Hospital Status Research Articles

Association of Minority-Serving Hospital Status with Post-Discharge Care Utilization and Expenditures in Gastrointestinal Cancer.

Disparities in utilization of post-discharge care and overall expenditures may relate to site of care and race/ethnicity. We sought to define the impact of minority-serving hospitals (MSHs) on postoperative outcomes, discharge disposition, and overall expenditures associated with an episode of surgical care. Patients who underwent resection for esophageal, colon, rectal, pancreatic, and liver cancer were identified from Medicare Standard Analytic Files (2013-2017). A MSH was defined as the top decile of facilities treating minority patients (Black and/or Hispanic). Theimpactof MSH on outcomes of interest was analyzed using multivariable logistic regression and generalized linear regression models. Textbook outcome (TO) was defined as no postoperative complications, no prolonged length of stay, and no 90-day mortality or readmission. Among 113,263 patients, only a small subset of patientsunderwent surgery at MSHs (n=4404, 3.9%). While 52.3% of patients achieved TO, rates were lower at MSHs (MSH: 47.2% vs. non-MSH: 52.5%; p<0.001). On multivariable analysis, receiving care at an MSH was associated with not achieving TO (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.76-0.87) and concomitantly higher odds of additional post-discharge care (OR 1.10, 95% CI 1.01-1.20). Patients treated at an MSH also had higher median post-discharge expenditures (MSH: $8400, interquartile range [IQR] $2300-$22,100 vs. non-MSH: $7000, IQR $2200-$17,900; p=0.002). In fact, MSHs remained associated with a 11.05% (9.78-12.33%) increase in index expenditures and a 16.68% (11.44-22.17%) increase in post-discharge expenditures. Patients undergoing surgery at a MSH were less likely to achieve a TO. Additionally, MSH status was associated with a higher likelihood of requiring post-discharge care and higher expenditures.

Differences in the surgical management of early-stage hepatocellular carcinoma at minority versus non-minority-serving hospitals

BackgroundWe examined differences in surgical intervention at minority-serving hospitals versus non-minority-serving hospitals among patients with early-stage hepatocellular carcinoma. We also investigated associations between surgical management and overall survival, stratified by minority-serving hospital status. MethodsPatients with early-stage hepatocellular carcinoma, defined as cT1, were identified within the National Cancer Database (2004–2018). The primary outcome was surgical intervention (resection, ablation, or transplantation). The proportion of minority (non-Hispanic Black or Hispanic) patients treated at each facility was determined, and hospitals in the top decile were considered minority-serving hospitals. ResultsA total of 46,703 patients with early-stage hepatocellular carcinoma were identified, of whom 4,214 (9.0%) were treated at minority-serving hospitals. Patients treated at minority-serving hospitals were less likely to undergo surgical intervention than patients treated at non-minority-serving hospitals (odds ratio = 0.87, 95% confidence interval: 0.81–0.94). Minority patients treated at non-minority-serving hospitals were less likely to undergo surgical intervention than White patients (odds ratio = 0.86, 95% confidence interval: 0.82–0.90) and had a further associated decrease in the likelihood of surgical intervention when treated at minority-serving hospitals (odds ratio = 0.81, 95% confidence interval: 0.69–0.94). Regardless of minority-serving hospital status, surgery was associated with improved overall survival. There were no clinically meaningful differences in overall survival between White and minority patients who underwent surgery either at minority-serving hospitals or non-minority-serving hospitals. ConclusionsPatients with early-stage hepatocellular carcinoma had an associated decrease in the likelihood of surgical intervention when treated at minority-serving hospitals. Minority patients treated at minority-serving hospitals had an associated decrease in the likelihood of surgery, but to a lesser extent when treated at non-minority-serving hospitals. Surgery was associated with improved overall survival regardless of minority or minority-serving hospital status.

