-
NPJ Primary Care Respiratory Medicine Jun 2024We sought to investigate the incidence of severe COVID-19 outcomes after treatment with antivirals and neutralising monoclonal antibodies, and estimate the comparative...
We sought to investigate the incidence of severe COVID-19 outcomes after treatment with antivirals and neutralising monoclonal antibodies, and estimate the comparative effectiveness of treatments in community-based individuals. We conducted a retrospective cohort study investigating clinical outcomes of hospitalisation, intensive care unit admission and death, in those treated with antivirals and monoclonal antibodies for COVID-19 in Scotland between December 2021 and September 2022. We compared the effect of various treatments on the risk of severe COVID-19 outcomes, stratified by most prevalent sub-lineage at that time, and controlling for comorbidities and other patient characteristics. We identified 14,365 individuals treated for COVID-19 during our study period, some of whom were treated for multiple infections. The incidence of severe COVID-19 outcomes (inpatient admission or death) in community-treated patients (81% of all treatment episodes) was 1.2% (n = 137/11894, 95% CI 1.0-1.4), compared to 32.8% in those treated in hospital for acute COVID-19 (re-admissions or death; n = 40/122, 95% CI 25.1-41.5). For community-treated patients, there was a lower risk of severe outcomes (inpatient admission or death) in younger patients, and in those who had received three or more COVID-19 vaccinations. During the period in which BA.2 was the most prevalent sub-lineage in the UK, sotrovimab was associated with a reduced treatment effect compared to nirmaltrelvir + ritonavir. However, since BA.5 has been the most prevalent sub-lineage in the UK, both sotrovimab and nirmaltrelvir + ritonavir were associated with similarly lower incidence of severe outcomes than molnupiravir. Around 1% of those treated for COVID-19 with antivirals or neutralising monoclonal antibodies required hospital admission. During the period in which BA.5 was the prevalent sub-lineages in the UK, molnupiravir was associated with the highest incidence of severe outcomes in community-treated patients.
Topics: Humans; Scotland; Antiviral Agents; Retrospective Studies; COVID-19 Drug Treatment; Male; Female; Middle Aged; COVID-19; Hospitalization; Antibodies, Monoclonal; Aged; SARS-CoV-2; Antibodies, Neutralizing; Adult; Treatment Outcome; Severity of Illness Index; Intensive Care Units; Incidence
PubMed: 38942748
DOI: 10.1038/s41533-024-00374-x -
Boletin Medico Del Hospital Infantil de... 2024The worldwide prevalence of arterial hypertension in pediatric patients is 3.5%, and it has repercussions at renal, cardiovascular, neurological, and lifestyle levels.... (Observational Study)
Observational Study
BACKGROUND
The worldwide prevalence of arterial hypertension in pediatric patients is 3.5%, and it has repercussions at renal, cardiovascular, neurological, and lifestyle levels. This study aimed to estimate the prevalence of arterial hypertension, mortality, and follow-up in patients with acute renal failure in the nephrology outpatient clinic at a second-level hospital in Northwestern Mexico.
METHODS
We conducted a descriptive, retrospective, and observational study. Men and women aged 1-18 years diagnosed with acute kidney injury were analyzed from January 1, 2012, to December 31, 2021. The medical and electronic records of the candidate patients were analyzed, and nutritional data, laboratory analysis, most frequent etiology, and follow-up in the pediatric nephrology clinic were collected. Those with exacerbated chronic kidney disease and previous diagnosis of high blood pressure were excluded.
RESULTS
One hundred and seventy-four patients were evaluated, and only 40 were eligible for the study (22.98%), predominantly males with a mean age of 9.9 years. The degree of arterial hypertension was 50% for grade I and 50% for grade II (p = 0.007); the mortality rate was 32%. One hundred percent of hypertension cases were controlled at 6 months after discharge (p = 0.000080).
CONCLUSIONS
Our results were similar to those reported in other studies. Follow-up and early detection of arterial hypertension in children need to be strengthened.
