISC (4). One JIA-ERA patient developed lymphoma six months after stopping adalimumab and recovered after chemotherapy. One cSLE patient received rituximab and developed EBV-related CNS lymphoma with repeated infections that required hospitalization. Most patients tolerated the biologic DMARs well without complications. There was no tuberculosis infection or activation. Two cSLE patients developed herpes zoster after rituximab infusion and required hospital treatment. Two patients on adalimumab developed recurrent folliculitis and one had to stop treatment. One patient developed bacteria endophthalmitis while on adalimumab. Four patients on adalimumab developed injection site reactions and one patient need to change to another biologic. One patient on adalimumab developed positive lupus serology without clinical features. Conclusion: A broad spectrum of biologics has been used in children with various rheumatic diseases without major complications. Although rare, 2 patients developed lymphoma during the study period. Although there is no causal relationship identified with the use of biologics, continuous monitoring of the long-term safety of these drugs in the paediatric cohort is recommended.

Cardiac deceleration capacity is associated with severity of inflammation in COVID-19

PurposeIn this pilot study, we investigated the cardiac autonomic activity of coronavirus disease 2019 (COVID-19)-infected hospitalized patients. COVID-19 is characterized by cough, fever, and dyspnea, which in some severe cases can lead to hypoxia, respiratory failure, and shock. Since breathing disorders and pulmonary diseases are tightly linked to autonomic dysfunction, we analyzed the cardiac autonomic activity by measuring the deceleration capacity (DC) in COVID-19 patients.MethodsIn 14 adults (4 men and 10 women) with a median age of 63.5 years and positive for SARS-CoV-2 by polymerase chain reaction (PCR) with severe symptoms requiring hospital treatment, a high-resolution digital 30 min electrocardiogram (ECG) in Frank leads configuration was performed in a resting supine position within the first 48 h after hospital admission. DC was assessed using validated software and associated with several markers of inflammation and clinical course.ResultsThe study revealed a significant association between reduced DC (≤ 2.5 ms) and older age (74 years) in COVID-19 patients, compared to those with a higher DC > 2.5 ms (56.5 years). However, the duration of hospitalization was similar for both groups. There was a nonsignificant trend towards a higher maximum viral load in patients with reduced DC. Further, patients with a DC ≤ 2.5 ms showed higher levels of inflammatory markers such as C-reactive protein (CRP) and procalcitonin (PCT), as well as leukocytosis, compared to patients with a DC > 2.5 ms. Also, the COVID-19-severity marker ferritin was significantly elevated in patients with lower DC. Other markers associated with COVID-19, such as lactate dehydrogenase (LDH) and creatine kinase (CK), exhibited comparable levels in both groups.ConclusionsReduced DC (≤ 2.5 ms) was significantly associated with older age, increased inflammatory markers, and elevated ferritin in patients with COVID-19. These findings suggest that DC might serve as a valuable indicator for predicting the risk of severe inflammation in COVID-19 and possibly complications associated with this disease, such as heart failure. Further studies are needed to confirm these observations and clarify the clinical significance of DC in COVID-19 and other infectious diseases.

Which burden of COVID-19 was greater: main diagnosis or comorbidity?

Abstract Background Severe cases of COVID-19 require hospital treatment due to the risk of developing a life-threatening condition. Monitoring and reporting indicators of severe forms of COVID-19 in the population can warn health authorities of its increasing presence and the growing demand for hospital treatment and measures to protect persons at risk. By estimating the total and age-sex disaggregated Years Lived with Disability (YLD), we differentiated the magnitude of the burden of COVID-19 among inpatients with COVID-19 as the main diagnosis and as comorbidity. Methods Within the EU-COST Action 18218 and as partners of the BoCO-19 study, we calculated the total age and sex-disaggregated YLD and YLD/100,000 population due to COVID-19 for hospitalized cases in Serbia from 2020 March 6 - December 31. The number of cases of ICD-X: U07.1 and U07.2 as the main diagnosis, separately and with U07.1 as comorbidity, were taken from the hospitalization database of the Institute of Public Health of Serbia, and disability weights and length of the disease from the German national BoD study. Results In 2020, 25,496 covid-19 cases were hospitalized (55.9% were men). 65.7% of all cases were covid-19 as a comorbidity diagnosis. 195.0 YLD was estimated for all hospitalized cases (man: 109.0 YLD or 3.2 YLD /100,000, women: 95.9 YLD or 2.4 YLD/100,000). YLD and YLD/100,000 due to covid-19 as a comorbidity diagnosis were the highest among males aged 40-84 and females aged 55-84. Conclusions In Serbia, more men than women were hospitalized due to COVID-19. Hospitalized adult men had the most YLD and the highest YLD rates. Inpatients in which covid-19 was diagnosed as a comorbidity had higher YLD and YLD rates, especially male patients. On average, the YLD burden of COVID-19 as a comorbidity for hospitalized cases was almost triple that of COVID-19 as the main diagnosis, suggesting the need for improving health protection and safety measures. Key messages • In Serbia, among hospitalized cases, the YLD due to COVID-19 is three times higher in patients diagnosed with COVID-19 as a comorbidity than in the main diagnosis. • To decrease the YLD due to severe COVID-19, enhancing the safety and health protection of inpatients from contracting COVID-19 as comorbidity is of utmost importance.