Pseudo-Chilblains in Adult Patients with Confirmed COVID-19: A Systematic Review

Background: Pseudo-chilblains have been associated with COVID-19. Many reports, however, lack confirmation of COVID-19 infection. While likely associated, all chilblains/chilblain-like lesions during this time should not be assumed to be COVID-19 related. This study examines the characteristics of adults with pseudo-chilblains and confirmed COVID-19. Methods: A systematic review of PubMed/MEDLINE database was performed using the PRISMA guidelines. Adults (&gt;18 years) with confirmed COVID-19 were included. De-identified registries were excluded to avoid duplication. We extracted study design, age, sex, race, geographic location, relationship of COVID-19 diagnosis to chilblains onset, confirmatory testing, hospitalization status, anatomical location, cold/damp exposure, presence/absence/description of pseudo-chilblains symptoms, presence/absence of biopsies/histopathologic findings, tissue IHC/PCR, presence/absence/details of extracutaneous COVID-19 disease, pre-existing chilblains, treatment and resolution timeline. The search was completed in July 2022. Results: We identified 13 studies (29 patients). In COVID-19-infected adults, pseudo-chilblains were reported primarily from North America and Europe, occurring in both sexes over a wide age-range, affected well and ill patients, favored the hands and feet and could be symptomatic or asymptomatic. Most patients had extracutaneous symptoms. Resolution time ranged from &lt;1 week to &gt;50 days. There was marked variation in treatment strategies and appearance of pseudo-chilblains relative to entire disease course. Biopsies were infrequently performed but findings similar to classical chilblains were described. Conclusions: Many patients reported as pseudo-chilblains of COVID-19 lack confirmed infection. Infection confirmation, photographic documentation and histopathology are critical to establish homogeneity in reported pseudo-chilblains during this global pandemic. Further work clarifying the relationship of acral eruptions and COVID-19 is necessary.

Body temperature as a predictor of mortality in COVID-19

It remains uncertain if body temperature (BT) is a useful prognostic indicator in coronavirus disease 2019 (COVID-19). We investigated the relationship between BT and mortality in COVID-19 patients. We used a de-identified database that prospectively collected information from patients screened for COVID-19 at the Mount Sinai facilities from February 28, 2020 to July 28, 2021. All patients diagnosed with COVID-19 that had BT data were included. BT at initial presentation, maximum BT during hospitalization, comorbidity, and vaccination status data were extracted. Mortality rate was assessed as a primary outcome. Among 24,293 cases, patients with initial BT below 36 °C had higher mortality than those with BT of 36–37 °C (p < 0.001, odds ratio 2.82). Initial BT > 38 °C was associated with high mortality with an incremental trend at higher BT. In 10,503 in-patient cases, a positive association was observed between mortality and maximum BT except in patients with BT < 36 °C. Multiple logistic regression analyses including the comorbidities revealed that maximum BT was an independent predictor of mortality. While vaccination did not change the distribution of maximum BT, mortality was decreased in vaccinated patients. Our retrospective cohort study suggests that high maximum BT is an independent predictor of higher mortality in COVID-19 patients.

Effect of the Profit and Teaching Status of Hospitals on the Patterns and Outcomes of Abdominal Aorta and Inferior Vena Cava Injuries after Severe Abdominal Trauma.

The inferior vena cava (IVC) and the abdominal aorta (AA) are two important blood vessels located in the abdomen. The outcomes of such injuries rely heavily on the experience, expertise, and resources available at the hospital where the patient is treated. However, our current understanding of the potential impact of the hospital profit and teaching status on surgical outcomes in the context of traumatic injuries to the IVC and AA remains limited, making it important to investigate the potential association between these hospital characteristics and patient outcomes to enhance the quality of care and optimize treatment strategies. This study aimed to compare demographics, trauma characteristics, and outcomes between nonprofit status (NPSH) and for-profit hospital status (FPSH), as well as among community hospitals (CHs), nonteaching hospitals (NTHs), and university hospitals (UHs), in patients with severe abdominal trauma and abdominal aorta injury (AAI), inferior vena cava injury (IVCI), and both (AAI + IVCI). Demographics, trauma, and outcome measures associated with AAI, IVCI, and AAI + IVCI were compared between the different profit and teaching status groups using NTDB. Multivariate regression was used to identify independent factors associated with death under care (DUC). In the 2017 NTDB-RDS, 1,479 patients met the inclusion criteria, resulting in an overall incidence of 0.17% for AAI, IVCI, and AAI + IVCI after severe abdominal trauma. More patients died under care in the FPSH group than in the NPSH group (nonprofit vs. for-profit: 60.3% vs. 47.2%; P < 0.001). The results indicated that FPSH independently affected DUC. NTH had no significant effect on DUC; although the in-hospital complication rate varied with NTH, no independent association was observed. The study findings demonstrated that in patients with severe abdominal trauma, including injuries to AAI, IVCI, or both (AAI + IVCI), the profit status of hospitals, rather than the teaching status, had a substantial influence on DUC. Future studies should examine differences in the volume of cases and levels of trauma centers to better understand how to improve patient outcomes in FPSH.