Topics: Humans; Mexico; Male; Female; Hypertension; Retrospective Studies; Adolescent; Acute Kidney Injury; Child; Prevalence; Infant; Child, Preschool; Hospitals, Pediatric; Follow-Up Studies; Secondary Care Centers
PubMed: 38941628
DOI: 10.24875/BMHIM.23000013 -
International Journal of Circumpolar... Dec 2024serotype a (Hia) has recently emerged as an important cause of invasive disease in the North American Arctic and Sub-Arctic regions, mainly affecting young Indigenous...
serotype a (Hia) has recently emerged as an important cause of invasive disease in the North American Arctic and Sub-Arctic regions, mainly affecting young Indigenous children. In this study, we addressed the question of whether the prevalence of Hia and all in the nasopharynx differed between paediatric populations from regions with high low incidence of invasive Hia disease. Nasopharyngeal specimens from children with acute respiratory tract infections (ARTI) collected for routine diagnostic detection of respiratory viruses were analysed with molecular-genetic methods to identify and serotype . In Nunavut, a region with a high incidence of invasive Hia disease, all and particularly Hia were found in the nasopharynx of 60.6% and 3.0% children. In Southern Ontario (Hamilton region), where Hia invasive disease is rare, the frequencies of all and Hia detection were 38.5% and 0.6%, respectively. In both cohorts, non-typeable was prevalent (57.0% and 37.9%, respectively). Considering that Hia is an important cause of severe invasive disease in Nunavut children, 3% prevalence of Hia among children with ARTI can reflect continuing circulation of the pathogen in the Northern communities that may result in invasive disease outbreaks.
Topics: Humans; Haemophilus influenzae; Haemophilus Infections; Child, Preschool; Nasopharynx; Prevalence; Infant; Male; Female; Incidence; Ontario; Child; Arctic Regions; Nunavut; Respiratory Tract Infections; Canada; Serogroup
PubMed: 38941555
DOI: 10.1080/22423982.2024.2371111 -
Medicine Jun 2024Idiopathic inflammatory myopathies, especially antisynthetase syndrome, often appear outside of the muscles as interstitial lung disease (ILD). Another typical finding... (Observational Study)
Observational Study
Idiopathic inflammatory myopathies, especially antisynthetase syndrome, often appear outside of the muscles as interstitial lung disease (ILD). Another typical finding is the presence of mechanic's hands. The aim of the present study was to describe the clinical, functional, tomographic, and serological data of patients with ILD and mechanic's hands and their response to treatment and survival rates. This is a retrospective study of ILD with concurrent myopathy. Among the 119 patients initially selected, 51 had mechanic's hands. All the patients were screened for anti-Jo-1 antibodies. An expanded panel of myopathy autoantibodies was also performed in 27 individuals. Of the 51 patients, 35 had 1 or more antibodies. The most common were anti-Jo-1, anti-PL-7, and anti-PL-12, while of the associated antibodies, anti-Ro52 was present in 70% of the 27 tested individuals. A significant response to treatment was characterized by an increase in predicted forced vital capacity (FVC) of at least 5% in the last evaluation done after 6 to 24 months of treatment. A decrease in predicted FVC of at least 5%, the need for oxygen therapy, or death were all considered treatment failures. All patients were treated with corticosteroids, and 71% with mycophenolate. After 24 months, 18 patients had an increase in FVC, 11 had a decrease, and 22 remained stable. After a median follow-up of 58 months, 48 patients remained alive and three died. Patients with honeycombing on high-resolution chest tomography (log-rank = 34.65; P < .001) and a decrease in FVC ≥5% (log-rank = 18.28, P < .001) had a poorer survival rate. Patients with ILD and mechanic's hands respond well to immunosuppressive treatment.