Plasma concentration of fucosyltransferase 7 is not associated with the number of clinically overt vaso-occlusive events in sickle cell disease.

To determine if the number of vaso-occlusive events in SCD relates to plasma concentration of fucosyltransferase 7 (FUT7), which catalyses the synthesis of selectin ligands. A prospective, analytical study. Haematology and Chemical Pathology Departments of tertiary healthcare centres. Steady state HbSS individuals aged 13-45 years, 20 had 3 or more vaso-occlusive crises that required hospital admission in the previous year (with or without complications of SCD); 17 other HbSS persons had 0-1 vaso-occlusive crisis that required hospital admission in the previous year and no disease complications. Steady-state plasma concentrations of FUT7 measured by ELISA were compared between SCD patients who had one vaso-occlusive crisis requiring hospital treatment in the previous year but no disease complications and those who had >3 crises with or without complications. Plasma level of FUT7and the number of vaso-occlusive events in each HbSS patient. Mean + standard deviation plasma concentration of FUT7 was 8.6 + 2.7 ng/ml in patients with >3 vasoocclusive crises in the previous year and 7.3 + 1.7 ng/ml in those with 0-1 crisis and no complications; independent sample t-test, p > 0.05, not significantly different. Plasma concentration of fucosyltransferase7 is not associated with the number of vaso-occlusive events in sickle cell disease. None declared.

Efficacy and safety of medical termination of pregnancy in a regional primary care setting.

Australia has demonstrated high efficacy and safety of medical termination of pregnancy (MToP) using a mifepristone-buccal misoprostol regime. The provision of medical termination services in primary care has the potential to alleviate access barriers, particularly in rural and regional populations. Large-scale data are needed to support the expansion of this model. The aim was to determine the efficacy and safety of nurse-led MToP within a regional general practice clinic. A retrospective cohort study of patients prescribed MToP from October 2014 to April 2020. Clinic nurses assessed patient eligibility and provided information, non-directive counselling and instructions. The general practitioner then confirmed eligibility, obtained informed consent and prescribed. Patients were administered 200 mg of mifepristone orally in a pharmacy and then self-administered 800-μg buccal misoprostol 36-48 h later at home. A total of 998 patients were included in this study, with the median patient age being 27.3 years and 30.3% of patients travelling over 100 km to access the service. MToP was successful in 965 (96.7%) patients. There were 36 (3.6%) complications, of which 33 were incomplete MToP. Haemorrhage requiring transfusion, pain requiring hospital treatment and suspected infection were rare, each having a frequency of one (0.1%). Our follow-up rate was 74.8%, with a strong correlation identified between increased gestational age and decreased follow-up (P < 0.001). This study is a large Australian example demonstrating high efficacy and safety of nurse-led MToP within regional general practice. The establishment of similar services in rural and regional Australia may address geographical and financial barriers to termination access.

Effect of COVID-19 on Musculoskeletal Performance in Gait and the Timed-Up and Go Test.

The total number of confirmed cases of COVID-19 caused by the SARS-CoV-2 virus infection is over 621 million in the world. In approximately 63% of cases, the patient still experiences persistent symptoms 30 days after the onset of symptoms or hospitalisation, and 45.9% of patients have experienced or will experience symptoms for at least three months. Despite the prevalence of chronic symptoms and pathological changes that may affect gait and functional mobility in people with a history of COVID-19, there are few publications investigating the impact of these abnormalities. This study aims to determine the long-term effects of COVID-19 on gait and the Timed-Up and Go Task. A total of 30 individuals took part in the experiment. The subjects in the study group were infected with the COVID-19 virus and required hospital treatment. Prior to the study, the subjects had no chronic diseases or other conditions affecting the musculoskeletal system. The non-infected by COVID-19 group was a healthy population with no history of COVID-19 disease. The study used the inertial system wireless motion analysis system based on 15 inertial sensors (inertial measurement units, IMUs). IMU sensors were placed on the following body segments: head, sternum, middle and lower spine, shoulder, arm, forearm, hand, shank, for the left and right limb. Movement task reports generated from the recording were created using myoRESEARCH 3.10. The subjects in the study group were asked to perform a movement task test-the Timed-Up and Go Test (TUG): sit-to-stand, walk (3 m) without change in direction, walk termination, and stand-to-sit. It took 46% longer for those infected by COVID-19 (participants) to complete the entire movement task compared to those in the not-infected by COVID-19 group. Sit-to-Stand Time [s] was greater in the infected by COVID-19 group and was 2.1 ± 0.7. Mean Walking Speed [m/s] was lower than in the not-infected by COVID-19 group and was 0.26 ± 0.07. Walking cadence [steps/min] was lower and was 21.2 ± 1.2. Infected by COVID-19 participants achieved a smaller anterior pelvic tilt angle (p < 0.001) and a smaller hip flexion angle (p = 0.025), with an increase in knee (p < 0.001) and ankle (p < 0.001) flexion angles. Individuals in the infected by COVID-19 group present changes in the ranges of motion and the time to complete the TUG task, despite the fact that at least eight weeks passed after hospital discharge.