The Role of the Multi-Inflammatory Index as a Novel Predictor of Hospital Mortality in Acute Ischemic Stroke.

Background and objective Ischemic strokes account for the majority of all strokes. The severity of an acute ischemic stroke (AIS) can be estimated with the help of a number of different scoring systems. However, there is a need for bedside tests that will support the clinical diagnosis and thus help predict the severity of stroke. The researchon the multi-inflammatory index (MII), which is calculated using hemogram parameters, has shown immense promise. In light of this, the aim of this study was to establish the association between MII and the severity of AIS. Methods The study included 452 ischemic stroke patients over the age of 18 years who presented to the hospital within 72 hours of the onset of symptoms.Demographic information such as patient age and gender, hemogram parameters, ratios, indices, hospitalization, and mortality status were all recorded. The demographic data, hemogram parameters, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP)/lymphocyte ratio (CLR), and MII 1, 2, and 3 were compared between surviving and deceased patients. Results The MII-1, MII-2, and MII-3 index values were determined to be significantly low in the patients with Glasgow Coma Scale (GCS) scores of 13-15 compared to those with GCS scores ≤8, and inpatients with National Institutes of Health Stroke Scale (NIHSS) score of 1-4 compared to those with scores of 5-14, 15-20, and ≥21. The NLR, CLR, PLR, MII-1, MII-2, and MII-3 index values were significantly higher in the non-survivors (PLR: p=0.004, all other values: p<0.001). The performances of multiple models developed for the mortality cut-off points were evaluated. Together with other factors, Model 1 included the MII-1, Model 2 the MII-2, and Model 3 the MII-3. Although there was no significant difference between the AUC values of the models, the highest sensitivity rate was reached with Model 2 (74.48%), and the highest specificity rate with Model 3 (90.62%). Conclusion Based on our findings, MII is a simple and practical biomarker that can be easily obtained from NLR, PLR, and CRP, and can help in the early detection of poor prognosis in AIS. NLR was found to be superior to PLR and CLR in distinguishing fatal AIS cases.

Beyond Acute COVID-19: Investigating the Incidence of Subacute Thyroiditis in Long COVID-19 in Korea.

The correlation between acute coronavirus disease 2019 (COVID-19) and subacute thyroiditis (SAT) has not been clearly investigated in "long COVID" patients. We aimed to investigate the incidence of SAT during convalescence and after the acute phase of COVID-19, comparing with that of the general population. Data from a total of 422,779 COVID-19 patients and a control group of 2,113,895 individuals were analyzed. The index date was defined as the date 3 months after confirmation of COVID-19. The incidence rate (IR) of SAT and hazard ratios (HRs) were calculated per 100,000 persons. Subgroup analysis included analysis of HRs 90-179 and 180 days post-COVID-19 diagnosis; and additional analysis was conducted according to hospitalization status, sex, and age group. The IR of SAT was 17.28 per 100,000 persons (95% confidence interval [CI], 12.56 to 23.20) in the COVID-19 group and 8.63 (95% CI, 6.37 to 11.45) in the control group. The HR of COVID-19 patients was 1.76 (95% CI, 1.01 to 3.06; P=0.045). The HR of SAT was 1.39 (95% CI, 0.82 to 2.34; P=0.220) up to 6 months after the index date and 2.30 (95% CI, 1.60 to 3.30; P<0.001) beyond 6 months. The HR for SAT among COVID-19 patients was 2.00 (95% CI, 1.41 to 2.83) in hospitalized patients and 1.76 (95% CI, 1.01 to 3.06) in non-hospitalized patients compared to the control group. The IR of SAT was 27.09 (95% CI, 20.04 to 35.82) for females and 6.47 (95% CI, 3.34 to 11.30) for males. In the 19 to 64 age group, the IR of SAT was 18.19 (95% CI, 13.70 to 23.67), while the IR was 9.18 (95% CI, 7.72 to 10.84) in the 65 to 69 age group. SAT could be a potential long-term complication of COVID-19. Long-term surveillance for thyroid dysfunction is needed especially in hospitalized, female and young-aged subjects.