Topics: Humans; Lung Diseases, Interstitial; Retrospective Studies; Male; Female; Middle Aged; Myositis; Aged; Treatment Outcome; Adult; Autoantibodies; Outpatients; Adrenal Cortex Hormones; Vital Capacity
PubMed: 38941439
DOI: 10.1097/MD.0000000000038642 -
Medicine Jun 2024Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but serious complication in patients with malignancy; its main manifestation includes acute pulmonary... (Review)
Review
RATIONALE
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but serious complication in patients with malignancy; its main manifestation includes acute pulmonary hypertension with severe respiratory distress. More than 200 cases have been reported since it was first identified in 1990. PTTM accounts for approximately 0.9% to 3.3% of deaths due to malignancy, but only a minority of patients are diagnosed ante-mortem, with most patients having a definitive diagnosis after autopsy.
PATIENT CONCERNS
Two middle-aged women both died within a short period of time due to progressive dyspnea and severe pulmonary hypertension.
DIAGNOSES
One patient was definitively confirmed as a gastrointestinal malignant tumor by liver puncture biopsy pathology. Ultimately, the clinical diagnosis was pulmonary tumor thrombotic microangiopathy.
INTERVENTIONS
The patient was treated symptomatically with oxygen, diuresis, and anticoagulation, while a liver puncture was perfected to clarify the cause.
OUTCOMES
Two cases of middle-aged female patients with rapidly progressive pulmonary hypertension and respiratory failure resulted in death with malignant neoplasm.
LESSONS
PTTM has a rapid onset and a high morbidity and mortality rate. Our clinicians need to be more aware of the need for timely diagnosis through a targeted clinical approach, leading to more targeted treatment and a better prognosis.
Topics: Humans; Female; Thrombotic Microangiopathies; Middle Aged; Fatal Outcome; Hypertension, Pulmonary; Gastrointestinal Neoplasms; Lung Neoplasms
PubMed: 38941435
DOI: 10.1097/MD.0000000000038618 -
Medicine Jun 2024Hypertension has long been a worldwide health concern. Our aim was to investigate the prevalence, awareness, treatment, and control rates of hypertension and analyze the...
Hypertension has long been a worldwide health concern. Our aim was to investigate the prevalence, awareness, treatment, and control rates of hypertension and analyze the factors related to hypertension among adult residents of the coastal areas of Tianjin, China. This was a cross-sectional study. Adults aged 35 to 75 years were selected for the study using cluster random sampling methods. Detailed information was collected via face-to-face surveys and medical checkups. We assessed the rates of hypertension in the total population and sub-populations and used multivariable logistic regression to identify the factors associated with the prevalence and the control of hypertension. In total, 6305 participants aged 55.22 ± 10.37 years were included in this study. Approximately 49.8% (95% confidence interval [CI]: 48.5%-51.1%) of the population had hypertension; the prevalence increased with age and body mass index (all P < .001). Multivariable logistic regression showed that the odds ratio of hypertension was 5.93 times more in participants aged 65 to 75 years than in those aged 35 to 44 (95% CI: 4.85-7.26, P < .001). The odds ratio of hypertension was 3.63 times more in obese participants than in those of normal weight (95% CI: 3.08-4.28, P < .001). Additionally, the awareness, treatment, control, and control under-treatment rates of hypertension were 89.7%, 83.6%, 54.4%, and 60.5%, respectively. Factors associated with having controlled hypertension included sex, body mass index, and dyslipidemia (all P < .01). Our study identified that in the coastal area of Tianjin, China, about half have hypertension, also the region has high rates of hypertension awareness, treatment and control, and more than half of hypertension patients receiving treatment have controlled hypertension.
Topics: Humans; Hypertension; Middle Aged; Male; China; Female; Cross-Sectional Studies; Prevalence; Adult; Aged; Health Knowledge, Attitudes, Practice; Body Mass Index; Risk Factors; Age Factors; Logistic Models
PubMed: 38941429
DOI: 10.1097/MD.0000000000038676 -
Medicine Jun 2024Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in... (Meta-Analysis)
Meta-Analysis
Neutrophil to lymphocyte ratio as a prognostic marker for cardiovascular outcomes in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis.