The impact of non-pharmaceutical interventions on the first COVID-19 epidemic wave in South Africa

ObjectiveIn this study, we investigated the impact of COVID-19 NPIs in South Africa to understand their effectiveness in the reduction of transmission of COVID-19 in the South African population. This study also investigated the COVID-19 testing, reporting, hospitalised cases, excess deaths and COVID-19 modelling in the first wave of the COVID-19 epidemic in South Africa.MethodsA semi-reactive stochastic COVID-19 model, the ARI COVID-19 SEIR model, was used to investigate the impact of NPIs in South Africa to understand their effectiveness in the reduction of COVID-19 transmission in the South African population. COVID-19 testing, reporting, hospitalised cases and excess deaths in the first COVID-19 epidemic wave in South Africa were investigated using regressional analysis and descriptive statistics.FindingsThe general trend in population movement in South African locations shows that the COVID-19 NPIs (National Lockdown Alert Levels 5,4,3,2) were approximately 30% more effective in reducing population movement concerning each increase by 1 Alert Level. The translated reduction in the effective SARS-CoV-2 daily contact number (β) was 6.12% to 36.1% concerning increasing Alert Levels. Due to the implemented NPIs, the effective SARS-CoV-2 daily contact number in the first COVID-19 epidemic wave in South Africa was reduced by 58.1–71.1% while the peak was delayed by 84 days. The estimated COVID-19 reproductive number was between 1.98 to 0.40. During South Africa’s first COVID-19 epidemic wave, the mean COVID-19 admission status in South African hospitals was 58.5%, 95% CI [58.1–59.0] in the general ward, 13.4%, 95% CI [13.1–13.7] in the intensive care unit, 13.3%, 95% CI [12.6–14.0] on oxygen, 6.37%, 95% CI [6.23–6.51] in high care, 6.29%, 95% CI [6.02–6.55] on ventilator and 2.13%, 95% CI [1.87–2.43] in isolation ward respectively. The estimated mean South African COVID-19 patient discharge rate was 11.9 days per patient. While the estimated mean of the South African COVID-19 patient case fatality rate (CFR) in hospital and outside the hospital was 2.06%, 95% CI [1.86–2.25] (deaths per admitted patients) and 2.30%, 95% CI [1.12–3.83](deaths per severe and critical cases) respectively. The relatively high coefficient of variance in COVID-19 model outputs observed in this study shows the uncertainty in the accuracy of the reviewed COVID-19 models in predicting the severity of COVID-19. However, the reviewed COVID-19 models were accurate in predicting the progression of the first COVID-19 epidemic wave in South Africa.ConclusionThe results from this study show that the COVID-19 NPI policies implemented by the Government of South Africa played a significant role in the reduction of COVID-19 active, hospitalised cases and deaths in South Africa’s first COVID-19 epidemic wave. The results also show the use of COVID-19 modelling to understand the COVID-19 pandemic and the impact of regressor variables in an epidemic.

The Association of Mental Illness With Outcomes of Emergency Surgery for Bowel Obstruction

IntroductionBowel obstruction is one of the most common surgical emergencies. The management of SBO is variable and influenced by numerous confounding factors. Recent studies have identified mental health as a health disparity that affects surgical outcomes. We aim to assess whether mental illness is a health disparity and its association with postoperative complications and secondary outcomes for bowel obstruction in Emergency General Surgery (EGS). MethodsThis was a retrospective study utilizing the National Inpatient Sample. Individuals aged 18-64 who underwent emergency adehesiolysis or bowel resection from 2015 to 2017 were identified. Postoperative complications, in-hospital mortality, length of stay, and total cost for surgical patients with and without mental illness were recorded. Univariate and multivariate analyses were used to evaluate the association between mental health and bowel obstruction. Results20,574 patients who underwent surgery for bowel obstruction were identified. 3756 of these patients had mental illness and 16,998 patients did not. Patients with mental illness did not have significantly worse outcomes compared to patients without mental illness. Among 3576 patients with mental illness, sex, race, patient location, insurance, location/teaching status of hospital, hospital control and procedure type were significant predictors of prolonged length of stay, higher cost, and increased postoperative complications. ConclusionsMental health does not appear to be a health disparity in outcomes for bowel obstruction procedures. However, the intersection of mental health with race and insurance status predicts worse outcomes. This essential area should be further explored to determine how marginalized populations are affected in emergency surgical care.

Hospitalization, Critical Illness, and Mortality Outcomes of COVID-19 in Patients With Rheumatoid Arthritis.

To investigate the clinical outcomes of patients with rheumatoid arthritis (RA) with COVID-19. This retrospective study consisted of 361 patients with RA+ and 45,954 patients with RA- (March 2020 to August 2022) who tested positive for SARS-CoV-2 by polymerase-chain-reaction in the Montefiore Health System, which serves a large low-income, minority-predominant population in the Bronx and was an epicenter of the initial pandemic and subsequent surges. Primary outcomes were hospitalization, critical illness, and all-cause mortality associated with SARS-CoV-2 infection. Comparisons were made with and without adjustment for covariates, as well as with 1083 matched controls of patients with RA- and COVID-19. Patients with RA+ andCOVID-19 were older (62.2 ± 23.5 vs. 45.5 ± 26.3; P < 0.001), were more likely females (83.1% vs. 55.8%; P < 0.001), were Black (35.5% vs. 30.3%; P < 0.05), and had higher rates of comorbidities (P < 0.05), hospitalization (52.4% vs. 32.5%; P < 0.005), critical illness (10.5% vs. 6.9%; P < 0.05), and mortality (11.1% vs. 6.2%; P < 0.01) compared with patients with RA- and COVID-19. Patients with RA+ with COVID-19 had higher odds of critical illness (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.09-1.93; P = 0.008) but no differences in hospitalization (aOR=1.18 [95% CI: 0.93-1.49]; P = 0.16) and mortality (aOR=1.34 [95% CI: 0.92-1.89]; P = 0.10) after adjusting for covariates. Odds ratio analysis identified age, hospitalization status, female sex, chronic kidney disease, chronic obstructive pulmonary disease, and Black race to be significant risk factors for COVID-19-related mortality. Pre-COVID-19 steroid and biologic therapy to treat RA were not significantly associated with worse outcomes (P > 0.05). Outcomes were not different between patients with RA+ and propensity-matched RA- controls (P > 0.05). Our findings suggest that risk factors for adverse COVID-19 outcomes were not attributed to RA per se but rather age and preexisting medical conditions of patients with RA.

Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors

BackgroundThis study aimed to examine urban-rural disparities in the prevalence and trends of depressive symptoms (DS) among Chinese elderly and associated factors. MethodsA total of 8025, 7808, and 4887 respondents aged 60 years and above were selected from the China Family Panel Studies (CFPS) in 2016, 2018, and 2020, respectively. DS was assessed using a short version of Center for Epidemiologic Studies Depression Scale (CES-D). Twenty-two associated factors from six categories were included in random forest (RF) models. All urban-rural comparisons were conducted based on good model performance. ResultsThe DS prevalence among all rural elderly was significantly higher than corresponding urban elderly. This disparity continued to widen among younger elderly, while it continued to narrow among older elderly. The top 10 common leading factors were sleep quality, self-rated health, life satisfaction, memory ability, child relationship, IADL disability, marital status, educational level, and gender. Urban-rural disparities in sleep quality, interpersonal trust, and child relationship continued to widen, while disparities in multimorbidity, hospitalization status, and frequency of family dinner continued to narrow. LimitationThis study may exist recall bias and lacks causal explanation. ConclusionsSignificant and continuing disparities in the DS prevalence were observed between urban and rural elderly in China, showing opposite trends in younger and older elderly. The top 10 leading associated factors for DS were nearly consistent across urban and rural elderly, with sleep quality having strongest contribution. Urban-rural disparities in associated factors also showed different trends. This study provides a reference for mental health promotion among Chinese elderly.

Anxiety, Depression, and Sleep Disorders After COVID-19 Infection.