BACKGROUND
Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in predicting in-hospital and long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).
METHODS
Electronic databases (PUBMED, Cochrane CENTRAL, ERIC, Embase, Ovid, and Google Scholar) were searched till June 2022 to identify studies having STEMI patients who underwent PCI. Risk ratios and mean differences (MDs), along with their corresponding 95% confidence intervals (Cis) and standard deviations (SDs), were pooled using a random-effect model. This meta-analysis has been registered on Prospero (ID: CRD42022344072).
RESULTS
A total of 35 studies with 28,756 patients were included. Pooled estimates revealed an increased incidence of primary outcomes; in-hospital all-cause mortality (RR = 3.52; 95% CI = 2.93-4.24), long-term all-cause mortality (HR = 1.07; 95% CI = 1.00-1.14), (RR = 3.32; 95% CI = 2.57-4.30); in-hospital cardiovascular mortality (RR = 2.66; 95% CI = 2.04-3.48), long-term cardiovascular mortality (RR = 6.67; 95% CI = 4.06-10.95); in-hospital major adverse cardiovascular events (MACE) (RR = 1.31; 95% CI = 1.17-1.46), long-term MACE (RR = 2.92; 95% CI = 2.16-3.94); length of hospital stay (WMD = 0.60 days; 95% CI = 0.40-0.79) in patients with high NLR compared to those with a low NLR.
CONCLUSION
NLR might be a valuable tool for prognostication (in-hospital) and stratification of patients with STEMI who underwent PCI.
Topics: Humans; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Neutrophils; Prognosis; Lymphocytes; Biomarkers; Lymphocyte Count; Hospital Mortality
PubMed: 38941418
DOI: 10.1097/MD.0000000000038692 -
Medicine Jun 2024Few studies have examined the risk factors associated with the type of acute respiratory failure (ARF) in patients with acute exacerbation of chronic obstructive... (Observational Study)
Observational Study
One-year mortality and readmission risks following hospitalization for acute exacerbation of chronic obstructive pulmonary disease based on the types of acute respiratory failure: An observational study.
Few studies have examined the risk factors associated with the type of acute respiratory failure (ARF) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). This study evaluated the clinical characteristics and prognosis of patients hospitalized for acute exacerbation of COPD based on the type of ARF. The medical charts of hospitalized patients with acute exacerbation of COPD between 2016 and 2021 were retrospectively reviewed. We classified ARF into 2 types: type 1 ARF with PaO2 < 60 mm Hg in room air or a ratio of arterial partial pressure to fractional inspired oxygen < 300, and type 2 ARF with PaCO2 > 45 mm Hg and arterial pH < 7.35. A total of 435 patients were enrolled in study, including 170 participants without ARF, 165 with type 1 ARF, and 100 with type 2 ARF. Compared with the non-ARF group, the frequency of high-flow nasal cannula, noninvasive ventilation, intensive care unit admissions, and in-hospital deaths was higher in the ARF group compared with the non-ARF group. The ARF group had higher 1-year mortality group (hazard ratio [HR], 2.809; 95% confidence interval [CI], 1.099-7.180; P = .031) and readmission within 1-year rates (HR, 1.561; 95% CI, 1.061-2.295; P = .024) than the non-ARF group. The type 1 ARF group had a higher risk of 1-year mortality (HR, 3.022; 95% CI, 1.041-8.774; P = .042) and hospital readmission within 1-year (HR, 2.053; 95% CI, 1.230-3.428; P = .006) compared with the non-ARF group. There was no difference in mortality and readmission rates between the type 1 and type 2 ARF groups. In conclusion, patients with type 1 ARF rather than type 2 ARF had higher mortality and readmission rates than those without ARF. The prognoses of patients with type 1 and type 2 ARF were similar.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Male; Female; Patient Readmission; Aged; Retrospective Studies; Respiratory Insufficiency; Risk Factors; Middle Aged; Disease Progression; Hospitalization; Hospital Mortality; Aged, 80 and over; Prognosis; Acute Disease