Introduction As of December 2019, the COVID-19 infection had spread rapidly across the globe, causing a pandemic. Although the virus primarily affects the respiratory and circulatory systems, neuropsychiatric disorders have been reported in a significant number of infected individuals. The aim of this study is to identify anxiety, depression, and sleep disturbances in the early post-COVID period, as well as potential risk factors. Method Symptomatic cases whose COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) positivity within the previous three months were evaluated in the COVID-19 follow-up clinic, where they were observed for at least four weeks after the diagnosis. Cases with no suspicious symptoms and no documented PCR positivity were selected as the control group. All participants completed the Hospital Anxiety Depression Scale (HADS) questionnaire and the Pittsburgh sleep quality questionnaire. The laboratory parameters of hospitalized patients with infection were recorded. Results A total of 283 patients were included in the study. While the median age of 144 patients with COVID-19 infection was 44 years, and 104 of them (72.2%) were female, the median age of the controls without COVID-19 infection was 52 years, and 65 of them (46.8%) were female. About 89 (61.8%) of the 144 patients with COVID-19 infections were hospitalized. When the results of the applied HADS questionnaire were analyzed, the median total value of all study participants was 10 points, whereas it was 13 in cases with COVID-19 and nine in those who did not have it (p<0.001). Taking into account the subgroups of the anxiety and depression questionnaires, both results are statistically significantly higher (p<0.001 and p=0.022, respectively) in post-COVID patients. When the hospitalization status of COVID-19 patients was compared, there was no difference in the development of anxiety (p=0.23), but depression(p<0.024) and poor sleep quality(p<0.001) were prevalent in hospitalized patients. The median PSQI score of the entire study population was five points, while it was seven points in cases with COVID-19 infection and four points in cases who did nothave it (p<0.001). Sleep latency (p<0.003), sleep disturbances (p<0.001), and daytime dysfunction (p<0.001) were statistically significantly worse in COVID-19-infected patients. Female gender (p<0.01) and the presence of past anxiety-depression symptoms (p<0.013) were found to be as risk factors in patients with infection. The correlation between the total HADS score, the PSQI, and the results of the complete blood count and biochemical analysis at the time of diagnosis in hospitalized patients was also investigated. CRP (CI 0.26-0.58) p<0.001 vs (CI 0.09-0.45) p=0.004 and ferritin (CI 0.05-0.43) p=0.017 vs (CI 0.01-0.40) p=0.047exhibited a positive correlation. Similarly, lymphocyte count (CI -0.65 to -0.37) p<0.001 vs (CI -0.39 to -0.01) p<0.001 and lymphocyte percentage (-0.57 to -0.24) p=0.001 vs (-0.65 to -0.37) p=0.039 were negatively correlated. Conclusion Early post-infection anxiety, depression, and sleep disturbances increased significantly in COVID-19 patients. Female gender and previous symptoms of anxiety and depression are risk factors, and inpatient treatment increases depression and poor sleep quality. High HADS and poor sleep quality scores are positively correlated with inflammatory parameters and should be evaluated in post-infection in particular.

Biomarkers Associated With Severe COVID-19 Among Populations With High Cardiometabolic Risk

Cardiometabolic parameters are established risk factors for COVID-19 severity. The identification of causal or protective biomarkers for COVID-19 severity may facilitate the development of novel therapies. To identify protein biomarkers that promote or reduce COVID-19 severity and that mediate the association of cardiometabolic risk factors with COVID-19 severity. This genetic association study using 2-sample mendelian randomization (MR) was conducted in 2022 to investigate associations among cardiometabolic risk factors, circulating biomarkers, and COVID-19 hospitalization. Inputs for MR included genetic and proteomic data from 4147 participants with dysglycemia and cardiovascular risk factors collected through the Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial. Genome-wide association study summary statistics were obtained from (1) 3 additional independent plasma proteome studies, (2) genetic consortia for selected cardiometabolic risk factors (including body mass index [BMI], type 2 diabetes, type 1 diabetes, and systolic blood pressure; all n >10 000), and (3) the COVID-19 Host Genetics Initiative (n = 5773 hospitalized and 15 497 nonhospitalized case participants with COVID-19). Data analysis was performed in July 2022. Genetically determined concentrations of 235 circulating proteins assayed with a multiplex biomarker panel from the ORIGIN trial for the initial analysis. Hospitalization status of individuals from the COVID-19 Host Genetics Initiative with a positive COVID-19 test result. Among 235 biomarkers tested in samples totaling 22 101 individuals, MR analysis showed that higher kidney injury molecule-1 (KIM-1) levels reduced the likelihood of COVID-19 hospitalization (odds ratio [OR] per SD increase in KIM-1 levels, 0.86 [95% CI, 0.79-0.93]). A meta-analysis validated the protective association with no observed directional pleiotropy (OR per SD increase in KIM-1 levels, 0.91 [95% CI, 0.88-0.95]). Of the cardiometabolic risk factors studied, only BMI was associated with KIM-1 levels (0.17 SD increase in biomarker level per 1 kg/m2 [95% CI, 0.08-0.26]) and COVID-19 hospitalization (OR per 1-SD biomarker level, 1.33 [95% CI, 1.18-1.50]). Multivariable MR analysis also revealed that KIM-1 partially mitigated the association of BMI with COVID-19 hospitalization, reducing it by 10 percentage points (OR adjusted for KIM-1 level per 1 kg/m2, 1.23 [95% CI, 1.06-1.43]). In this genetic association study, KIM-1 was identified as a potential mitigator of COVID-19 severity, possibly attenuating the increased risk of COVID-19 hospitalization among individuals with high BMI. Further studies are required to better understand the underlying biological mechanisms.

Long-term clinical outcomes and healthcare utilization of sickle cell disease patients with COVID-19: A 2.5-year follow-up study.

This study investigated whether patients with sickle cell disease (SCD) had elevated risk of worse long-term clinical outcomes and healthcare utilization 2.5 years post-SARS-CoV-2 infection. This study consisted of 178 patients with SCD who tested positive for COVID-19 between February 1, 2020 and January 30, 2022 in a major academic health system in New York City. The control cohort consisted of two-to-one matches of 356 SCD patients without a COVID-19 positive test. The last follow-up was July 18, 2022. The primary outcome was mortality. Secondary outcomes were annualized emergency department visits due to pain, pain hospital admission, length of stay due to pain, acute chest syndrome, episodic transfusion, and episodic exchange transfusion. There was no significant difference in mortality between SCD patients with and without COVID-19 (p > .05). There were no significant differences in secondary outcomes between pre- and postpandemic (p > .05). There were also no significant differences in these outcomes between SCD patients with and without COVID-19 (p > .05). SCD care utilization was not significantly associated with COVID-19 hospitalization status (p > .05). SCD patients with SARS-CoV-2 infection incurred no additional risk of worse long-term outcomes compared to matched controls of SCD patients not infected by SARS-CoV-2.

Is optic nerve sheath diameter diagnostic in methanol intoxication?

Background and aimMethyl alcohol intoxication causes severe morbidity and mortality, especially in developing countries. Formic acid is formed as a result of methanol metabolism. Formic acid accumulation and inhibition of adenosine triphosphate synthesis result in ophthalmic issues. This study aimed to demonstrate that the optic nerve sheath diameter (ONSD) measurement is an accurate prognostic marker and can be helpful in the diagnosis of methanol intoxication. Materials and methodsThis prospective study was conducted with 52 patients who were admitted to the emergency department after alcohol consumption and agreed to participate in the study. Age, gender, comorbid diseases, vital signs, ONSD ultrasonography measurements, hospitalization and discharge status, in-hospital mortality status, dialysis need, presence of visual impairment, blood gas parameters, respiratory status, time since alcohol intake, ethanol levels, urea levels, and creatinine levels were analyzed. ResultsROC curve analysis was performed to evaluate the predictive power of ONSD to diagnose methanol intoxication. The area under the curve was 0.857 for the cut-off value of 5.05 mm (95 % CI: 0.728–0.985; p < 0.001), with a sensitivity of 80.8 % and a specificity of 100 %. In the regression analysis performed to determine the prognostic value of the parameters in estimating mortality in methanol intoxication cases, an increase in ONSD (OR: 3.619; 95 % CI: 0.057–0.199; p = 0.001), an increase in lactate levels (OR: 5.653; 95 % CI: 0.040–0.085; p < 0.001), and increased duration after alcohol intake (OR: 2558; 95 % CI: 0.004–0.034; p = 0.014) were identified as independent predictors of mortality, but pH, HCO3, and base deficit levels were not significant predictors. ConclusionsWe believe that ONSD can be helpful for the differential diagnosis and prognosis of patients with suspected methanol toxicity who presented with alcohol intake.