PubMed: 38941408
DOI: 10.1097/MD.0000000000038644 -
Medicine Jun 2024This article aims to analyze the prevalence of sarcopenia among the elderly in Guizhou Province, China, and its association with human immunodeficiency virus (HIV)... (Observational Study)
Observational Study
This article aims to analyze the prevalence of sarcopenia among the elderly in Guizhou Province, China, and its association with human immunodeficiency virus (HIV) infection. This cross-sectional study included 377 patients aged 60 and above in Guiyang Public Health Treatment Center from December 2022 to October 2023, including 231 patients in the community clinic and 146 HIV-infected individuals. According to the Asian Working Group for Sarcopenia 2019 Consensus to diagnose sarcopenia. Logistic regression was used to explore association between sarcopenia and HIV, and stratified by sex and age group. The prevalence of sarcopenia in the non-HIV infection elderly in Guizhou Province was 7.8% (21.3% in males and 5.5% in females), and the prevalence of sarcopenia in HIV-infected individuals was 29.5% (33.3% in males and 13.2% in females), with a statistically significant difference between HIV groups (χ2 = 30.946, P < .001). After control of gender, age, body mass index, body fat percentage, hypertension, diabetes, taking statins, smoking status, medium to high-intensity physical activity, whether childhood poverty, and parents died young, HIV infection was significantly associated with sarcopenia in the elderly (odds ratio = 4.635, 95% confidence interval = 1.920-11.188, P = .001). The results of stratified regression were similar to the main results. The prevalence of sarcopenia in the elderly population in China was severe. HIV infection was a risk factor for sarcopenia. It is urgent to establish a prevention and treatment system for sarcopenia in the elderly population, especially for elderly HIV-infected male.
Topics: Humans; Male; Female; Sarcopenia; China; HIV Infections; Prevalence; Cross-Sectional Studies; Aged; Middle Aged; Risk Factors; Aged, 80 and over
PubMed: 38941377
DOI: 10.1097/MD.0000000000038532 -
Medicine Jun 2024Elevated red blood cell distribution width (RDW) can be associated with disease severity. However, studies on RDW for the prognosis of elderly patients with... (Observational Study)
Observational Study
Elevated red blood cell distribution width (RDW) can be associated with disease severity. However, studies on RDW for the prognosis of elderly patients with non-traumatic coma (NTC) are lacking. This study aims to examine the relationship between RDW and outcomes in elderly patients with NTC. This observational cohort study included elderly patients (aged ≥ 65 years) with NTC between January 2022 and December 2022. We measured RDW upon patient arrival at the emergency department (ED). We conducted a multivariable analysis using logistic regression of relevant covariates to predict in-hospital mortality. Survival curves based on 30-day mortality were designed using the Kaplan-Meier method. The primary outcome was in-hospital mortality, and the secondary outcome was 30-day mortality. A total of 689 patients were included in the study, and in-hospital mortality was 29.6% (n = 204). Our results found that the RDWs of non-survivors were significantly greater than those of survivors (14.6% vs 13.6%). Multivariable analysis showed that RDWs at ED arrival were independently associated with in-hospital mortality (odds ratio, 1.126; 95% confidence interval, 1.047-1.212; P < .001). The Kaplan-Meier curve indicated that the survival probability of patients with a low RDW was greater than those with a high RDW. Having a high RDW at ED arrival was associated with in-hospital mortality in elderly patients with NTC.
Topics: Humans; Aged; Female; Male; Erythrocyte Indices; Hospital Mortality; Coma; Aged, 80 and over; Prognosis; Emergency Service, Hospital; Kaplan-Meier Estimate; Cohort Studies
PubMed: 38941367
DOI: 10.1097/MD.0000000000038773