The Effect of Workload on Nurses Who Are Taking Care of COVID-19 Patients

Nurses, especially ICU staff, complain of high level of stress regarding the workload. This can be related to many factors such as: nurse-patient ratio, doctor’s orders, timing, hospital environment to name a few. Nursing workload can be defined as all nursing work that must be carried out over a defined period of time. For example the effect of workload on covid-19 patients in intensive care units (ICUs) showed that higher RN staffing was associated with lower levels of hospital related mortality. Each additional full time equivalent RN per patient day corresponds to a 9% reduction in odds of death in ICUs. The aim of this study was to determine the extent of the effect of workload on nurses and other associated factors. A descriptive cross-sectional study was conducted in July to September 2020. 406 staff nurses were enrolled in the study. Instrument of the study was a questionnaire on the effect of workload on nursing staff who were taking care of covid-19 patients. Multiple logistic regression was utilized to identify the factors associated with high nursing workload of nurses. By using bivariate analysis; workload was found to be significantly associated with: nurse patient ratio, duty hours and type of department; the critical care units such as ICU, CCU and HD complained of higher workload (28.8, SD 3.7) than general units (20.7, SD 3.0) the P-value was 0.033. There was no significant difference between the workload and other demographic variables such as: environmental status, nationality, and type of hospital.

Results of a 12-month follow-up of patients with type 2 diabetes mellitus after hospitalization with COVID-19: gliclazide MR use in the hospital and metabolic status at the posthospital stage

BACKGROUND: The role of antidiabetic drugs in inpatient with COVID-19 and type 2 diabetes mellitus (T2DM) is usually considered in the context of target glycemiа maintaining. Except for insulin therapy sulfonylurea may be used in moderate COVID-19. The use of original gliclazide MR has advantages due to low risk of hypoglycemia and established cardio- and nephroprotective effects. But it is not clear whether the choice of antidiabetic drugs during hospitalization may affect patient’s condition in post-COVID period.AIM:. To assess the 12-month dynamics of carbohydrate metabolism in patients with T2DM after hospitalization for COVID-19 considering the character of hypoglycemic therapy in the hospital and the use of gliclazide MRMATERIALS AND METHODS: A 12-month prospective study was performed; T2DM patients were observed after hospitalization for COVID-19. They received in hospital: 1) original gliclazide MR (Diabeton MR, n=20) and 2) insulin (control group, n=20). Changes in antidiabetic therapy, glycemic control and biochemical tests were assessed at baseline and after 3, 6, 12 months. RESULTS: In the main and control groups the intensification of T2DM therapy was observed: the proportion of patients without hypoglycemic drugs decreased within a year by 3.0 (p = 0.001) and 2.8 (p =0.010) times respectively. Mean HbA1c values,the dynamics of inflammation markers and transaminases in both groups were similar (p&gt;0.05 at all visits). Blood creatinine was at baseline 82.9±18.67 and 120.9±45.52 µmol/l (p=0.010), after 3 months — 88.0±18.77 and 104, 5±17.99 µmol/l (p=0.024), after 6 months — 89.3±12.17 and 97.5±9.03 µmol/l (p=0.072), after 12 months — 86.7±10.50 and 93.9±16.76 µmol/l (p=0.16). According to the data obtained during «3 months» visit, the dose of original gliclazide MR was directly correlated with the improvement in renal function in terms of glomerular filtration rateGFR (R=0,59, р=0,010). In addition, there was a close-to-significance correlation between continued gliclazide MR at visit 3 and improvement in GFR at visit 6 (R=0.31, p=0.076).CONCLUSION: The post-hospital period in patients with COVID-19 and T2DM was characterized by a tendency to hyperglycemia and increased need for hypoglycemic therapy. The use of original gliclazide MR by in patients with moderate COVID-19 and T2DM is appropriate and safe in terms of clinical and metabolic parameters dynamics during long-term post-hospital follow-up. When original gliclazide MR is continued during the post-hospital period its nephroprotective properties may contribute to the process of renal functions normalization which should be confirmed by further research.

Characteristics, Clinical Manifestations, Length of Hospitalization and Nutritional Status of COVID-19 patients

Characteristics, Clinical Manifestations, Length of Hospitalization and Nutritional Status of COVID-19 patients

Long-term neurological complications in COVID-19 survivors: study protocol of a prospective cohort study (NeurodegCoV-19)

BackgroundEvidence suggests an association between SARS-CoV-2 infection and worse performance on cognitive tests, and a higher risk of Parkinson’s disease (PD) and dementia up to 6 and 12 months after...

Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis.

community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults' independent living and quality of life (QoL). we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00-1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77-0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02-0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01-0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03-0.13). complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs.